Research indicates that long-term effects of child sexual abuse in adult survivors include chronic depression, self-destructive behavior, feelings of isolation, poor self- esteem, revictimization, substance abuse, and difficulty in trusting others. Other reactions include dissociative and trauma-intrusive phenomena, intergenerational abuse, and increased HIV/AIDS risk. Child sexual abuse has also been suggested as a factor in the development of some personality disorders. The three reported case studies involved a 79- year-old black woman living independently in a senior housing facility, a 66-year-old married white woman who sought couple counseling for problems related to her manic- depression, and an 81-year-old white woman living independently in an older adult housing facility. Counselors handling these cases determined that unresolved sexual trauma can threaten an individual's ability to live independently, that negative self-perceptions can cause depression, that an inaccurate diagnosis of sexual abuse as dementia or mental illness can circumvent effective mental health assistance to adult survivors of child sexual abuse, and that adult survivors of unresolved abuse may be revictimized by abusive adult relationships. Implications of the case findings for professionals are discussed, particularly with respect to expanding clinical training activities to include child sexual abuse survivor assessment and treatment techniques. 35 references