Background: Both objective body shape and perceived body image have been known to influence the mental health. The purpose of this study was to explore the relationship of a combination between actual body mass index (BMI) status and perceived body image with anxiety·depressive condition (ADC) in Korean men and women. Methods: This cross-sectional study analyzed data of 26,239 subjects ≥20 years old from the National Health and Nutrition Examination Survey (2010–2014). This study performed a Rao-Scott chi-square and multivariate logistic regression analyses reflecting survey characteristics and used a variety of independent variables such as socio-demographics and health behavior factors. Results: With all independent variables considered, people with normal weight who perceived themselves as overweight were more likely associated with ADC than a referent group with normal weight who perceived themselves as normal weight, as shown for both men (odds ratio [OR], 1.52; confidence interval [CI], 1.07–2.15) and women (OR, 1.25; CI, 1.06–1.48). Meanwhile, compared to the referent group, men with underweight who perceived themselves as underweight showed a lower association with ADC (OR, 0.63; CI, 0.41–0.97), whereas women with underweight who perceived themselves as underweight showed its higher association (OR, 1.47; CI, 1.10–1.96). Conclusion: A certain group of people categorized as a combination between actual BMI status and perceived body image showed a relatively high likelihood of having ADC, and the gender difference in the likelihood of having the condition for a group was clear. Therefore, this study suggests the need to identify the group at a high risk of ADC on the basis of actual BMI status and perceived body image and to develop an appropriate mental health management program for the group.