Ritual abuse is defined as repeated physical, emotional, mental, and spiritual assaults combined with the systematic use of symbols and ceremonies designed to attain malevolent effects. Although one purpose of ritual abuse may be to gain personal spiritual power or "please Satan," another purpose may be to systematically break down the victim's sense of self in order to assure cooperation with group goals. The three case studies demonstrate medical, legal, social, and family issues associated with ritual abuse. Identifying the type of abuse experienced is an important initial step in assessing victim psychopathology. It is essential to recognize behavioral indicators that may differentiate sexual abuse victims from those who also experience ritual abuse. Characteristics of ritual abuse victims include confusion about values, deep mistrust of authority figures and social structures, concerns of a spiritual nature, fear of being abducted or killed by a cult, and concerns about being different and unacceptable. Many victims of ritual abuse suffer from some form of post-traumatic stress disorder, and dissociation and hallucinations may be present. The most effective treatment for ritual abuse victims must be determined on an individual basis, taking into account the victim's age, the degree of involvement in ritual practices and abuse, and the extent of psychopathology involved. 17 references