Most adult survivors of childhood abuse struggle with a negative or undefined self-image; have difficulties with self-esteem, trust, and dependency; and exhibit possible feelings of helplessness or revictimization. The behavioral manifestations of these issues are unique to the child and his or her personality structure. The type of abuse that is experienced may also have a direct link to the type of adult problems that surface. If sexual abuse occurs within the family, there are common behavioral manifestations, including sexual dysfunctions, drug and alcohol abuse, aggressive behavior, and depression. Two other psychological disorders recently documented as relevant in the diagnosis and treatment of adult survivors are dissociation and posttraumatic stress disorder (PTSD). Some treatment goals in working with adult survivors are broadening the self-image and esteem, trauma resolution, and reclaiming sexuality. The most important aspect of therapy is forming a therapeutic alliance to provide a safe, corrective, reparative experience. 10 references