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To examine posttraumatic stress symptoms in college students with a chronic illness, volunteers who endorsed having a chronic illness (N = 61) were administered the Posttraumatic Diagnostic Scale (PTDS: Foa, Cashman, Jaycox, & Perry, 1997). Over 50% met the criteria for reexperiencing symptoms and interference with functioning; however, few participants met criteria for Posttraumatic Stress Disorder (PTSD). Higher threat appraisals (endorsement of A criteria, general appraisal/level of pessimism) explained a significant portion of the variance in total PTSD symptoms beyond the significant contributions of anxiety, life events, and illness interference with daily functioning. Our findings document the presence of posttraumatic stress symptoms among college students with chronic illness and highlight the role of anxiety and perceived threat in the development of symptoms. College students face a number of demands from chronic illness and stressors not related to their health indicating the need for services targeted at responses to stress.