Background: Psychiatric co-morbidity (PCM) constitutes a major complicating factor for patients with hidradenitis suppurativa (HS) but individuals at risk are ill defined. Objectives: To examine the differences in demographic and clinical characteristics, co-morbidities, and disease burden in patients with HS with and without PCM. Methods: Data were obtained through clinical examination and interviews. Disease burden was evaluated based on clinical severity, VAS-10 for overall bother and pain, and dermatology life quality index. Analysis was conducted on all patients and amongst PCM-subgroups. All current physician diagnosed psychiatric conditions were included. Results: 667 consecutive, adult patients with HS from a dermatological university outpatient clinic were included. Of these, 183 (27.4 %) had a diagnosis of PCM, with affective disorders (16.2%) being most prevalent. PCM was associated with being unemployed (52.5 vs. 18.7 %) OR 5.50 (3.73–8.10) p < 0.001, Caucasian (88.5 vs. 80.6 %) OR 1.86 (1.12–3.09) p < 0.05, younger at HS-onset (23.6 vs. 26.2 years) p < 0.01, obese (44.0 vs. 34.5 %) OR 1.50 (1.06–2.13) p < 0.05 and smoker (89.6 vs. 73.2 %) OR 3.76 (2.20–6.40) p < 0.001. Differences within PCM-subgroups were also discovered. Patients with PCM were more likely to have asthma or/and chronic obstructive pulmonary disease (9.8 vs. 5.6 %) OR 1.94 (1.03–3.66) p < 0.05. Patients with PCM had higher VAS-10 bother scores (mean 7.3 vs. 6.7) p < 0.05, but no differences in disease severity. Patients with HS-onset before the age of 15 had the highest risk of developing PCM within the following 10 years, HR 3.37 (1.56–7.31) p = 0.002. Conclusions: Patients with PCM and HS vary in demographic and clinical characteristics, risk factors and burden of disease, compared to patients with HS without PCM. This calls for a multidisciplinary approach and increased awareness from the clinician.