Although psychiatric problems are seen less frequently than previously, the orthopaedic surgeon must remain aware of their possible effect. A high index of suspicion for the presence of psychiatric disorders is important in treating the orthopaedic patient with multiple trauma, chronic disease, factitious disorder, or suspected malingering or who fails to improve with recognized treatment. Recognition of a psychiatric problem should be part of preoperative planning in orthopaedic practice, and a formal psychiatric referral for diagnosis and treatment should be made for the patient with significant psychiatric involvement. When associated psychiatric disease is diagnosed and controlled before orthopaedic treatment commences, the patient is more likely to comply with the treatment regimen, which may lead to better results.