The authors argue that posttraumatic stress disorder (PTSD) is not an automatic consequence of a trauma. A review of empirical research demonstrates that there must be subjective mediating factors. On the basis of a conceptual reasoning, the existence of an actual-neurotic structure prior to the traumatic event is put forward as a precondition for the development of PTSD. Freud's theory on actual neurosis is interpreted as the impossibility to process the arousal coming from the drive in a symbolic way. The reason for this impossibility is sought in the failure of the primary caretakers in presenting the child with the necessary symbolic tools for drive regulation. The therapeutic implications of the presence of an actual-neurotic structure are important, because it can lead to a failure of free association. Suggestions for a more fruitful approach are formulated.