Organized and ritual child sexual abuse (ORA) is often rooted in the child's own family. Empirical evidence on possible associations between ORA and trauma-related symptoms in those who report this kind of extreme and prolonged violence is rare. The aim of our study was to explore socio-demographic and clinical characteristics of the individuals reporting ORA experiences, and to investigate protective as well as promotive factors in the link between ORA and trauma-related symptom severity. Within the framework of a project of the in Germany, we recruited 165 adults who identified themselves as ORA victims via abuse- and trauma-specific networks and mailing lists, and they completed an anonymous online survey. We used variance analyses to examine correlations between several variables in the ORA context and PTSD symptoms (PCL-5) as well as somatoform dissociation (SDQ-5). Results revealed a high psychic strain combined with an adverse health care situation in individuals who report experiences with ORA. Ideological strategies used by perpetrators as well as Dissociative Identity Disorders experienced by those affected are associated with more severe symptoms (η² = 0.11; η² = 0.15), while an exit out of the ORA structures is associated with milder symptoms (η² = 0.11). Efforts are needed to improve health care services for individuals who experience severe and complex psychiatric disorders due to ORA in their childhood.