Most mental health professionals are familiar with individuals, usually female, who recurrently injure themselves. The five females studied ranged from 15 to 40 years of age when first seen. Their clinical features included self- injury, drug abuse, depression and mood swings, sleep disorders, eating disorders, somatic symptoms such as abdominal pain and migraine headaches, sexual disorders, relationship difficulties, behavior disorders, phobic anxiety, religious conflicts, dissociative features, and perceptual disorders. In each case, at least a year elapsed between the onset of psychiatric intervention and the disclosure of Satanist ritual abuse. All disclosures began with sexual abuse, either of themselves as children or the witnessing of the abuse of others. The ritual abuse included almost every imaginable type of physical, sexual, psychological, emotional, and spiritual abuse. Professionals are often skeptical about ritual abuse, but should consider the possibility of this kind of abuse in patients with these symptoms. Table and 13 references (Author abstract modified)