Full opinion text
HULL, Circuit Judge: After his guilty plea to possession of child pornography, David Rothenberg appeals from the district court's restitution order requiring him to pay a total of $142,600 in restitution to nine victims depicted in the images of child pornography that he possessed. Section 2259 mandates that district courts order defendants "to pay the victim ... the full amount of the victim's losses" as determined by the court. 18 U.S.C. § 2259. This case involves the question of how to calculate the amount of restitution a possessor of child pornography, like the defendant Rothenberg, must pay to a victim whose childhood sexual abuse appears in the pornographic images he possessed but did not create or distribute. On appeal, Rothenberg argues that: (1) the district court's restitution order is flawed as to all of the victims because it failed to calculate and then disaggregate the victim's losses caused by the initial abuser, distributors, and other possessors from those caused by Rothenberg himself; and (2) as to eight of the victims, the restitution award is not supported by competent evidence. After review, and with the benefit of oral argument, we conclude that the district court was not required to calculate and disaggregate the victim's losses in the manner Rothenberg suggests and that reliable evidence supports the restitution awards as to eight victims, but not as to one victim. We thus affirm the restitution amounts as to eight victims and vacate and remand as to one victim. I. INDICTMENT AND GUILTY PLEA Defendant Rothenberg used to be a lawyer, a fact he told an undercover officer in an internet chatroom called "daddaughtersex." Rothenberg also sent the officer videos of child pornography and bragged that he was sexually exploiting a young girl at his house. In 2016, local and federal law enforcement went to Rothenberg's house and rescued the young girl, who confirmed that Rothenberg had engaged in sexual activity with her. The officers also found and seized Rothenberg's laptop, which contained approximately 1,000 unique video and picture files of child pornography. Some of those images depicted prepubescent children under the age of 12, and some portrayed sadistic and masochistic conduct, such as the binding and gagging of minor children. In 2016, a grand jury charged Rothenberg with: (1) four counts of distribution of child pornography, in violation of 18 U.S.C. § 2252(a)(2) & (b)(1) (Counts 1, 3, 4, and 5); (2) one count of receipt of child pornography, in violation of 18 U.S.C. § 2252(a)(2) & (b)(1) (Count 2); and (3) one count of possession of child pornography depicting a minor under the age of 12, in violation of 18 U.S.C. § 2252(a)(4)(B) & (b)(2) (Count 6). Pursuant to a written plea agreement, Rothenberg pled guilty to the possession offense in Count 6, and the government agreed to dismiss the receipt and distribution charges in Counts 1 through 5. The district court sentenced Rothenberg to 210 months' imprisonment. On appeal, Rothenberg does not challenge his guilty plea or sentence. Rather, Rothenberg challenges only the district court's restitution order granting a total of $142,600 to nine victims, which consists of: (1) $10,000 to Sierra; (2) $3,000 to Jane; (3) $5,000 to Pia; (4) $5,000 to Mya; (5) $20,000 to Sarah; (6) $9,000 to Vicky; (7) $23,000 to Amy; (8) $42,600 to Jenny; and (9) $25,000 to Casseaopeia. We outline the thorough process the district court followed, the evidence submitted, and then the district court's findings and conclusions. II. RESTITUTION PROCEEDINGS After sentencing, the district court considered restitution requests pursuant to 18 U.S.C. § 2259(a), which provides for mandatory restitution to child pornography victims. Generally, the process worked as follows. First, the government identified the individual victims depicted in the images of child pornography found on Rothenberg's computer and notified them or their attorneys of the upcoming restitution hearing. Then a victim's attorney submitted a restitution request and supporting documentation to the government. Next, the government determined whether to support that request or ask the district court for a different amount. Rothenberg could agree to the request, try to negotiate down with the government or the victim's attorney, or challenge the request before the district court. Eventually the government submitted restitution requests on behalf of ten victims, all of whom were identified in at least one of the images of child pornography from Rothenberg's computer. One of the victims, "Angela," later withdrew her request, leaving nine requests at issue for the hearing. A. Pre-Hearing Memoranda Prior to the restitution hearing, both parties submitted lengthy memoranda addressing (1) how the restitution determination should be made, and (2) what the award should be for each victim. The government and Rothenberg agreed that the Supreme Court's decision in Paroline v. United States, 572 U.S. 434, 134 S. Ct. 1710, 188 L.Ed.2d 714 (2014), governed how the restitution awards should be made, established a proximate cause requirement, and set forth a variety of factors for district courts to consider in determining the proper amount of restitution. Under Paroline's proximate causation requirement, a defendant should pay restitution "in an amount that comports with the defendant's relative role in the causal process that underlies the victim's general losses." Paroline, 572 U.S. at 458, 134 S. Ct. at 1727. But the parties disagreed about how exactly to apply the Paroline factors and how to calculate and determine that amount. The government recognized that, under Paroline, the district court must impose restitution in an amount that reflects the particular defendant's relative role in the continuing traffic in the child pornography images of the victim. The government proposed that the district court make that calculation by using a variation of what is known as the "1/n method," whereby the court would divide the total amount of each victim's losses by the number of defendants, across multiple prosecutions, who had been ordered to pay restitution to the victim. The government submitted that this method would provide the district court a starting point from which to exercise its discretion in determining the appropriate amount of restitution vis-à-vis Rothenberg, as only a possessor of images of child pornography. Rothenberg argued, by contrast, that the starting point should be "apportionment between the original abuser of the child, versus the distributor, and later, possessor of the pornography," which Rothenberg referred to as "disaggregation." Rothenberg asserted that this disaggregation requires two steps: first, the district court must separate the harm caused by the original abuser from that caused by later distributors and possessors; and second, the district court must separate the harm caused by the defendant from that caused by other distributors or possessors. Below, we detail for each victim (1) the victim's restitution request and supporting evidence, (2) the government's position, and then (3) Rothenberg's position. B. Sierra Sierra submitted a restitution request for $10,000. In support of her request, Sierra submitted a medical letter from Dr. Sharon W. Cooper, a forensic pediatrician, based on her December 2015 evaluation of Sierra. Dr. Cooper explained that victims of child pornography can experience physical, emotional, and