Abstract Objectives To compare the general psychopathology in an eating disorders (ED) and a child mental health outpatient sample and investigate the implications of comorbidity on psychological and physical measures of ED severity. Methods One hundred thirty-six children and adolescents with a DSM-IV ED diagnosis were compared with age- and gender-matched controls. Measures included the Eating Disorders Examination and the Child Behavior Checklist. Results The ED group had lower general and externalizing psychopathology scores and no difference in internalizing (anxiety–depression) symptoms. Of the anorexia nervosa group, 49% experienced comorbid psychopathology. This group had significantly higher ED psychopathology, longer duration of illness, and more gastrointestinal symptoms, but no difference in malnutrition status. Eating disorders not otherwise specified (EDNos) group measures were less influenced by comorbidity status. Conclusions Anxiety–depressive symptoms are very common in children and adolescents with EDs. Comorbidity status influences illness severity, especially in the anorexia nervosa group. The management implications of these findings are discussed.