Velo-cardio-facial syndrome (vcfs) is a congenital disorder with a markedly variable clinical expression. The majority of those affected have cognitive-behavioural symptoms and psychiatric problems. Most of the somatic characteristics can be treated effectively. The quality of life of patients with vcfs is therefore determined largely by cognitive and behavioural symptoms, including the increased risk of psychiatric disorders. On the basis of a case-study featuring a 41-year-old vcfs patient and by reviewing the literature we describe the psychiatric disorders that can occur in conjunction with this syndrome.