spiritual issues as a result of their online exploitation, including immunological problems, posttraumatic stress disorder ("PTSD"), anxiety, depression, suicidal ideation, and feelings of hopelessness. Dr. Cooper noted that "[w]hen images are known to be in distribution, the pre-existing dysfunction caused by the initial abuse is typically worsened, since children remain at risk for further victimization by the ongoing downloading, trading and possession of their images." With respect to Sierra specifically, Dr. Cooper stated that Sierra's medical evaluation showed she suffered from worsening insomnia, attention deficit hyperactivity disorder ("ADHD"), depression, suicidal ideation, PTSD, and mood lability. Dr. Cooper noted that, despite being on five different medications, Sierra's condition remained unstable and she recently required emergency treatment for suicidality. Dr. Cooper opined that "[t]he ongoing presence of trafficking in images [of Sierra] on the Internet constitutes a significant aspect of psychological maltreatment that will add on to the initial adversities" caused by the original abuse. Based on Sierra's past medical history, the documented adversities faced by victims of child sexual abuse and child pornography offenses, and Sierra's present medical symptoms, Dr. Cooper estimated a total cost of $661,453.00 for Sierra's future medical care. Sierra's counsel also submitted a declaration of attorney's fees, indicating Sierra had incurred nearly $5,000 in attorney's fees in connection with this case. The government supported Sierra's $10,000 restitution request. The government observed that four other defendants had been ordered to pay restitution to victims in the same series of images as Sierra. Those awards were for $4,000, $1,000, $9,000, and $2,000. Rothenberg opposed Sierra's restitution request. Rothenberg noted that he possessed only one image of Sierra and that the requested restitution amount was more than double the average of Sierra's prior awards ($4,000). Rothenberg argued that Sierra's restitution materials made no attempt at disaggregation and that the government provided no information to demonstrate the relative amount of Sierra's harm caused by his conduct. C. Jane Jane submitted a restitution request for $3,000. In support of her request, Jane submitted a victim impact statement, a psychological report, and an economic report. In her victim impact statement, Jane specifically described how the online trade in her child pornography images had affected and would continue to affect her. Jane explained: "Knowing people are watching what happened gives me a mix of anxiety, sadness, anger and it disgusts me. ... If it wasn't out there, I wouldn't be as fearful as I am now." Jane elaborated that the circulation of her images made her feel afraid and unsafe because she worried that someone who had seen her images online might recognize her and try to harm her. Jane felt that her future would not be "very bright" and would be lonely because the existence of her images online made her socially isolated. Jane's psychological evaluation was performed by Dr. Jennifer Clark in December 2014 "to determine the psychological effects of her continuous re-victimization in the form of Internet pornographic images and videos of her being exchanged and viewed." Dr. Clark opined that the online trade in Jane's images was currently impacting her, causing her great fear and anxiety and leaving her feeling unsafe and vulnerable. Dr. Clark observed that the trade in Jane's images would continue to impact her in the future by exacerbating her "deep sense of mistrust in others" from the original abuse and hindering her healing and recovery process. Dr. Clark explained: "[Jane's] awareness of the ongoing presence and distribution of [her] images will remain an ever present trigger to memories of what happened and a source of fear for her safety, and thus, ongoing psychological distress. Therefore, Jane will require therapy throughout her life. ... Given that much of Jane's distress manifests in somatic symptoms and physiological distress, she likely will also seek and need significant medical attention in the future." Jane's economic evaluation estimated that she would have future medical and therapy costs of $101,027, and lost wages of between approximately $1.9 and $3.9 million. The government agreed that Jane's $3,000 restitution request was appropriate. The government noted that seven other defendants had been ordered to pay restitution to Jane. Three of those seven defendants were ordered to pay $1,000, two were ordered to pay $2,500, one was ordered to pay $3,000, and one was ordered to pay $500. Rothenberg disputed Jane's requested amount and argued that a restitution amount of $800 would be appropriate. Rothenberg noted that he possessed four images of Jane and that the average award to Jane from the prior cases was $1,642. Rothenberg acknowledged that Jane's restitution materials were "the best of all provided to attempt disaggregation," but argued his possession did not warrant a $3,000 award when compared with other defendants. Specifically, Rothenberg noted that one of the prior cases with a $1,000 restitution order involved distribution, and three of the other cases involved receipt of Jane's images. D. Pia Pia submitted a restitution request for $5,000. In support of her request, Pia submitted an interim impact statement from Dr. Marsha Hedrick, who conducted a forensic psychological evaluation of Pia, a declaration of attorney's fees, and a victim impact statement from Pia's mother. Dr. Hedrick noted that Pia experienced anxiety, nightmares, suspiciousness, and sadness and was emotionally withdrawn. Dr. Hedrick explained that "[s]eparating the extent to which these difficulties are related to sexual abuse by her father versus her awareness that her sexual abuse is being viewed by others is not entirely possible," but it was clear internet exploitation adds a layer of complexity to the psychological damages victims of child sexual abuse face. Indeed, Dr. Hedrick noted that Pia's mother had explained to Pia there was no way to remove from the internet the images of her sexual abuse, resulting in "a level of suspiciousness and concern about exploitation that is atypical for Pia's peers" and likely caused Pia to experience feelings of powerlessness. Dr. Hedrick estimated the cost of Pia's therapy needs as $81,900, but explained that estimate reflected only the "current, most critical needs" for Pia and there was no way to know what the full extent of her losses would be over the course of her lifetime. The government concurred in Pia's $5,000 restitution request. The government did not have information on any other defendants that were ordered to pay restitution to Pia, but Pia's counsel advised one other defendant was ordered to pay restitution. Rothenberg disputed Pia's requested amount and instead proposed a restitution award of $1,100. Rothenberg contended there was "no real attempt at disaggregation" in Pia's restitution documents, but agreed some amount of restitution was appropriate based on the number of images (14) he possessed of Pia. Rothenberg reasoned that $1,100 was appropriate because the government had requested $2,000 in restitution for Jenny (discussed below), and he possessed half as many images of Pia as he had of Jenny. E. Mya Mya submitted a restitution request of $5,000. In support of her request, Mya's counsel submitted