background: The aim of this study was to assess the psychological features in women with different polycystic ovary syndrome (PCOS) phenotypes [National Institute of Health (NIH) and non-NIH diagnostic criteria] and women without PCOS. methods: An observational, cross-sectional study compared overweight (BMI =25 kg/m2) premenopausal women with PCOS (n ? 29 NIH and n ? 25 non-NIH) and controls (n ? 27). Anxiety and depression were compared between women with NIH or non-NIH PCOS and women without PCOS. Health-related quality of life (HRQoL) domains related to emotions, body hair, weight, infertility and menstrual problems were compared between women with NIH and non-NIH PCOS. results: Overall, women with PCOS had worse anxiety (P ? 0.007) and depression (P ? 0.048) compared with women without PCOS. Both women with NIH PCOS and non-NIH PCOS presented more often with moderate anxiety (P ? 0.005 and P ? 0.01, respectively) compared with women without PCOS. Women with NIH PCOS had worse HRQoL related to infertility (P ? 0.012), emotions (P ? 0.02) and weight (P ? 0.016). No significant differences were observed between the two PCOS phenotypes for HRQoL domains related to body hair or menstrual problems. Both NIH (b ? 0.30, P ? 0.024) and non-NIH (b ? 0.32, P ? 0.016) PCOS status predicted anxiety, whereas age (b ? 0.35, P ? 0.008) and free androgen index (b ? 0.31, P ? 0.027) predicted depression. conclusions: PCOS is associated with anxiety and depression. Non-NIH phenotypes present with similar psychological profiles to NIH PCOS, indicating increased psychological dysfunction in PCOS, even in milder reproductive phenotypes. However, women with NIH PCOS appear to have worse HRQoL in some areas than women with non-NIH PCOS. Psychological function and HRQoL should be considered in all women with PCOS.