Often, sexual orientation and sexual orientation identity are not distinguished, which can impact accurately assessing sexual identity and whether or not sexual orientation is able to change; sexual orientation identity can change throughout an individual's life, and may or may not align with biological sex, sexual behavior or actual sexual orientation. While the Centre for Addiction and Mental Health and American Psychiatric Association state that sexual orientation is innate, continuous or fixed throughout their lives for some people, but is fluid or changes over time for others, the American Psychological Association distinguishes between sexual orientation (an innate attraction) and sexual orientation identity (which may change at any point in a person's life).