The psychological impact of chronic, disabling, disfiguring and painful conditions such as systemic sclerosis (SSc) may be considerable. The purpose of the study was to examine the psychological impact of SSc and to investigate the relative importance of disease parameters, functional ability and cognitive variables specifically regarding fear of negative evaluation and negative body related attitudes in relation to psychological adjustment to the condition. Forty-nine consecutive patients with SSc completed a range of standardized psychological assessments measuring anxiety, depression, attitudes towards the body, fear of negative evaluation and specific SSc-related clinical problems experienced. Over one-third of patients sampled were classified as being probable cases for anxiety or depression. Multiple regression analysis indicated that fear of negative evaluation was the most important variable accounting for 56% of the variance in anxiety, whereas overall interference of SSc on activities made the most significant contribution (F1,38 = 17.3, p <0.001) to depression. Holistic assessment of patients with SSc including psychosocial as well as clinical assessments may be pertinent in optimizing patient management.