From a large school-based sample (N = 3,084), 49 Mainland Chinese adolescents (31 girls, 18 boys) who endorsed all DSM-IV criteria for bulimia nervosa (BN) or sub-threshold BN and 49 matched controls (31 girls, 18 boys) completed measures of demographics and sociocultural experiences related to body image. Compared to less symptomatic peers, those in the BN group reported higher levels of appearance pressure from their network of close relationships and mass media, appearance comparisons and conversations, and fear of negative appearance evaluation. A hierarchical logistic regression analysis based seven predictors resulted in the correct identification of 82.7% of respondents, including 83.7% of the BN group and 81.7% of controls. Responses on sociocultural measures, especially those reflecting appearance pressure, added to the classification rate, after controlling for body mass index and household socioeconomic status. When repeated within each sex, classification accuracy was 90.3% for girls and 86.1% for boys. This study establishes clear links between sociocultural influences and BN among urban adolescent girls and boys living in the People's Republic of China.