evaluated for the possibility of  comorbid anorexia nervosa, given that the substance use
may represent a persistent behavior that inte rferes with weight gain (Criterion B).
Social anxiety disorder (social phobia), ob sessive-compulsive disorder, and body dys-
morphic disorder. Some of the features of anorexia ne rvosa overlap with the criteria for
social phobia, OCD, and body dysmorphic diso rder. Specifically, individuals may feel hu-
miliated or embarrassed to be seen eating in public, as in social phobia; may exhibit obses-
sions and compulsions related to  food, as in OCD; or may be preoccupied with an imagined
defect in bodily appearance, as in body dysmor phic disorder. If the in dividual with anorexia
nervosa has social fears that are limited to eating behavior alone, the diagnosis of social pho-
bia should not be made, but social fears unrelate d to eating behavior (e.g., excessive fear of
speaking in public) may warrant an additional diagnosis of social phobia. Similarly, an ad-
ditional diagnosis of OCD should be considered only if the individu al exhibits obsessions
and compulsions unrelated to food (e.g., an ex cessive fear of contamination), and an addi-
tional diagnosis of body dysmorphic disorder sh ould be considered only if the distortion is
unrelated to body shape and size (e.g., preoccupation th at one’s nose is too big).
Bulimia nervosa. Individuals with bulimia nervosa ex hibit recurrent ep isodes of binge
eating, engage in inappropriat e behavior to avoid weight ga in (e.g., self-induced vomit-
ing), and are overly concerned with body sh ape and weight. However, unlike individuals