Although theoretical accounts of adaptation in the terminally ill suggest that realistic acceptance of one's disease is adaptive, some investigations suggest that such responses are associated with increased mortality. This prospective psychobiological investigation involved 74 gay men with AIDS. Six scores reflecting responses to disease were derived from a detailed psychosocial questionnaire. One pattern of response, Realistic Acceptance, was a significant predictor of decreased survival time. Median estimated survival time for participants with low Realistic Acceptance scores was 9 months greater than for participants with high Realistic Acceptance scores. This effect was not accounted for by time since diagnosis with AIDS, self-reported health status, number of CD4 T lymphocyte cells, psychological distress, age, education, initial diagnosing condition, use of AZT, smoking, or alcohol and drug use.