Objective: To examine whether young adults with highly performance-based self-esteem (PBSE) were present at work/studies when ill more frequently than were others. Methods: By using data from a Swedish cohort of young adults aged 20 to 25 years (n = 5582 at baseline), we examined the association between PBSE and sickness presenteeism (SP) >5 times/yr (retrospectively at 1-year follow-up). Results: PBSE was a predictor of SP even when adjusting for general health, psychological demands, physical demands, economic problems, and main occupation. A synergy effect was also observed between PBSE and environmental and personal factors in relation to SP. The effect of PBSE on SP was four times higher among individuals with poor health, compared to individuals with good health. Conclusions: These results provide support for the role of personality characteristics as a predictor of frequent SP.