BACKGROUND: Cardiac patients with Type D ('distressed') personality perceive more stress. It is unclear to what extent Type D personality might represent deficits in emotion regulation that are known to play an important role in the development of mental disorders. This study evaluated the relationship between emotion regulation and Type D personality and assessed the influence of mood and stress on Type D. METHODS: Emotion regulation, mood, perceived stress and Type D personality were assessed in 163 cardiac patients. RESULTS: Maladaptive emotional regulation was more pronounced in Type D patients. Depressed mood and perceived partner-related stress were higher in patients with Type D than in those with Non-Type D. Regression models revealed a stronger association between emotion regulation and Type D personality (odds ratio=3.16; 95% confidence interval=1.53, 6.54) than for depressed mood (odds ratio=1.19; 95% confidence interval=1.02, 1.38). CONCLUSION: Patients with deficits in emotion regulation are more likely to have Type D personality. Deficits in emotion regulation might be an agent for future intervention studies to change Type D and its prognostic effect.