Sexual abuse in childhood is a pathogenetic factor for psychological disorders. The attention given to this phenomenon varies between therapists and therapeutic schools. The question is how often sexual abuse is recognized as a problem in cognitive behaviour therapy and how this is related to the present symptoms and therapeutic problems. 1223 case reports, written as application for reimbursement of routine cognitive behaviour therapy, were submitted to a content analysis in respect to childhood sexual abuse. Sexual abuse was mentioned in 10.3% of the cases; 59% of female and 50.0% of male victims were abused by relatives. Sexually abused patients showed significantly increased rates of inadequate care and negative life events during childhood. In comparison to controls, cases showed significantly increased rates of “eating disorders” (15 vs. 6; p<.05), “substance abuse/addiction” (16 vs. 6; p<.05), “suicide attempts” (15 vs. 3; p<.01), “strict refusal of sexual partners” (15 vs. 5; p<.05), “frequently changing partners” (21 vs. 3; p<.001), “problems in marriage/partnership” (95 vs. 77; p<.05) and “sexual problems” (51 vs. 24; p<.001). Childhood sexual abuse is a problem, frequently seen in behaviour therapy patients and therefore also warranting special attention in routine patient care. Sexual abuse is understood by cognitive behaviour therapists as an indicator for traumatizing conditions in general during childhood. It is associated with specific treatment problems and therapeutic needs in adulthood.