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Image-based sexual abuse (IBSA) involves harm inflicted upon children through the creation, distribution, and misuse of explicit images. This presentation examines the impact of IBSA, independent of child sexual abuse and adversity, on drug overdoses, suicide attempts and self-injuries during. Participants were young adults, aged 18 to 28 (n = 2,652), recruited through social media. Questions asked participants to reflect back on experiences prior to age 18. Data was collected between February 27, 2024 and April 1, 2024. IBSA was associated with elevated odds mental health impact, independent of in-person sexual abuse and adversity. Gender minority participants were more likely than cisgender participants to report IBSA; sexual minority youth more likely than those identifying as heterosexual. Gender minority youth with IBSA had increased odds of drug overdoses (aOR 3.0, p=.05) and suicide attempts (aOR 3.0, p<.001). Among sexual minority youth, IBSA was associated with increased odds of drug overdoses (aOR 4.0, p=.001), suicide attempts (aOR 2.4, p<.001) and non-suicidal self-injury (aOR 2.9, p<.001). Youth serving professionals should be aware that IBSA is associated with increased public health problems. Vulnerability to IBSA should be included among the concerns that clinicians and educators screen for, particularly among vulnerable populations.