Victims of a recent trauma were compared with posttraumatic stress disorder (PTSD) patients and healthy controls to assess whether a specific anxiety response and an attentional bias were evident initially or only in chronic PTSD. Heart rate (HR) and startle response were measured, and a dot-probe task was carried out using trauma-relevant pictures. Severely affected recent trauma victims and chronic PTSD patients showed HR acceleration to trauma-related material, which was the only significant group difference. A bias away from trauma-related material was related to severity of intrusions in recent trauma victims, and the bias toward trauma-related material increased with amplitude of the HR response in PTSD patients. A specific anxiety reaction is present initially in severely affected trauma victims.