Although many coexisting disorders have been reported with post-traumatic stress disorder (PTSD), little reference has been made to the presence of psychotic symptoms. Psychotic symptoms are not included in the Diagnostic and Statistical Manual of Mental Disorders IV or International Classification of Diseases 10 diagnoses of PTSD. The hallucinations and delusions described here in two cases of PTSD were accompanied by psychotic symptoms. These symptoms clearly differ from flashbacks but have a strong symbolic relationship to the trauma, and they do not respond to antipsychotic drugs. The question is whether there are two separate diagnoses or if psychotic symptoms are an integral part of PTSD. More systematic studies are required to explore the possibility of changing the current classifications of PTSD to include a diagnosis of PTSD with psychotic features.