Patients with a history of extremely traumatic experiences show a complex pattern of psychological and physical disorders which represents a special challenge for psychiatric care. This problem is described using the example of the psychiatric/ psychotherapeutic treatment of 13 civil war refugees with a history of traumatic experiences from former Yugoslavia in psychiatric treatment at the Psychiatric Clinic of the University of Ulm. One substantial problem encountered by these patients is that, in addition to the original traumatization in their country of origin, the unstable psychosocial conditions of their legal exile condition can lead to re-traumatization which must be responded to with psychiatric treatment.