a restitution cover letter and declarations from both of her attorneys. Mya's counsel represented that they were still awaiting the results of Mya's psychological evaluation, but that other similarly situated child pornography victims they had represented had psychological treatment costs exceeding $100,000. Mya's counsel stated that Mya was aware of the existence of her images on the internet and "the knowledge that others have witnessed and even enjoyed [her] abuse is extremely upsetting to [her]." Counsel further represented that Mya was distrustful of other people and was at risk of being stalked or victimized by individuals who had seen her images online. Counsel also represented that they had expended $2,077.44 thus far in representing Mya and two other victims in the same series (one of whom was victim Pia, discussed above), and anticipated total legal costs of $30,000 for those three victims. The government did not concur in Mya's $5,000 restitution request. The government noted that there was no information on whether other defendants were ordered to pay restitution to Mya and determined that "[g]iven that [Rothenberg] possessed a single image of Mya and the future medical costs have not yet been established," a restitution award of $500 was appropriate. The government stated that amount was neither trivial nor too severe. Rothenberg argued there was no sufficient basis for awarding any restitution to Mya given the lack of information regarding her future medical costs. Rothenberg also noted that he made an offer to Mya's counsel to pay the $500 amount the government sought, but that offer was rejected. F. Sarah Sarah submitted a restitution request of $25,000. In support of her request, Sarah submitted, among other things, a cover letter, a victim impact statement, a 2014 psychological evaluation by Dr. Randall Green, and an economic report. In the cover letter, Sarah's counsel represented that her requested restitution amount of $25,000 would be "less than 1%" of her total losses and that 327 other defendants were ordered to pay restitution to Sarah. In her victim impact statement, Sarah explained that she worried that people who had seen her images online would "come after" her and try to victimize her in the same way her original abuser had. Sarah elaborated: "Every time someone else sees pictures or videos of me it feels like they are the ones who hurt me to begin with. ... It is like I am just here for other people's pleasure and am not a person myself with my own wants and needs." Sarah stated that her fear prevented her from leaving the house by herself and from engaging in other normal activities like going to school, having a job, or socializing with more than a few people. In his psychological evaluation, Dr. Green assessed "the impact and injuries caused by the discovery and daily awareness that multiple individuals are viewing images of sexual crimes being perpetrated against [Sarah] as a child." As part of his assessment, Dr. Green interviewed Sarah and also performed various psychological tests. Based on these sources of information, Dr. Green opined that "the discovery of multiple downloaders and distributors of her images effectively exponentially multiplied in [Sarah's] mind the number of sick and dangerous males 'out there' who might ... do her harm." Dr. Green explained that Sarah's knowledge of the dissemination of her child pornography images online caused her daily psychological damage in the form of fear "that has reached a paranoid-like level of intensity." Dr. Green determined that Sarah required "extensive and intensive therapy" for the trauma caused by both the original abuse and the continuing traffic in her images. Dr. Green estimated the costs of Sarah's future psychiatric care were between $265,710 and $303,150. Sarah's counsel reported that Sarah had incurred $31,433.77 in attorney's fees. The economic assessment for Sarah estimated a minimum of approximately $1.9 million in lost wages over her lifetime. The government did not concur in Sarah's $25,000 restitution request and instead requested an award of $7,895 based on its 1/n calculation method. The government also provided a list of 155 prior restitution awards to Sarah, which ranged from $0 at the low end to $51,500 at the high end. Rothenberg opposed Sarah's restitution request. Rothenberg cited three other cases involving Sarah in which the government presented the same restitution evidence and the courts found the government failed to establish proximate cause. Rothenberg argued that the government provided no evidence to disaggregate the harm proximately caused by his possession of six images of Sarah from that caused by the other defendants in the list it had provided. G. Vicky Vicky submitted a restitution request of $10,000. In support of her request, Vicky submitted several victim impact statements, several psychological reports from Dr. Green, an economic report, and a statement of attorney's fees. In her victim impact statements, Vicky described the effects of the ongoing distribution of the images of her sexual abuse as a child, including feelings of fear and paranoia, nightmares, and panic attacks. In a 2014 psychological status report, Dr. Green opined that Vicky continued to require therapy as a result of the continuing traffic in her images, as well as her discovery of attempts by some viewers of her images to invade her privacy. Dr. Green explained that Vicky continued to experience anxiety, dissociative responses, social withdrawal, anger, feelings of powerlessness, and sleep disruption. Dr. Green estimated Vicky's total therapy costs to be between $108,975 to $113,600. The economic report estimated Vicky's net lost wages over the course of her lifetime to be $828,150. Vicky's counsel represented that Vicky had incurred attorney's fees and costs of $92,371.96. The government did not concur in Vicky's $10,000 request and instead requested an award of $1,283 using its 1/n method. The government provided a list of 659 other restitution awards to Vicky, which ranged from approximately $24 at the low end to $1 million at the high end. Rothenberg opposed Vicky's restitution request for the same reasons he opposed Sarah's request, noting that other courts had denied restitution requests based on the same evidence and that the government failed to disaggregate. Rothenberg also noted that he possessed only one image of Vicky and that the average post- Paroline restitution award to Vicky was $3,632. H. Amy Amy submitted a restitution request of $25,000. In support of her request, Amy provided a victim impact statement, several psychological evaluations from Dr. Joyanna Silberg, and an economic report. In her victim impact statement, Amy stated that she "live[s] in constant fear that someone will see [her] pictures and recognize [her]." Amy expressed feelings of powerlessness related to the traffic in the images of her sexual abuse as a child because "the crime has never really stopped and will never really stop." Amy explained that she experienced fear, shame, and humiliation at the thought of her friends and other people she encounters discovering her images online. In a December 2014 report, Dr. Silberg opined that although Amy had made strides as a result of an intensive treatment plan initiated in 2012, ongoing issues related to PTSD remained. Dr. Silberg explained that Amy continued to experience flashbacks and nightmares, as well as "fear about the