Background: Adolescence has been recognized as a critical period for mental health during which it is fundamental\ud to the well-being of adolescents to provide early and appropriate mental health interventions. Self-image\ud perceptions play a particularly relevant role during adolescence since individuals are extensively\ud involved in reorganizing their identity and relationships. Although the self-image development implies adaptive\ud outcomes for most adolescents, some age-related tasks can be difficult to deal with and lead to psychological\ud suffering for a minority of them. Method: This study examined how domain-specific self-image was\ud associated with psychological distress in 128 treatment-seeking adolescents aged 13–18 (60.9% female). The\ud adolescents completed the Offer Self-Image Questionnaire to measure their global and domain-specific self-image\ud and the Youth-Outcome Questionnaire to assess their psychological distress. Results: Regression analyses\ud indicated that impulse control, emotional tone, family, and social functioning significantly predict worse\ud psychological functioning in the entire group. Moreover, significant gender differences emerged showing a\ud more complex set of risk factors among adolescent females, thus suggesting the need for gender-targeted preventive\ud and treatment strategies. Conclusions: The findings highlight that adolescents’ feelings and concerns\ud about their self-image may be key factors to consider in planning, developing, and delivering effective public\ud mental health services for adolescents