Some patients exhibit adverse psychologic responses to the diagnosis and treatment of hypercholesterolemia. These responses are, in part, a function of the patient's perception of the distinction between disease and illness and the patient's understanding of the probabilistic relationship between risk factors and associated diseases. Moreover, failure to acknowledge some of the specific complexities of hypercholesterolemia (e.g., natural fluctuations in serum cholesterol levels, variability of response to diet, etc.) may result in considerable anxiety. Clinicians should recognize and address these potential sources of dysfunctional psychologic reactions when they counsel hypercholesterolemic patients.