Much of what nurses know about bulimia nervosa stems from a reductionistic medical model that views bulimia from psychological, physiological and sociocultural perspectives. This study was designed to utilize Newman's (1986) holistic framework of patterning, which views disease as a manifestation of person/environmental patterning, to examine binging and purging as manifestations of relational patterning in a woman with bulimia nervosa.

Utilizing principles from Newman, Rogers and the Stone Center at Wellesley College, this single subject case study investigated the participant's patterning of relationships and how binging and purging manifested those patternings. The subject was a twenty-four year old female who met criteria for bulimia nervosa. Data regarding relationships, significant events and activities of daily living were collected through interviews, daily logs and direct observations. This data was concurrently collected and analyzed by the researcher over a period of eight weeks, validated by the participant during week nine, and further analyzed over another eight month period.

Two analytical strategies were utilized. The first was Newman's patterning assessment framework that allowed for categorization within the nine dimensions of exchanging, valuing, choosing, moving, relating, perceiving, knowing, communicating and feeling. The patternings that were discovered were binging, purging, binge/purging, comfort and stuck which were then viewed in relative chronological order to assess their integrative and evolving nature. The second strategy, pattern matching, was used, successfully, to validate and enhance the first, and involved recategorizing the coded data thematically after it was reorganized. The evolving patternings were permeability, fluctuation, confinement and profusion. These patternings were then explored to uncover the participant's action potential, her knowing participation in change through the awareness of feelings, thoughts and attitudes (Barrett, 1990).