Biotic disturbances are affecting a wide range of tree species in all climates, and their occurrence is contributing to increasing rates of tree mortality globally. Mistletoe is a widespread group of parasitic plants that establishes long-lasting relationships with a diverse range of host tree species. With climate change, ecophysiological stress is increasing, potentially making trees more susceptible to mistletoe infection, which in turn leads to higher forest mortality rates. The perception of mistletoe presence in individual trees and forest stands is divided within the scientific community, leading to an ongoing debate regarding its impacts. Forest managers concerned about stand health and carbon sequestration may view mistletoe as a foe that leads to reduced productivity. In contrast, ecologists may see mistletoe as a friend, in light of the wildlife habitat, biodiversity and nutrient cycling it promotes. However, individual studies typically focus on isolated effects of mistletoe presence within their respective research area and lack a balanced, interdisciplinary perspective of mistletoe disturbance. With this conceptual paper we aim to bring together the positive and negative impacts of mistletoe presence on tree physiology, soil nutrient cycling as well as stand health and stand dynamics. We focus on the role of mistletoe-induced tree mortality in ecosystem succession and biodiversity. In addition, we present potential modifications of mistletoe presence on the energy budget and on forest vulnerability to climate change, which could feed back into stand dynamics and disturbance patterns. Lastly, we will identify the most pressing remaining knowledge gaps and highlight priorities for future research on this widespread agent of biotic disturbance.