One of the pathways whereby abuse in childhood is related to problems in adulthood pertains to self-destructive behaviors, including substance abuse, obesity and eating disorders, suicide, high-risk sexual behavior, smoking, and sleep difficulties. Another pathway that links childhood abuse to unhealthy adult living pertains to social experiences, which can include the avoidance of interpersonal ties or an intrusive need for closeness, attraction to abusive relationships, and homelessness. A third pathway pertains to cognitive development, which encompasses beliefs and attitudes that shape a person's life. Persons abused in childhood are at higher risk of being chronically negative, fearful, or mistrusting, which can in turn influence physical health. The cognitive pathway can also pertain to perceptions of one's health. Belief about one's health has been found to be a strong predictor of both the frequency of illness and mortality. The final pathway that links adult experiences to childhood abuse pertains to emotional states. The adult emotional states that tend to be characteristic of people abused in childhood are depression and posttraumatic stress disorder (PTSD). In the latter case, childhood abuse apparently makes adults more vulnerable to the development of PTSD when they are exposed to a current life stressor. PTSD, in turn, has a negative impact on health. In order to improve health outcomes for adult survivors of childhood abuse, clinicians must consider and address each of the ways by which victimization can influence health. 61 references