Cases of child sexual abuse vary greatly and may or may not have a lasting impact on the child. In this article, the author focuses on cases in which the sexual abuse is severe and the impact on the individual and may meet the criteria for the diagnosis of posttraumatic stress disorder (PTSD). Posttraumatic stress usually manifests as acute, chronic, and/or delayed. The author also discusses the routine use of dissociation as a psychological defense against trauma that is often seen in child victims, especially when the abuse is chronic. This use of dissociation causes harm because it interferes with the functioning of consciousness, identity, and memory. The author also reviews the available research literature regarding the after-effects of incest/child sexual abuse, and focuses on research that describes four main trauma-inducing dimensions of abuse: traumatic sexualization, betrayal, powerlessness, and stigmatization. The author then goes on to describe the sexual after-effects of child sexual abuse, including such topics as sexual identity and gender-preference issues, sexual development in adolescents, and sexual dysfunction. Also discussed are the oft-noted overlapping issues between child sexual abuse and chemical, relational, and sexual addictions or co-addictions in both men and women. In conclusion, the author contends that not all survivors of child sexual abuse manifest adverse sexual effects and thus, therapists should approach each new case with an open mind regarding the possible after-effects of abuse. 42 References