Reports of ritualistic abuse are consistently associated with increased impact on victims. Similarities in allegations and increased severity in symptomatology do not prove accounts of ritualistic abuse are valid but suggest the possibility that children are abused in brutal and bizarre ways. Allegations of ritualistic abuse typically involve reports of forced sexual activity; physical abuse or torture; the ingestion of blood, semen, or excrement; drug involvement; threats of violence or death; threats with supernatural powers; satanic reference or paraphernalia, animal mutilations; and killing of adults and children. Characteristics of ritualistic abuse allegations are compared, the impact of ritualistic abuse on children is assessed, and victim and offender characteristics are briefly examined. 20 references and 3 figures