Women's responses to childhood and adulthood sexual violence are complex and highly individualized. Some survivors experience severe and chronic psychological symptoms, whereas others experience little or no distress. The wide range of consequences may be attributed to assault characteristics, environmental conditions, survivor attributes, and availability of social support and resources. The use of different methodologies may also contribute to mixed findings across studies. Sexual trauma refers to one or multiple sexual violations that invoke significant distress. The term sexual trauma is used based on clinical observations that some survivors do not label their experiences as rape or assault due to familiarity with the perpetrator or the absence of force.