There are substantial data supporting a strong relationship between cardiovascular diseases and psychological conditions. However, the criteria for scientific validation of the entities currently subsumed under the DSM-IV category of 'Psychological factors affecting a medical condition' have never been clearly enumerated and the terms 'psychological symptoms' and 'personality traits' that do not satisfy traditional psychiatric criteria are not well defined; moreover, it is difficult to measure these subtypes of distress and there is always the need for a clinical judgment. In recent years psychosomatic research has focused increasing attention on these clinical and methodological issues. Psychosocial variables that were derived from psychosomatic research were then translated into operational tools, such as Diagnostic Criteria for Psychosomatic Research; among these, demoralization, irritable mood, type A behavior are frequently detected in cardiac patients. The joint use of DSM-IV criteria and Diagnostic Criteria for Psychosomatic Research allow then to identify psychological factors that seem to affect cardiologic condition. There remains the need to further investigate if treating both clinical and subsyndromal psychological conditions can improve quality of life and reduce the risk of morbidity and mortality in these patients.