Temporomandibular joint dysfunction (TMD) is a common condition; yet multifactorial in nature. Our understanding of the interplay between clinical symptoms in relation to Magnetic resonance imaging (MRI) findings and quality of life is limited. Our primary objective was to identify features of TMD contributing to anxiety and depression. Our secondary objective was to determine whether clinical symptoms, baseline characteristics, and mental health outcomes are associated with underlying disease severity, as determined by MRI. A retrospective analysis of 202 TMD patients was performed. Mental health outcomes were quantified using the IMPARTS psychometric questionnaire (Visual Analog Score, VAS; Generalised Anxiety Disorder Assessment, GAD7;, Patient Health Questionnaire, PHQ-9), and patients were categorised based on temporomandibular joint pathology severity (normal, anterior disc displacement with reduction, anterior disc displacement without reduction and severe degeneration). On multivariable analyses, both higher anxiety (p<0.001) and depression (p<0.001) scores on IMPARTS assessment were associated with worst perceived pain (on VAS). Unilateral joint involvement (OR2.48[95%CI 1.20;5.46],p=0.018), locking (OR4.28[95%CI 1.63;13.63],p=0.006) , and clicking (OR2.14[95%CI1.05;4.60],p=0.006) were significantly associated with increased odds of an abnormal TMJ on MRI, whereas higher anxiety scores (OR0.93[95%CI 0.88;0.99],p=0.006) and male gender (OR0.35[95%CI 0.15;0.79],p=0.012) were significantly predictive of a normal joint morphology on MRI. Our findings support a complex interplay between patient symptomology, mental health outcomes and objective radiologically-defined joint pathology in the TMD patient population.