This chapter discusses the issues involved with ritualistic child abuse and the emotional, behavioral, and medical indicators in a child who is being ritualistically abused. It explains the concept of dissociative identity disorder and the issues involved when investigating possible ritualistic child abuse. The Diagnostic and Statistical Manual of Disorders, fourth edition states that the predisposing factor included in nearly all cases is the fact that the disorder has been preceded by abuse or by another form of severe emotional trauma in childhood. The emotional, behavioral, and medical indicators present in a child who has been sexually abused may also indicate that the child has been ritualistically victimized. The concept of ritual abuse, that groups of adults would terrorize and torture children in order to control them, is frightening and controversial, raising for all of us problems of denial and fear of the consequences of information.