internet and shame associated with the ongoing viewing of her picture." Dr. Silberg concluded that Amy "continues to suffer from the ongoing effects of her victimization from child abuse and from the continued use of her image by child pornography traders, viewers, and abusers," and recommended continued psychological treatment and monitoring. Amy's economic report estimated her net lost wages as $2,855,173, and her future counseling costs as $512,681. The government did not concur in Amy's $25,000 request and instead requested a restitution amount of $15,664 using its 1/n method. The government provided a list of 215 other restitution awards to Amy, ranging from $50 at the low end to $3.5 million at the high end. Rothenberg opposed Amy's restitution request. Rothenberg noted that he possessed only one image of Amy and that the average post- Paroline restitution award to her was $3,891. Rothenberg asserted that the government's list of prior restitution orders was inaccurate as to some of the awards and argued that the government made no attempt to disaggregate his conduct from that of other defendants. I. Jenny Jenny submitted a restitution request of $42,600. In support of her request, Jenny submitted a victim impact statement and a cover letter from her counsel. In her victim impact statement, Jenny stated that she worried about the images of her sexual abuse that were "out there" and feared being recognized in public. Jenny expressed a strong desire to forget the abuse she had suffered but explained that "[w]ith the pictures still out there I can't." In their cover letter, Jenny's counsel represented that this was Jenny's seventh restitution request. Counsel stated that they were still in the process of obtaining expert reports for Jenny, but asserted that "such formal reports" were not necessary for the district court to determine restitution. Counsel discussed a proposed bill which would set a $25,000 minimum restitution award for child pornography possession offenses, and represented that Jenny had costs of $5,100 for legal and attorney's fees and $12,500 for the preparation of expert reports. Because these three items totaled $42,600, Jenny's counsel contended that $42,600 amount was the appropriate restitution amount for Jenny. The government did not concur in Jenny's $42,600 restitution request and instead requested a restitution award of $2,000. The government emphasized that Rothenberg possessed 34 images and one video of Jenny but noted the lack of documentation to support Jenny's restitution request. The government pointed out that one other defendant was ordered to pay restitution to Jenny in the amount of $7,500. Rothenberg likewise noted the lack of evidence supporting Jenny's $42,600 restitution request. Nevertheless, based on the number of images of Jenny he possessed, Rothenberg agreed that the government's requested amount of $2,000 was reasonable. J. Casseaopeia Casseaopeia submitted a restitution request of $25,000. In support of her request, Casseaopeia provided a victim impact statement, a psychological report from Dr. Joyce Vesper, and an economic assessment. In her victim impact statement, Casseaopeia described her ongoing victimization as a result of the online trade in her child pornography images. Casseaopeia stated that she worried the people viewing her images would seek her out and harm her. She explained that she suffers from anxiety, which makes it hard for her to work or go out in public, and experiences panic attacks when she thinks someone recognizes her from the internet. Casseaopeia further explained that the continuing traffic in her images made recovery from her PTSD and depression more difficult and "prevent[ed] the wound from healing." In her September 2015 psychological report, Dr. Vesper described her clinical interview with Casseaopeia and the psychological tests she administered. From these assessments, Dr. Vesper concluded that Casseaopeia was "tortured by constant memories of childhood sexual abuse" and experienced "constant head chatter, graphic flashbacks, [and] panic attacks that are so overwhelming they feel like heart attacks." Dr. Vesper described Casseaopeia as living "in constant fear that the people viewing the pornographic films and pictures of her" online would capture her and subject her to the same abuse all over again. Dr. Vesper opined that "[w]ithout the appropriate psychotherapy to address [her] dissociation, depersonalization, derealization, amnesia, anxiety and depression," Casseaopeia would continue to experience flashbacks, nightmares, and depression. Dr. Vesper recommended intensive psychotherapy for Casseaopeia. In a supplemental report, Dr. Vesper specifically addressed the effects on Casseaopeia of the ongoing traffic in her images. Dr. Vesper explained that Casseaopeia experienced persistent anxiety that people she knows will see on the internet images of her sexual abuse as a child and that this anxiety affects her recovery process. The economic assessment estimated Casseaopeia had economic damages totaling $1,078,159, including $748,438 in lost earning capacity and $329,721 in future medical expenses. The government requested a slightly lower restitution award of $21,563 for Casseaopeia, which was calculated using the 1/n method. The government noted that 49 other defendants were ordered to pay restitution to Casseaopeia and submitted a list of those prior awards. Those prior awards ranged from $0 at the low end to $50,000 at the high end. Rothenberg opposed Casseaopeia's restitution request. Rothenberg noted that he possessed only two images of Casseaopeia and that the average restitution award to her was $3,974. Rothenberg argued that, like many of the other requests, the government did not differentiate between the harm he caused and that caused by other perpetrators. Rothenberg contended that Dr. Vesper's report primarily dealt with effects of the original abuse rather than the traffic in Casseaopeia's images. K. Restitution Hearing On November 18, 2016, the district court held a restitution hearing. At the restitution hearing, the government submitted the evidence on which its restitution requests were based, all of which was admitted into evidence. That evidence consisted of 891 pages of exhibits submitted by the victims and charts prepared by the government listing each victim's prior restitution awards in other federal cases. The exhibits included the declarations, psychological evaluations, letters, and other evidence referenced in the government's restitution requests. Rothenberg noted, at the outset of the hearing, that he agreed with the government's requested award of $2,000 to Jenny and therefore did not offer any argument as to that award. The remaining requests were disputed, and the parties essentially reiterated the arguments raised in their prior memoranda as to those victims. III. COURT'S RESTITUTION ORDER Six months later, on May 9, 2017, the district court issued its restitution order. After outlining in detail Paroline's framework (and expressing some frustration with its inexactitude), the district court analyzed each victim's restitution request. As a preliminary matter, the district court stated that, with respect to each victim, it had assigned restitution in a manner that comported with Rothenberg's relative role and only for damages he proximately caused. The district court explicitly explained that it had not "attempted to hold [Rothenberg] responsible