During her first few weeks at home, Nicole slept all day in her childhood bedroom and stayed up late watching sitcoms like “Sabrina” and “The Nanny.” Finally, she started counseling and was able to get a job doing administrative work at a nuclear-waste site. That June, she testified at the sentencing hearing of four child-pornography defendants caught with her images, hoping to gather strength from speaking out. Instead, the experience made her feel exposed.

More than a year later, in the fall of 2010, she left for a four-year college away from home. She was worried about being on her own, but she wanted to try. “I push myself,” she told me. “I don’t like to say something is too much for me.” Like Amy, however, she took a psychology course, about child development, that brought up unbearable memories. During lectures, she began going blank. “All of a sudden class would be over, and I would be like, ‘What happened?’ ” she said. She started skipping class for fear of continuing to disassociate.

Nicole, who wasn’t in counseling at the time, failed all but two of her courses that spring. “I just totally broke down,” she said. “I’d come home and sit in the same position and stare into space, and then I’d look at the clock, and it was six hours later.” Nicole talked about this period of her life with Hepburn and me over dinner one night last summer. She showed us a tattoo on her right wrist: a heart sheltered by wings that she got after her father’s sentencing. She also learned to make tattoos, and she took out her phone to show us a picture of the first one she created, an anchor with a rope curled around it. “My cousin is a tattoo artist, and he taught me,” she said. “We grew up together, and he was a very easy person to hang out with during that bad time. I’d go over to his place, and he’d be drawing, and he said, ‘You’re into design, you could do this.’ When I tried I felt this release of emotions. We started drawing for hours to music — Tom Petty, Cake, everything. You have to learn how to go smoothly and keep the same pressure on the line the whole time. I drew anchors over and over again on grapefruit. I’d been numb for months, and now I could feel again. I actually felt joy.”

In the fall of 2011, Nicole transferred to a campus closer to her family. She made her way through her course work by avoiding subject matter that upset her and by allowing for her own limitations. “I had to accept that, because I have this extra stressor, I get overwhelmed by things that other people can do,” she said.

Nicole decided to spare herself going to court, so she wasn’t in El Paso, in September 2011, for the sentencing of Luis Enriquez-Alonso, a student at the University of Texas. He agreed to plead guilty after being caught with thousands of illegal videos and images, including Nicole’s, on his computer. At the hearing, Enriquez-Alonso and his parents listened while the prosecutor read into the record a statement Nicole wrote about what it is like to know men are looking at her pictures: “After all these years and going to different counselors, I still haven’t learned the trick to let my mind rest,” Nicole wrote. “When I do sleep, my dreams are vivid and I remember them for weeks. A common theme is finding myself naked in front of a crowd of people or in an enclosed space and I can’t escape or run away fast enough.”

That day, without a court order, Enriquez-Alonso’s family handed over a check for $150,000, along with an expression of remorse. “That really touched me,” Nicole said, “that his family wanted to make sure that I was taken care of, that I could get all the counseling I need. Most of the time when I get restitution, there’s no story behind it. I feel like they’re forced to give the money. In this case, they wanted to do it, and there were words behind it, kind words.” Enriquez-Alonso, who faced a maximum of 10 years in prison, is serving 5.

Study after study links child sexual abuse to psychological trauma, addiction and violent relationships in adulthood. There is almost no research, however, that deals with the specifics of Amy and Nicole’s experiences: What additional harm comes from knowing that pictures of your childhood exploitation are circulating widely?