OBJECTIVES: To determine whether emotional expression, alexithymia, illness behavior, and coping strategies differed between women with muscle tension voice disorder (MTVD) and those without voice disorder and between women with and without mucosal pathology of the vocal folds, and to explore possible links between psychosocial constructs and clinical features in women with MTVD. STUDY DESIGN AND METHOD: A within-subjects design matched 20 women with MTVD and 20 women without voice disorder on validated self-report measures of the psychosocial constructs. The effect of mucosal pathology was assessed using between-groups analyses. Correlations assessed relationships between psychosocial constructs and clinical features. RESULTS: Comparisons between women with MTVD and those without voice disorder showed an elevated sense of illness identity and greater belief in the presence of somatic illness in women with MTVD. There was a trend toward women with MTVD showing lower levels of emotional awareness. Women without vocal fold pathology reported lower levels of emotional awareness than those with pathology, whereas women with pathology reported greater use of a mixed pattern of adaptive and maladaptive coping strategies than those with no pathology. Low vocal load was associated with higher scores on alexithymia, higher numbers of vocal symptoms were associated with the use of adaptive coping, and greater impact of symptoms was associated with higher levels of emotional awareness and greater belief in the presence of somatic illness. CONCLUSIONS: These findings encourage further investigation of relationships between emotional awareness, illness behavior, and coping in women with functional voice disorders.