for all losses sustained by any victim." Furthermore, the district court expressly noted there was no evidence that Rothenberg was connected to the initial abuse of any of the victims or that he had reproduced or distributed their images. Instead, Rothenberg was a possessor only. And the district court specifically stated that it had "taken these factors into consideration in assigning [Rothenberg] a relative role as the proximate cause of these victims' losses." Turning to the specific awards, the district court determined that Sierra's $10,000 request was reasonable. The district court found that: (1) Rothenberg possessed one image of Sierra; (2) a small number of criminal defendants had paid restitution to Sierra; (3) Sierra's current mental health condition was severe; and (4) Sierra's projected costs of care exceeded $600,000. The district court found "in consideration of her large amount of total costs, the small number of contributing offenders, and a request for a proportion of these costs proximately caused and to be paid by [Rothenberg], who neither created nor distributed her image, that $10,000 is a reasonable request under the Paroline analysis and factors." Next, the district court determined that Jane's $3,000 request was reasonable. The district court found that: (1) Rothenberg possessed four images of Jane; (2) a small number of criminal defendants had paid restitution to Jane; (3) Jane's victim impact statement specifically addressed how the existence of her images on the internet affected her and isolated the harm caused by possessors and distributors from that caused by the original abuse; and (4) Jane's estimated medical and therapy costs were $101,027. The district court found "in consideration of her medical costs, the small number of contributing offenders, and a request for a proportion of these costs to be paid by [Rothenberg], who neither created nor distributed her images, that $3,000 is a reasonable request under the Paroline analysis and factors." The district court then determined that Pia's $5,000 request was reasonable. The district court found that: (1) Rothenberg possessed 14 images of Pia; (2) there was no evidence regarding the number of other criminal defendants ordered to pay restitution to Pia, though Pia's counsel indicated that one other defendant was so ordered; and (3) Pia's estimated therapy costs over the next 20 years totaled $81,900. The district court found "in consideration of her total costs, the fact that she has only received restitution from one other defendant, the large number of images possessed by [Rothenberg] of [Pia], and a request for a proportion of these costs to be paid by [Rothenberg], who neither created nor distributed her images, that $5,000 is a reasonable request under the Paroline analysis and factors." The district court also determined that Mya's $5,000 request was reasonable, despite the government's requested amount of only $500. The district court found that: (1) Rothenberg possessed one image of Mya; (2) there was no indication as to whether any other criminal defendants were ordered to pay restitution to Mya; and (3) Mya's counsel indicated a reasonable treatment estimate for Mya would be more than $100,000. The district court found "in consideration of her total costs, the fact that she has not received any restitution at this time, and a request for a proportion of these costs to be paid by [Rothenberg], who neither created nor distributed her images, that $5,000 is a reasonable request under the Paroline analysis and factors." As to Sarah, the district court determined that an award of $20,000-$5,000 less than Sarah's requested amount-was reasonable. The district court explained that: (1) Rothenberg possessed six images of Sarah; (2) over 150 criminal defendants were ordered to pay restitution to Sarah; (3) Sarah's victim impact statement explicitly addressed how the existence of her images on the internet affected her, thereby isolating the harm caused by possession of her images from that caused by the original abuse; and (4) Sarah's estimated cost of psychiatric care was nearly $300,000. The district court found, "in consideration of the amount of costs, the fact that many other offenders have been required to pay restitution to [Sarah]-which in the case of Sarah, the Court finds contributes to a finding that the request is reasonable and acknowledged by many other courts-the large number of images possessed of [Sarah], and a request for a proportion of these costs proximately caused and to be paid by [Rothenberg], who neither created nor distributed her image[s], that $20,000 is an appropriate amount under the Paroline analysis and factors." In a similar vein, the district court determined that for Vicky, $9,000-$1,000 less than Vicky's requested $10,000 amount-was a reasonable award. The district court found that: (1) Rothenberg possessed one image of Vicky; (2) more than 600, and possibly more than 800, other criminal defendants were ordered to pay restitution to Vicky; (3) Vicky's victim impact statement specifically addressed how the online traffic in her images affected her and explained the distinct harm caused by possessors and distributors of her images; and (4) Vicky's predicted therapy costs exceeded $100,000. The district court found "in consideration of the amount of costs, the fact that many other offenders have been required to pay restitution to [Vicky]-which in the case of Vicky, the Court finds contributes to a finding that the request is reasonable and acknowledged by many other courts-and a request for a proportion of these costs proximately caused and to be paid by [Rothenberg], who neither created nor distributed her image, that $9,000 is an appropriate amount under the Paroline analysis and factors." The district court likewise awarded a reduced amount to Amy. The district court noted that Amy requested $25,000 and that the government requested $15,664, but the district court ultimately determined that $23,000 was reasonable. The district court explained that: (1) Rothenberg possessed one image of Amy; (2) more than 200 criminal defendants had paid restitution to Amy; (3) Amy's victim impact statement "provide[d] strong support for the different and separate harm that possessors proximately cause to victims such as [herself]"; and (4) Amy's counseling and therapy costs could exceed $500,000. The district court found "in consideration of the large amount of costs, the fact that other offenders have been required to pay restitution to [Amy]-which, again, in the case of Amy, the Court finds contributes to a finding that the request is reasonable and acknowledged by other courts-and a request for a proportion of these costs proximately caused and to be paid by [Rothenberg], who neither created nor distributed her image, that $23,000 is an appropriate amount under the Paroline analysis and factors." Regarding Jenny, the district court acknowledged that both the government and Rothenberg agreed that $2,000 was an appropriate amount, but that Jenny requested $42,600. The district court determined that Jenny's requested amount was reasonable. The district court emphasized that (1) Rothenberg possessed 34 images and one video of Jenny, and (2) only one other defendant had paid restitution to Jenny. The district court conceded there was "less documentation of Jenny's psychological and medical expenses as compared with some other victims in this case," but found that