This article examined correlates of and gender differences in extreme dieting behaviours among 15,425 US adolescents from the 2011 Youth Risk Behavior Survey. Suicidal thoughts and plans and binge drinking were related to extreme dieting behaviours in females, but not in males. Suicide attempts, daily smoking and marijuana use were related to extreme dieting behaviours in males, but not females. Results suggest extreme dieting behaviours are associated with a range of negative psychosocial factors and substance use behaviours, and that these differ for boys and girls. Additional research is required to elucidate these relationships, and these results provide a focus for future research, prevention and intervention efforts.