Previous work from our group revealed two groups of women with bulimia nervosa (BN), one with, and one without alcohol dependence (AD). The current study sought to determine whether women with lifetime BN and AD (BN+AD+) were more similar to women with BN and no AD (BN+AD-) or to women with AD and no BN (BN-AD+) in terms of lifetime psychiatric comorbidity and psychological functioning. Data on BN and AD from 407 female relatives in a family study of alcoholism were used to create three mutually exclusive groups: BN+AD+ (n=30), BN+AD- (n=55), and BN-AD+ (n=322). Bivariate analyses revealed fewer differences between BN+AD+ and BN-AD+ women than between BN+AD+ and BN+AD- women. BN+AD+ women were more likely than BN+AD- women to have drug dependence, conduct disorder, and suicidality, and were more likely to have major depression, lower GAF scores, and to engage in unsafe sex than both BN+AD- and BN-AD+ women. After adjusting for other psychopathology and demographic variables, BN+AD+ women were more likely than BN+AD- women to have major depression, drug dependence, and tobacco dependence and more likely than BN-AD+ women to have major depression and obsessive-compulsive disorder. These results suggest that BN+AD+ women exhibit more severe psychopathology than either BN+AD- or BN-AD+ women and may represent a distinct subgroup within bulimia nervosa or alcohol dependence.