the $2,000 amount requested by the parties was insufficient. Considering "the extremely large number of images [Rothenberg] possessed of [Jenny], her costs, the fact that only one other defendant has so far contributed to these costs, and a request for a proportion of these costs to be paid by [Rothenberg], who neither created nor distributed her images, the Court finds that $42,600 is a reasonable request under the Paroline analysis and factors." Lastly, as to Casseaopeia, the district court determined that her requested award of $25,000 was reasonable, even though the government requested only $21,563. The district court found that: (1) Rothenberg possessed two images of Casseaopeia; (2) more than 50 criminal defendants were ordered to pay her restitution; and (3) her projected costs of care exceeded $300,000. Considering "her costs, the number of contributing offenders, and a request for a proportion of these costs proximately caused and to be paid by [Rothenberg], who neither created nor distributed her image," the district court found that "$25,000 is a reasonable request under the Paroline analysis and factors." In total, the district court ordered Rothenberg to pay $142,600 in restitution, to be apportioned to the nine victims in the amounts set out above. On appeal, Rothenberg argues that the district court erred as to all nine restitution awards. We begin with the restitution statute and then review the Supreme Court's Paroline decision, which both parties agree governs this appeal. IV. 18 U.S.C. § 2259 Congress has mandated that district courts award restitution to victims of certain federal crimes, including child pornography possession. See 18 U.S.C. § 2259(a) (2012). The possessor of child pornography must pay restitution to the victim whose childhood abuse appears in the pornographic materials he possessed. See id. § 2259(b)(1), (c)(4). The statute requires that "[t]he order of restitution ... shall direct the defendant to pay the victim ... the full amount of the victim's losses as determined by the court." Id. § 2259(b)(1). The statute defines the term "full amount of the victim's losses" to include any costs incurred by the victim for: (A) medical services relating to physical, psychiatric, or psychological care; (B) physical and occupational therapy or rehabilitation; (C) necessary transportation, temporary housing, and child care expenses; (D) lost income; (E) attorneys' fees, as well as other costs incurred; and (F) any other losses suffered by the victim as a proximate result of the offense. Id. § 2259(b)(3) (emphasis added). The statute defines a victim as "the individual harmed as a result of the commission of a crime under this chapter." Id. § 2255(c)(4) (emphasis added). A court may not decline to issue restitution because of the economic circumstances of the defendant or because the victim has received compensation from another source. See id. § 2259(b)(4)(B). "The burden of demonstrating the amount of the loss sustained by a victim as a result of the offense shall be on the attorney for the Government." Id. §§ 3664(e), 2259(b)(2) (emphasis added). In Paroline, the Supreme Court addressed the meaning of "as a result of" and "proximate result" in § 2259 and precisely what type of causal connection or proximate cause must exist between the victim's losses and the defendant's offense. We review Paroline next. V. SUPREME COURT'S PAROLINE DECISION Like this case, Paroline involved a possessor of child pornography images in wide circulation on the internet. In Paroline, the defendant was a possessor and not a distributor or the initial abuser. See 572 U.S. at 439, 134 S. Ct. at 1716. The Supreme Court grappled with the question of what causal relationship must be established between a defendant possessor's conduct and a victim's losses for purposes of determining the right to, and the amount of, restitution under § 2259. Id. As a preliminary matter, the Supreme Court interpreted § 2259 's statutory language to impose a general proximate-cause limitation. Id. at 448, 134 S. Ct. at 1721. The Supreme Court determined that "[r]estitution is therefore proper under § 2259 only to the extent the defendant's offense proximately caused a victim's losses." Id. at 448, 134 S. Ct. at 1722. The difficulty, the Supreme Court explained, comes in applying that causation requirement in a particular child pornography case. Id. at 449, 134 S. Ct. at 1722. This is so because of the "somewhat atypical causal process underlying the losses [a child pornography] victim claims." Id. The Supreme Court reasoned that it may be "simple enough" for a victim to prove the aggregate losses that stem from the ongoing traffic in her images as a whole. Id. Importantly, the Supreme Court observed that it is more difficult to determine "the 'full amount' of those general losses, if any, that are the proximate result of the offense conduct of a particular defendant who is one of thousands who have possessed and will in the future possess the victim's images but who has no other connection to the victim." Id. Therefore, in child pornography possession offenses, the Paroline Court recognized that it would be virtually impossible to show that the defendant possessor was a but-for cause of any particular portion of the victim's losses "where the defendant is an anonymous possessor of images in wide circulation on the Internet." Id. at 450-51, 134 S. Ct. at 1722-23. Nevertheless, the Supreme Court observed that "[w]hile it is not possible to identify a discrete, readily definable incremental loss [a defendant possessor] caused, it is indisputable that [the defendant possessor] was a part of the overall phenomenon that caused [the victim's] general losses." Id. at 456-57, 134 S. Ct. at 1726. And it would undermine the purposes of § 2259 to deny restitution in cases involving possessors of child pornography. Id. at 456-58, 134 S. Ct. at 1726-27. The Supreme Court also recognized that the original abuse crime is compounded by the distribution and possession of images of the victim's original abuser's "horrific acts, which meant the wrongs inflicted on her were in effect repeated; for she knew her humiliation and hurt were and would be renewed into the future as an ever-increasing number of wrongdoers witnessed the crimes committed against her." Id. at 441, 134 S. Ct. at 1717. It does not matter that the victim does not know the name of the possessor because the losses do not flow from any specific knowledge of him; rather, the cause of the victim's losses "is the trade in her images." Id. at 456, 134 S. Ct at 1726. The Supreme Court also observed that "the victim suffers continuing and grievous harm as a result of her knowledge that a large, indeterminate number of individuals have viewed and will in the future view images of the sexual abuse she endured." Id. at 457, 134 S. Ct. at 1726. "In a sense, every viewing of child pornography is a repetition of the victim's abuse." Id. at 457, 134 S. Ct. at 1727. "The cause of the victim's general losses is the trade in her images." Id. at 456, 134 S. Ct. at 1726. After rejecting a but-for test for proximate cause, the Paroline Court adopted a causation-in-fact standard for cases where: (1) "a defendant possessed a victim's images"; (2) "a victim has outstanding losses caused by the continuing traffic in those images"; and yet (3) "it is impossible to trace a particular amount of those losses to the individual defendant by recourse to a more