We reviewed the records of 20 patients admitted with a diagnosis of frostbite. In addition to their thermal injury, all had overt, or covert, psychiatric disease. This prompted us to review hospital records of patients admitted to the Department of Veterans Affairs (DVA) Hospital system with a diagnosis of frostbite. During fiscal years 1991 and 1992, 37% and 36.7% of all patients admitted to DVA hospitals had a psychiatric disorder as primary or secondary diagnosis. When we selected those patients who additionally had a primary or secondary diagnosis of frostbite, the incidence increased to 61% and 65.6%, respectively. Urban patients with frostbite sufficiently severe to necessitate hospital admission have concomitant psychiatric disease at a rate that far exceeds the expected. Urban patients admitted to the hospital with a diagnosis of frostbite should be carefully screened for the presence of psychiatric disorder.