Kleine-Levin syndrome, there is disturbed eating behavior, but the characteristic psycho-
logical features of bulimia nervosa, such as overconcern with body shape and weight, are
not present. 
Major depressive disorder, with atypical features. Overeating is common in major de-
pressive disorder, with atypical  features, but individuals with this disorder do not engage
in inappropriate compensatory behaviors an d do not exhibit the excessive concern with
body shape and weight characteristic of bulimia  nervosa. If criteria for both disorders are
met, both diagnoses should be given. 
Borderline personality disorder. Binge-eating behavior is included in the impulsive be-
havior criterion that is part of the definition  of borderline personality disorder. If the cri-
teria for both borderline personality disorder and bulimia nervosa are met, both diagnoses
should be given.
Comorbidity 
Comorbidity with mental diso rders is common in individuals with bulimia nervosa, with
most experiencing at least on e other mental disorder and many experiencing multiple co-
morbidities. Comorbidity is not limited to any particular su bset but rather occurs across a
wide range of mental disorders. There is an  increased frequency of depressive symptoms
(e.g., low self-esteem) and bipo lar and depressive disorders (particularly depressive dis-
orders) in individuals with bu limia nervosa. In many indivi duals, the mood disturbance
begins at the same time as or following th e development of bulimia nervosa, and individ-
uals often ascribe their mood disturbances to  the bulimia nervosa. However, in some in-
dividuals, the mood disturbance clearly precedes the development of bulimia nervosa.
There may also be an increased frequency of anxiety symptoms (e.g., fear of social situa-