Five case reports that illustrate the possible contribution of psychological factors in the etiopathogenesis of reflex sympathetic dystrophy (RSD) are presented. All five patients at the time of physical trauma were confronted with a significant loss that either accidentally coincided with the trauma, or was related to the experience of the trauma itself. The patients' reaction to the loss was invariably characterized by helplessness. A biopsychosocial hypothesis which considers the possible role of psychophysiological and behavioral aspects of helplessness in the precipitation, maintenance, and/or enhancement of RSD is outlined.