Pre-service mathematics teachers' content knowledge is an important issue. Therefore, detailed studies are needed to be conducted on mathematical topics. The study examines preservice elementary mathematics teachers' (PEMTs) special content knowledge (SCK) of integer addition and subtraction in the context of using multiple representations, explaining mathematical reasons lying behind the concepts and justifying them. The findings obtained from the written responses of 42 PEMTs reveal that preservice teachers do not have sufficient and balanced special content knowledge. This is especially more so in the case of addition and subtraction of numbers with opposite signs. The preservice teachers were observed to have more difficulty in using the number line model compared to the use of other representations. The findings offer some indicators about how PEMTs understand integer addition and subtraction through multiple representations and why more emphasis on the SCK components