The negative effects of a history of severe abuse as a child are becoming increasingly well known to the physician and, in the adult survivor, include both mental health and physical sequelae. Intervention for emotional and psychologic consequences can include a mental health referral. Awareness of physical sequelae can aid the physician in diagnosis and intervention. However, the impact of severe childhood abuse in the medical encounter does not end with diagnosing and managing somatic complaints and/or providing a mental health referral. Severe childhood abuse directly affects the physician-patient relationship by causing the predictable difficulties that adult survivors of severe abuse experience in any of their intimate relationships.