INCREASED RISK for serious negative outcomes has been reported for individuals with a history of childhood sexual abuse (CSA).1- 3 However, 2 major methodological issues, ascertainment or selection bias and confounding aspects of the family environment (eg, parental alcoholism), complicate interpretation of reported associations. Many investigations have relied on samples ascertained via agency involvement1- 4(with CSA of greater severity occurring in more problematic family environments) or from clinical populations1- 3,5(with higher rates of psychiatric illness and greater functional impairment). Still, general population studies have confirmed findings from these samples including increased risk for psychiatric illness (anxiety disorders,6- 11 depression,6,7,9,10,12- 14 alcohol abuse and/or dependence,6,7,9- 11,14,15 drug abuse and/or dependence,6,7,10 eating disorders,7,14,16 conduct disorder,6- 10 and borderline personality disorder17) and other adverse outcomes (suicide attempt,6,14 current smoking,18 sexual revictimization,16,19,20 and relationship problems12,14,16,20,21)associated with self-reported CSA. Most studies have used retrospective designs(ethically mandated interventions preclude entirely naturalistic, prospective approaches), and are, therefore, subject to retrospective reporting bias. One study6 that assessed psychiatric diagnoses prospectively during adolescence and CSA history (required to have occurred before the age of 16 years) retrospectively at the age of 18 years found increased rates of subsequently occurring psychiatric disorders, particularly when CSA involved intercourse.