The distressed personality (Type D) is an emerging risk factor in cardiovascular disease (CVD) that incurs a risk on par with left ventricular dysfunction in patients with ischemic heart disease. Type D is defined as the co-occurring tendencies to experience increased negative emotions and to inhibit self-expression in social interactions. Evidence is accumulating that Type D may also be a risk factor for adverse outcome across CVD patient groups, including patients undergoing revascularization with drug-eluting stent implantation or bypass surgery, patients with heart failure, peripheral arterial disease, and arrhythmia. In these patient groups, Type D personality has been associated with a 2-5 fold increased risk of adverse prognosis, impaired quality of life and symptoms of anxiety and depression independent of traditional biomedical risk factors, including disease severity. Although little is known about the pathways responsible for the detrimental effects of Type D on clinical outcome, the immune system and health-related behaviors, such as smoking and noncompliance, are likely candidates. Further research is warranted to investigate whether Type D personality is here to stay as a risk factor for CVD, but weighing current evidence on Type D against a set of external criteria shows that Type D personality fulfills the majority of these criteria. Importantly, Type D can easily be assessed in clinical research and practice with the standardized and validated DS14.