Amanda Knox, who thought she had beaten back her conviction of murder, continues to face an uphill legal battle. On March 26, 2013, Italy's highest criminal court overturned the acquittal of Knox in the murder of her British roommate and ordered a new trial.

The marathon legal ordeal is now entering its sixth year for the 25-year-old, who has been living in Seattle with her family since she was exonerated in 2011.

The new trial does not mean that Knox would be back in an Italian prison anytime soon. She would not be required to return to Italy for the trial. And if she is found guilty, it would take even more legal proceedings to extradite Knox to Italy. Experts do not believe such an effort would be successful.

Regardless, Knox is entering at least another year (likely a lot more) of uncertain fate and was reportedly “shocked” by the news.

Whatever people think about the woman dubbed “Foxy Knoxy” by the media and named one of Barbara Walters’ 10 most fascinating people of 2011, her formative years have been undisputedly unique.

I have never evaluated or treated Knox, and have no idea as to her guilt or innocence, but as a psychiatrist I can assert that the transition into adulthood is laden with anxiety and stress. Even for the most carefree of individuals, this can be a turbulent time. Imagine navigating such a milestone under the weight of a murder charge and unsettled future. In a statement released, Knox said the court's decision was "painful" and "completely unfounded and unfair."

Those 20-something years are extremely important to growth and establishment of a healthy maturity. Erik Erikson articulated eight stages of development through which a healthy human should pass from infancy to late adulthood.

The existential questions facing Knox, regardless of the court's ultimate ruling, as she moves through this decade are; Can she love? and Can she make her life count?

Knox spent the first four years of her twenties in an Italian prison. During that time and since her release, she has shown many signs of resilience that bode well for her psyche. I'm not sure what happened to her in that prison, but there have been allegations that guards in Italy were sexually inappropriate with their ward.  Knox reportedly was able to connect with visiting musicians there, nonetheless, and even wrote a screenplay for one of their videos. Her ability to connect with others, even in the most dire of circumstances, is a positive sign that Knox has the ability to adapt to her environment without losing her internal sense of self.

Since reintegrating into American life in Seattle, Knox has been linked to a new boyfriend. This is a good sign that she is interested in intimate and reciprocal relationships. Also in her favor are expressions of generativity. Through her creativity and earnerst, Knox has produced socially-valued work in the form of an upcoming memoir, and she is also taking college classes.

Knox issued the following statement, "No matter what happens, my family and I will face this continuing legal battle as we always have, confident in the truth and with our heads held high in the face of wrongful accusations and unreasonable adversity."

These signs of resiliency are excellent strengths and should help Knox get through the ambiguity ahead as she prepares legally and emotionally for a retrial. Central tasks to her continued well-being include avoiding isolation and stagnation.

According to Harper Collins, in Knox’s memoir she "tells the full story of her harrowing ordeal in Italy -- a labyrinth nightmare of crime and punishment, innocence and vindication -- and of the unwavering support of family and friends who tirelessly worked to help her win her freedom." She will need to continue to rely on that support, as the labyrinth has just gotten more complex.

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About the Author

Helen M. Farrell, M.D.

Helen M. Farrell, M.D., is a psychiatrist with Harvard Medical School. She researches forensic psychiatry and violence.

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