For kidnap victims like Jaycee Lee Dugard, recovery is rare.
A full portion of her life -- her entire teens and 20s -- was poisoned by her abduction at age 11 and the 18 years of brutal captivity and deprivation that followed. So uncommon are situations like hers that mental health experts have few examples to guide them.
They can turn to the case of Natascha Kampusch of Vienna, kidnapped at age 10 on her way to school in 1998 and held for 8 1/2 years before escaping. After an apparent recovery that included her own television talk show and celebrity dating, she retreated into her apartment and rarely leaves it now.
Or they can look to Elisabeth Fritzl of Amstetten, Austria, dragged into a dungeon by her father at 18 and held for 24 years as she gave birth to seven children. Despite extensive rehabilitation, media reports indicate she is not doing well.
Even psychologists and psychiatrists skilled at confronting the worst of human nature find it hard to fathom how Dugard can put the pieces back together and live some semblance of a normal existence.
Things could well be worse for Dugard's two daughters, who were born into captivity in a ramshackle Antioch compound and have known only lives of deprivation. They have never attended school or visited a doctor, and their father, Phillip Garrido, is now in El Dorado County Jail facing charges of rape, kidnapping and other criminal offenses.
Authorities searching Garrido's Antioch house Saturday expanded the crime scene to include the neighboring home of Damon Robinson, according to the Associated Press. Robinson told The Times on Friday that Garrido had taken care of the house before he moved in three years ago, and that Robinson found "all the locks on my home were backward. You could lock people in" but not out.
For Dugard and her daughters, adjusting to freedom will be a long, arduous process.
Dugard's top priority, experts said, should be to get reacquainted with her mother -- though not too fast -- and begin intensive psychological and psychiatric treatment.
She is at risk for post-traumatic stress disorder now that her ordeal is over. But if proper steps are taken early, the chances of her developing that and other problems, such as depression, can be minimized.
Still, the psychological scars from her experience will probably affect her day-to-day life for the foreseeable future and may make it impossible for her to ever live on her own, hold a job or form lasting romantic relationships.
"The adjustment to the outside world is going to be very brutal," said psychologist Naftali Berrill, director of the New York Center for Neuropsychology and Forensic Behavioral Science. "How do you undo years of abuse, years of being held captive?"
Studies of children who have suffered abuse and neglect have found the victims have a high risk of suicide, depression and sexual acting-out.
And a 2000 study of 24 kidnap victims from Italy found that 46% suffered from post-traumatic stress disorder and 38% were diagnosed with major depression after their release. More than two-thirds reported "intrusive recollections," maintained a state of hyper-vigilance and said they had a sense of a "foreshortened future." The average length of captivity among these people was only 99 days.
"The picture is not rosy," said psychologist John Lutzker, an expert on child maltreatment who teaches at Georgia State University.
In the first weeks and months after a kidnap victim is freed, he or she is likely to experience anxiety, tension, sleep disturbances, loneliness, headaches and intestinal problems, among other symptoms.
In Europe, kidnap victims are placed in residential treatment centers to give them time to adjust to their changed circumstances, but there are no equivalents in the United States, said Katherine van Wormer of the University of Northern Iowa in Cedar Falls, who has studied the behavior of kidnapping victims. Both Kampusch and Fritzl were treated in such facilities.
A key issue for Dugard, now 29, will be how she re-establishes her relationship with her mother, Terry Probyn, who lives in Riverside County.
Mother and daughter should resist the urge to try to pick up their lives where they left off in June 1991, when Dugard was abducted in her South Lake Tahoe neighborhood as she walked to a bus stop. Dugard "needs to be in intensive therapy and slowly come back so that her emotional feelings can be transferred back to her mother," van Wormer said.
And though it may seem cathartic to recount 18 years' worth of horrific details, this might make matters worse.
"It runs the risk of really overwhelming Jaycee with the entirety of what she's going through instead of helping her very, very gradually face the new day-to-day issues of creating a life in this larger world," said Dr. Jim McCracken, director of child and adolescent psychiatry at UCLA's David Geffen School of Medicine.
Discussing details of the ordeal in public is especially discouraged.
The parents of Shawn Hornbeck were roundly criticized when they appeared with their 15-year-old son on "The Oprah Winfrey Show" in 2007, less than a week after he was rescued from the suburban St. Louis apartment of kidnapper Michael Devlin. The 11-year-old had been bicycling near his Richwoods, Mo., home when Devlin snatched him.
Hornbeck's parents told the national TV audience that their son suffered sexual abuse during his 4 1/2 years of captivity. Media critics and mental health experts were appalled.
Therapy is not just for the victim. Probyn may also need counseling to help her deal with feelings of abandonment and adjust to the fact that her daughter is no longer a little girl, experts said. She may struggle with things Dugard might say that seem infuriating, such as expressing sympathy or affection for her captors.
Such feelings are not uncommon among those who have been kidnapped: Kampusch, whose captor, Wolfgang Priklopil, committed suicide after her escape, mourned his death and purchased the house in which she was held for those 8 1/2 years.
Carl Probyn, Dugard's stepfather, said his wife told him that Dugard "feels guilty about bonding with" Garrido. (The Probyns are separated.)
"I think he had total control," Carl Probyn said. "Maybe she felt guilty because she didn't fight him off."
Ed Smart, whose 14-year-old daughter, Elizabeth, was abducted in June 2002 from her Salt Lake City bedroom and held for nine months by a pair of drifters, said the family saw a psychiatrist for some time.
But they did not ask her to relive or explain the experience to them. She was encouraged to return to activities she had enjoyed before the abduction and has focused on not dwelling on what happened.
Smart said the biggest hurdle is helping the victim know she has nothing to feel guilty about. Society, he said, may ask: "Why didn't you run away?"
"But this is not her fault," he said.
Dugard's two daughters, 11 and 15, will certainly affect their mother's recovery. They "are constant traumatic reminders," McCracken said. "At every moment, they would tend to evoke memories, feelings, even flashbacks of the traumatic experience."
But the girls may have helped her cope with captivity, and the relationships she has with them could now make it easier for her to form attachments with others, van Wormer said.
"It's better that she had the children," she said. "She wasn't alone."
In many ways, the task of building a normal life will be harder for the daughters.
If they haven't already learned basic skills like reading and writing, it's not too late for them to do so -- though it will be more difficult because of their deprivation. And though they will need intensive therapy, they have one advantage of youth: adaptability.
But unlike Dugard, who according to her stepfather recalls a lot about her life before the kidnapping, they don't have any memory of a well-adjusted childhood to draw on.
All they have known is the bizarre dominion Garrido had in his Antioch home.
"These children have missed normal developmental stages for their entire lives," said psychologist Frederic Bemak of George Mason University, an expert in human trafficking. "It's almost like they are from another planet."
Times staff writers My-Thuan Tran and Jeannine Stein also contributed to this story.