Childhood sexual abuse (CSA) has been linked to adult mental health problems and indicators of severity of psychiatric illness. There exist large, unexplained individual differences in the presentation of mental health problems following CSA. Complex statistical methodologies allow researchers to examine models of response to CSA and its impact on mental health. Two early models are presented and critiqued. Two more recent models are then presented. It is concluded that whereas no single variable can, on its own, account for individual variation in symptom development, empirically tested models point toward a complex interaction between abuse-related factors, interactions with others (e.g., responses to disclosure, attachment), and individual factors (e.g., attributions, emotion-focused coping) as mediators and moderators of outcome. The implications of increased understanding of the complex interaction of these factors in understanding clinical presentations and in the formulation of treatment plans are explored.