Freud's dilemma with regard to whether or not he should believe his patients' allegations of sexual abuse in childhood is well known. A century later, psychoanalysts are still dealing with this important issue. In this article, I describe the criteria I have developed in recent years, criteria that have been useful for me when attempting to determine whether my child and adult patients' allegations of sex abuse are more likely to be true or more likely to be false. Although these differentiating criteria were developed in the context of forensic evaluations, they should prove useful in clinical settings as well.