Negative self-referential processing and identity disturbance are not uncommon clinical outcomes in adults who were significantly maltreated as children. In this study a novel cognitive paradigm, akin to mirror viewing while experiencing negative versus positive thoughts, was developed to investigate verbal and visual self-referential processing disturbances in women with maltreatment-related posttraumatic stress disorder (PTSD). Relative to women without PTSD, women with PTSD endorsed more negative and less positive trait-adjectives as self-descriptive, and experienced more negative and less positive affect in response to viewing pictures of themselves while listening to both negative and positive trait adjectives. In an fMRI study, women without PTSD demonstrated increased blood oxygenation level dependent (BOLD) response within the perigenual region of the anterior cingulate cortex during self-referential processing while listening to positive trait adjectives relative to neutral words. Positively valenced self-descriptiveness and affective response ratings predicted BOLD response within the right amygdala during self-referential processing within women with PTSD. The theoretical and clinical significance of abnormal self-referential processing in trauma-related psychiatric disorders is discussed.