Although a definitive causal relationship between such difficulties and child sexual abuse cannot be established using current retrospective research methodologies, the consistent findings in the literature have led many to conclude that childhood sexual abuse is a major risk factor for a variety of problems. A variety of studies document chronic self-perceptions of helplessness and hopelessness, impaired trust, self-blame, and low self-esteem in abused children. However, child sexual abuse has no single universal or uniform impact. In addition, as many as one- fourth of all sexually abused children either report no initial abuse-related problems or may no longer present with demonstrable symptomatology within 2 years of their abuse. Photograph and 97 reference notes (Author abstract modified)