Existing criminology and victimization research suggests that youth victims of commercial sex often have mental health issues stemming from their sex victimization and/or emerging out of their long histories of family abuse, neglect and family conflict. However, what is not known is whether youth commercial sex victims, when compared to adjudicated delinquent, serious adolescent offenders, present unique mental health issues when they contact the juvenile justice system. We use the Pathways to Desistance longitudinal data that contains a sample of 1354 serious, adjudicated, juvenile offenders from Philadelphia, Pennsylvania and Phoenix, Arizona to address this question. According to our analyses, youths who had ever been paid for sex had significantly higher rates of several mental health disorders when compared to their high risk, adjudicated delinquent peers who had not engaged in commercial sex. We explain our findings concerning the potentially increased mental health diagnoses for youth commercial sex exploitation victims during and after their periods of adjudication.