Amanda Knox is no longer sleeping in a prison cell, but she is haunted by her 1,400 nights in an Italian jail.
Panic attacks and symptoms of PTSD plague her and often leave her in shambles.
Knox says physical freedom did not mean a free mind.
"I was continuing to have panic attacks and nightmares, and I was continuing to think that strangers on the street were prisoners that I had known," she told ABC News in a recent interview.
She says the breakdowns began in prison. "I had panic attacks and just broke down. And I couldn't breathe," she said.
Knox, 26, is just days away from going back on trial for the alleged murder of her roommate Meredith Kercher in November 2007. Knox was convicted in 2009, but then acquitted on appeal and set free on Oct. 4, 2011.
In March, however, the Italian Supreme Court rejected the Appeals Court ruling and ordered a new trial for Knox and her ex-boyfriend Raffaele Sollecito, 29 set to begin Sept. 30 in Florence, Italy. Knox says she will not return for the trial.
Though Knox was paid nearly $4 million by Harper Collins for her book, "Waiting to Be Heard," she says most of that money has gone to legal bills, taxes and other debt her family accrued during the four year ordeal between her arrest and release.
After her return home to Seattle, Knox's mother, Edda Mellas, suggested she see a therapist.
"I started talking [to the therapist] about how difficult it was coming back and coming back into a world of the familiar, but feeling like I had to get to know it all over again. And in the course of talking to him-- I think it took about 15 minutes of speaking before I was inconsolable. I was weeping and unable to speak and I had to leave. Leave. I had to cut the session short. And I left. And my boyfriend picked me up and I spent the rest of the night crying," she said.
Mellas says Knox brought some of her prison habits home with her. When Knox returned home, she immediately cleaned her room almost bare.
"She was just overwhelmed by stuff because she had been in such a stark environment," her mother said. "So I saw things like her hand washing her clothes. We had to reintroduce her to 'This is a washing machine, and it's okay, you don't have to hand wash your clothes, and hang them up.'"
Knox had also never heard of Justin Bieber or seen an iPhone.
Knox says the emotional toll of her ordeal hit her as she wrote her memoir and re-lived every minute of her ordeal.
"I was at times so angry and so sad and I had to, I just had to step away. I had to get away from my computer, I had to get away from the memory, I had to go on my bed and cry. I had to go and walk around the block five, 10 times to just breathe and get my way through it and then go back and try not to instill the emotions that I was experiencing now into the emotions I was experiencing then. I was, I mean, I'm very aware of that."
Knox has begun to recognize the changes from the 20-year-old girl who left for Italy to study aboard.
"I've become a little more introverted and quiet and less sociable. My sister's always telling me that I should go out more and have more fun when what I tend to look for now is quiet. And space to move. That's really important. I'll take ridiculous walks just because I can. So that's different. I'm a lot quieter," Knox said.