Child sexual abuse (CSA) is an important public health problem with long-standing neurobiological, developmental, and psychiatric abnormalities. The present review analyzes the long-term effects of CSA from a developmental, psychiatric morbidity, neurochemical and neurobiological perspective and then tries to posit a developmental neurobiological trajectory from CSA to the genesis of psychopathology in later life. The role of various neurotransmitters such as serotonin and dopamine affected by CSA are discussed. Serotonin abnormalities have been reported in various studies among participants exposed to CSA. Structures such as the prefrontal cortex, superior temporal gyrus, corpus callosum, parietal lobes, hippocampus, and cerebellum all demonstrate volumetric and structural changes in response to the trauma of CSA. Neurocognitive studies demonstrate memory and spatial awareness as well as decrements in general cognitive performance and memory when compared to normal individuals. The hypothalamic–pituitary–adrenal axis has also been implicated in CSA, and there is an alteration in corticotropin-releasing hormone response due to the continuous cumulative trauma of CSA. This paper also reviews a section on the role of genetic and epigenetic factors in the development of psychiatric disorders as a result of exposure to episodes of CSA where studies have demonstrated changes in DNA methylation in response to CSA. This review tries to hypothesize a developmental trajectory framework which is individual for every case where exposure to CSA may lead to psychopathology and psychiatric morbidity later in life. Rapid and emerging fields such as developmental traumatology in relation to CSA are also discussed.