traditional causal inquiry." Id. at 458, 134 S. Ct. at 1727. In that situation, the Supreme Court concluded that a defendant possessor of child pornography should be ordered to pay restitution "in an amount that comports with the defendant's relative role in the causal process that underlies the victim's general losses." Id. The Supreme Court explained that the award "would not be severe" in a case where the possessor is only one of many thousands of offenders, but also would not be "a token or nominal amount." Id. at 458-59, 134 S. Ct. at 1727. Rather, the required restitution would be "reasonable and circumscribed" and "suited to the relative size of [the defendant's] causal role." Id. at 459, 134 S. Ct. at 1727. Further, the Supreme Court instructed, there is no "practical way to isolate some subset of the victim's general losses that [the possessor] Paroline 's conduct alone would have been sufficient to cause." Id. at 451, 134 S. Ct. at 1723. In Paroline, the defendant possessor was one of thousands who possessed the victim's images. Id. at 450, 134 S. Ct. at 1723. The Supreme Court stressed that even though the victim does not know the possessor, the victim's "knowledge that her images were circulated far and wide renewed the victim's trauma and made it difficult for her to recover from her abuse." Id. at 440, 134 S. Ct. at 1717. "While it is not possible to identify a discrete, readily definable incremental loss he [the possessor] caused, it is indisputable that he was a part of the overall phenomenon that caused her general losses." Id. at 456-57, 134 S. Ct. at 1726. In other words, the defendant possessor of the images caused in fact part of the general losses, even if "it is impossible to trace a particular amount of those losses to the individual defendant." Id. at 458, 134 S. Ct. at 1727. The Paroline Court then turned to the question of how district courts are to determine the proper amount of restitution in these "possessor" cases. Id. As a general matter, the Supreme Court stated that a district court "must assess as best it can from available evidence the significance of the individual defendant's conduct in light of the broader causal process that produced the victim's losses." Id. at 459, 134 S. Ct. at 1727-28. The Supreme Court emphasized that this "cannot be a precise mathematical inquiry," but rather involves the exercise of "wide discretion" and "sound judgment" of the sort district courts typically exercise in the context of criminal sentencing and restitution more broadly. Id. at 459-62, 134 S. Ct. at 1728-29. The Supreme Court then expressly identified "a variety of factors district courts might consider" in determining a proper restitution amount for possession. Id. at 459-60, 134 S. Ct. at 1728 (emphasis added). As a starting point, the Supreme Court suggested that district courts "determine the amount of the victim's losses caused by the continuing traffic in the victim's images." Id. at 460, 134 S. Ct. at 1728 (emphasis added). Then, to determine the defendant possessor's relative role in causing those general losses, the district court could consider factors such as: (1) "the number of past criminal defendants found to have contributed to the victim's general losses"; (2) "reasonable predictions of the number of future offenders likely to be caught and convicted for crimes contributing to the victim's general losses"; (3) "any available and reasonably reliable estimate of the broader number of offenders involved (most of whom will, of course, never be caught or convicted)"; (4) "whether the defendant reproduced or distributed images of the victim"; (5) "whether the defendant had any connection to the initial production of the images"; (6) "how many images of the victim the defendant possessed"; and (7) "other facts relevant to the defendant's relative causal role." Id. The Supreme Court reiterated that these factors should not be used as a "rigid formula," but should instead serve as "rough guideposts" in determining a restitution amount for the possessor criminal defendant. Id. The Supreme Court noted that "[t]his approach is not without its difficulties," as it "involves discretion and estimation," but "courts can only do their best to apply the statute as written in a workable manner." Id. at 462, 134 S. Ct. at 1729. The Supreme Court emphasized that district courts regularly exercise wide discretion, and there was "no reason to believe they cannot apply th[is] causal standard ... in a reasonable manner." Id. VI. STANDARD OF REVIEW We review de novo the legality of a restitution order, but review for clear error the factual findings underlying that order. United States v. McDaniel, 631 F.3d 1204, 1207 (11th Cir. 2011) ; see also United States v. Osman, 853 F.3d 1184, 1188 (11th Cir. 2017). We review the amount of the district court's restitution award only for an abuse of discretion. See United States v. Robertson, 493 F.3d 1322, 1330 (11th Cir. 2007) ; see also Paroline, 572 U.S. at 459, 134 S. Ct at 1727-28 (emphasizing that "determining the proper amount of restitution" involves "the use of discretion and sound judgment" on the part of the district court). A district court abuses its discretion if it applies an incorrect legal standard, follows improper procedures, or makes clearly erroneous findings of fact. United States v. Jordan, 582 F.3d 1239, 1249 (11th Cir. 2009). The abuse of discretion standard recognizes that the district court has a range of choices, and this Court will not reverse the district court's choice as long as its decision does not amount to a clear error of judgment. Id. Osman, our only published post- Paroline restitution decision to date, did not address how the abuse of discretion standard applies in assessing whether the district court adequately considered the Paroline factors and imposed a reasonable restitution award. See generally Osman, 853 F.3d at 1189-92. But Paroline itself provides some important clues. In Paroline, the Supreme Court emphasized that determining the proper restitution amount "involves the use of discretion and sound judgment" in a manner akin to that exercised "in the wider context of criminal sentencing," and that the ultimate award must be "reasonable and circumscribed." Paroline, 572 U.S. at 459, 134 S. Ct. at 1727-28 ; see also id. at 462, 134 S. Ct. at 1729 (explaining that "[d]istrict courts routinely exercise wide discretion ... in sentencing as a general matter" and should likewise apply Paroline's causal standard "in a reasonable manner"). And to guide the district court's exercise of its discretion, the Paroline Court identified a number of factors district courts may consider in fashioning an appropriate restitution award. Id. at 459-60, 134 S. Ct. at 1728. Paroline thus established a framework not unlike the one we apply in assessing the reasonableness of a defendant's sentence, in which we look to see whether the district court appropriately exercised its sentencing discretion in light of the 18 U.S.C. § 3553(a) factors. See, e.g., Gall v. United States, 552 U.S. 38, 51, 128 S. Ct. 586, 597, 169 L.Ed.2d 445 (2007) ; United States v. Irey, 612 F.3d 1160, 1188-91 (11th Cir. 2010) (en banc). In that § 3553(a) context, we evaluate whether the district court failed to consider relevant factors, improperly weighed the relevant factors, or considered improper factors, and ultimately assess whether, under the totality of the circumstances, the sentence is reasonable. See