OBJECTIVES. This study investigated the role of family variables in the development of psychological problems in childhood sexual abuse (CSA) survivors, contributing to the debate between the 'abuse related' perspective, which assumes a direct causal link between abuse and later problems, and the 'family dysfunction' perspective, which assumes that these problems are caused by the dysfunctional nature of families in which abuse occurs. The two questions of central concern were: (1) whether maladaptive family dynamics and CSA were each associated with later adjustment; and (2) whether these associations acted independently of one another. DESIGN. A retrospective cohort study comparing sexually abused and non-abused participants matched one-to-one on demographic variables. METHODS. The 64 clinical participants were recruited by sending questionnaires to clients on a psychological therapy waiting list, and 44 students were recruited from questionnaires made available at University Health Centres. Participants completed measures of psychological and sexual adjustment, family functioning, and construing. Multiple linear regression models investigated overall and independent associations between abuse, family circumstances, and adjustment in adulthood. RESULTS. There was only weak evidence for the influence of CSA, independently of family environment, on later psychological distress and sexual adjustment, but strong evidence for the influence of aspects of family environment, independent of abuse, on later psychological distress, sexual adjustment, self-esteem, body image, and sexual attitude. CONCLUSIONS. The findings provide support for the 'family dysfunction' perspective on the long-term effects of CSA.