There is a considerable body of research demonstrating that childhood sexual abuse (CSA) is associated with widespread short- and long-term psychopathology, and moreover, is connected with the most severe, chronic and life-threatening consequences of a wide range of psychiatric disorders. More specifically, there is a growing body of evidence reporting that CSA is related to psychotic symptoms and diagnoses of schizophrenia, and some authors have found thematic links between the nature of abuse and the content of psychotic symptoms. A wide range of biological, psychological and social factors have been postulated in the literature as mediating or moderating the relationship between childhood abuse and psychotic symptoms in adulthood. Cognitive models of psychosis, and delusions in particular, are increasingly influential. There is ongoing debate as to the nature of the relationship between childhood abuse and psychosis, with some theorists proposing a causal relationship. Despite the consistently demonstrated relationship between child abuse and adult psychopathology, research suggests that the majority of abuse and trauma is unidentified by mental health services in routine clinical practice. Clinical issues related to enquiring about abuse are examined.