Irey, 612 F.3d at 1189. And we will vacate a sentence imposed by the district court only if we are "left with the definite and firm conviction that the district court committed a clear error of judgment in weighing the § 3553(a) factors by arriving at a sentence that lies outside the range of reasonable sentences dictated by the facts of the case." Id. at 1190 (internal quotation marks omitted). Additionally, in sentencing cases, we do not require district courts to make detailed findings or give a thorough explanation for the sentence it chose. See id. at 1194-95. Specifically, "[t]he district court need not state on the record that it has explicitly considered each factor and need not discuss each factor," United States v. Dorman, 488 F.3d 936, 938 (11th Cir. 2007), "so long as the record reflects the court's consideration of many of those factors," United States v. Carpenter, 803 F.3d 1224, 1232 (11th Cir. 2015). "Rather, an acknowledgment by the district court that it has considered the defendant's arguments and the § 3553(a) factors will suffice." Dorman, 488 F.3d at 938. A similar approach makes sense here. As in the sentencing context, in evaluating child pornography restitution awards under Paroline, appellate courts must determine whether the district court appropriately exercised its broad discretion in light of the facts of the particular case and awarded restitution in an amount that comports with the particular defendant's conduct. See Paroline, 572 U.S. at 458-59, 462, 134 S. Ct. at 1727-29 ; Irey, 612 F.3d at 1190. And as in the sentencing context, a number of relevant factors guide the district court's exercise of its discretion. See Paroline, 572 U.S. at 459-60, 134 S. Ct. at 1728 ; Gall, 552 U.S. at 51, 128 S. Ct. at 597. Furthermore, the Supreme Court in Paroline indicated that the exercise of discretion at issue in child pornography restitution cases is similar to that exercised in criminal sentencing more generally. See Paroline, 572 U.S. at 459, 134 S. Ct. at 1727-28. Accordingly, in reviewing child pornography restitution awards under Paroline, this Court should consider whether, in light of the Paroline factors, the district court arrived at a restitution amount that lies within the general range of reasonable restitution awards dictated by the facts of the case. See Irey, 612 F.3d at 1190. In doing so, this Court should give due deference to the district court's determination that the Paroline factors, on the whole, justify the restitution amount awarded and should not vacate an award unless left with the definite and firm conviction that the district court committed a clear error of judgment in setting the award amount. See id.; Gall, 552 U.S. at 51, 128 S. Ct. at 597. Moreover, so long as the district court acknowledges that it has considered the Paroline factors and the defendant's arguments regarding restitution, we will not vacate a restitution award solely on the basis that the district court did not address each factor explicitly. See Carpenter, 803 F.3d at 1232 ; Dorman, 488 F.3d at 938. With these principles in mind, we turn now to Rothenberg's disaggregation argument, which is a legal challenge to the district court's restitution order that we review de novo. Osman, 853 F.3d at 1188. VII. DISAGGREGATION On appeal, Rothenberg first argues that, as to all nine victims, the district court failed to "disaggregate" their losses. Rothenberg contends that Paroline requires district courts to engage in disaggregation at two levels: first, by disaggregating the portion of the victim's losses caused by the original abuse; and second, by disaggregating the losses caused by the defendant from those caused by other possessors or distributors. Rothenberg asserts that the district court here failed at the first level by relying on total loss estimates for each victim that did not separate out and deduct the losses caused by the original abuser. Because the expert reports did not disaggregate the losses caused by the original abuser from those caused by the distributors or possessors, Rothenberg contends that the district court was required to conduct that separating out itself. Rothenberg maintains that the district court also failed to disaggregate at the second level by failing to use the amounts of the prior restitution orders against other defendant possessors or distributors for the same victims as a guidepost for determining his relative level of culpability. The government responds that nothing in Paroline requires district courts to engage in the sort of formal disaggregation Rothenberg envisions. Rather, the government contends that Paroline simply requires that the district court consider the Paroline factors and exercise its discretion in determining the amount of a victim's losses caused by the instant defendant. The government submits that the district court here complied with those requirements, explicitly stating it was not holding Rothenberg accountable for the original abuse or distribution of the victims' images and setting restitution amounts that "best approximat[ed] Rothenberg's relative role." This Court has not yet addressed whether, in awarding restitution post- Paroline, district courts first must formally disaggregate a victim's losses between the original abuser, distributors, and subsequent possessors. Several of our sister circuits, however, have grappled with that question, and the results are mixed. A. Eighth and Fifth Circuits' Decisions We start with the Eighth Circuit's decision in United States v. Bordman, 895 F.3d 1048, 1058-59 (8th Cir. 2018), cert. denied, 2019 WL 1886056, --- U.S. ----, 139 S.Ct. 1618, --- L.Ed.2d ---- (U.S. Apr. 29, 2019), a restitution case involving a defendant convicted of only possessing child pornography. In Bordman, the Eighth Circuit expressly held that a district court is not required to formally disaggregate categories of loss before ordering restitution, such as the loss caused by the initial abuser. Id. at 1058-59. In doing so, the Eighth Circuit affirmed the district court's $3,000 award of restitution to a victim where the district court considered multiple factors, including: (1) the 1/n method, which took into account the number of defendants (32) who had already paid the victim restitution plus 1 (the defendant Bordman), for a total of 33; (2) the child pornography being videos with two copies of the same video in different folders; and (3) the "very aggravating factor" of the nature of the video. Id. at 1052-53, 1059. The victim's losses included $91,900 in therapy, related expenses, and for a vocational assessment and counseling, legal costs of 10,187.13, and attorney's fees. Id. at 1052. At the sentencing hearing, the government took the sum of $95,295.71 ($91,900 plus one third of the attorney's fees) and divided it by 33 defendants, resulting in the sum of $2,887.75. Id. at 1052-53. One-third of the attorney's fees was used because this same attorney had represented three victims. Id. at 1052. The district court imposed a $3,000 restitution amount for the victim. Id. at 1054. On appeal, the defendant-possessor Bordman specifically claimed that "the district court abused its discretion by failing to disaggregate the harm caused by the initial abuse from the harm that his later possession caused." Id. at 1058. In rejecting that claim, the Eighth Circuit reasoned that "one of the Paroline factors already accounts for disaggregation"-namely, "whether the defendant had