The findings suggest that the more childhood abuse disrupts self-capacities, the more distress the adult survivor experiences when discussing abuse. The severity of physical abuse, emotional abuse, and neglect in childhood, combined with analysis of current self-capacities predicted distress in response to telling one’s story of childhood sexual abuse. Additionally, self-capacities mediated the relationship between severity of childhood abuse and distress upon telling the story. Based on the findings, it appeared that when childhood sexual abuse occurred in the context of physical or emotional abuse and neglect, the distress experienced when telling one’s story of sexual abuse was magnified. The consequences of childhood sexual abuse were worse in family environments that were also physically abusive and neglectful. The sample included 134 women with a mean age of 37.97 years with specific criteria of experienced abuse combined with at least one HIV risk factor. After completing several baseline measures, the participants were asked to tell their story of child sexual abuse to a trained interviewer. Immediately after recounting their trauma, participants completed the Post-Trauma Interview Questionnaire (PTI) to measure trauma-related affective responses to a salient reminder of the past childhood sexual abuse. Limitations of the study were discussed. It was suggested that future research should incorporate a longitudinal design and use non-retrospective measures of childhood maltreatment and self-capacities. The study has implications for treatment and supports the contention of some clinicians and researchers that therapy for childhood sexual abuse must consider the context in which the abuse occurred, that therapists should keep in mind both the context of the abuse and the survivor’s self-capacities, and that therapists should consider titrating memory work with survivors who have impaired self-capacities. Tables, references