This chapter reviews the psychological aspects of congenital heart defects (CHD). The hitherto often neglected side of the psychological problems associated with CHD has an impact on the course of the disease, its treatment, and, to a considerable extent, on the well-being and quality of life of those affected. Even though CHD can be repaired to a large degree, CHDs remain chronically ill which has an impact on their psychological well-being. Various study results demonstrate elevated prevalence of psychological comorbidities, especially of depression, anxiety, and posttraumatic stress symptoms. However, research findings show that despite a serious and complex chronic illness, well-being can be attained, and a good quality of life is possible. A central mediator is patients’ cognitive appraisal and personal understanding of their medical condition and its potential consequences. This has been referred to as illness identity. Illness identity provides a good framework for understanding patients’ individual experiences and mental frames living with a disease. The management of the chronic illness and the development of well-being and quality of life can be impeded by the negative forms of illness identity. Thus, treatment should involve awareness of illness identity of patients. Furthermore, general resistance resources can be developed in CHD. For example, social support affects patients’ sense of coherence which is found to prevent mental health issues in ACHD.