OBJECTIVE This is the second in a series of articles that describe the prevalence, correlates, and consequences of childhood sexual abuse (CSA) in a birth cohort of more than 1,000 New Zealand children studied to the age of 18 years. This article examines the associations between reports of CSA at age 18 and DSM-IV diagnostic classifications at age 18. METHODS A birth cohort of New Zealand children was studied at annual intervals from birth to age 16 years. At age 18 years retrospective reports of CSA prior to age 16 and concurrently measured psychiatric symptoms were obtained. RESULTS Those reporting CSA had higher rates of major depression, anxiety disorder, conduct disorder, substance use disorder, and suicidal behaviors than those not reporting CSA (p < .002). There were consistent relationships between the extent of CSA and risk of disorder, with those reporting CSA involving intercourse having the highest risk of disorder. These results persisted when findings were adjusted for prospectively measured childhood family and related factors. Similar but less marked relationships between CSA and nonconcurrently measured disorders were found. CONCLUSIONS The findings suggest that CSA, and particularly severe CSA, was associated with increased risk of psychiatric disorder in young adults even when due allowance was made for prospectively measured confounding factors.