Visual imagery is reported to play a central role in posttraumatic stress disorder (PTSD). This pilot investigation examined visual imagery ability in patients with varying degrees of posttraumatic stress. Eighty one survivors of motor vehicle accidents with either (a) diagnosed PTSD, (b) diagnosed Specific Phobia, or (c) no psychiatric diagnosis and low anxiety were assessed on a measure of vividness of visual imagery. Low Anxiety subjects displayed superior visual imagery compared to PTSD and Specific Phobic subjects. Incidence of flashbacks and nightmares, however, was associated with visual imagery ability in PTSD subjects. Findings suggest that visual imagery ability may be associated with PTSD flashbacks. These results are discussed in terms of use of imagery-based treatments with traumatized patients, and of the need for further investigation of the role that imagery plays in posttraumatic adjustment.