One hundred and twelve adults admitted to a surgical ward due to accidental injuries were studied. Thirty-seven percent had a psychiatric disorder on admission (DSM-III axis I) and 21% had a personality disorder (axis 2). Substance abuse and dependence and antisocial personality disorders were most frequent. Eighteen percent were definitely distressed when injured. Persons with a personality disorder were distressed significantly more often and had sustained clinically more severe injuries. No support could be found for a hypothesis of accidental injuries being the result of hidden or unconscious self-destructive tendencies, and only one patient was injured in a suicide attempt. Defense Mechanism Test applied to a subgroup of 20 patients suggested that high perceptual defense may be related to injury occurrence in patients at fault for the accident.