Adverse developmental effects associated with traumatic life experiences such as child sexual abuse will not apply to all individuals exposed. This general population study, compared the health and life circumstances of 45 respondents who spontaneously identified the experience of sexual abuse before age 22 as changing their life for the “better” ( n = 12) versus “worse” ( n = 33); with respondents who reported exposure to child sexual abuse on a standard questionnaire; and respondents not reporting such exposure. Individuals exposed versus non-exposed to sexual abuse experienced more adversity in early life and exhibited lower functioning in adulthood. However, individuals associating sexual abuse with a life change for the “better” exhibited a constellation of features consistent with more stable, supportive home environments and better prospects early on and healthier functioning later-on as adults. Studies are needed to understand the complex pathways between early exposure to sexual abuse and these diverse outcomes.