"I lived on the 12th floor and would never use the elevator," she says. "I swam a lot, I ran a lot, I just did everything a lot, to extremes."

The summer after seventh grade, living abroad, Elizabeth began to drop weight. "I just didn't eat. I numbed out to the world," she says. "It was a very disturbing time of upheaval because I had just moved and moved again."

At 5'4', she reached a weight of 88 pounds and stopped weighing herself.

"At that point the weight didn't even matter, I just had to keep on losing it," she says. "I blocked out a lot of it, but [I remember] that whenever I hit something with my hip bones I'd get a bruise. I could count my ribs."

A typical daily menu would include a breakfast consisting of one half a pear, a half glass of milk and half a piece of bread. Lunch would consist of the other halves of each of these items, and dinner would be a small portion of the family's meal.

No matter how much she lost, it never seemed to satisfy her. Elizabeth recalls. "I went to bed at night and count the calories I'd eaten that day. I remember thinking one night that I'd reached my goal, and feeling totally bottomless misery."

En route to back to the United States before eighth grade, Elizabeth's mother read an article in Seventeen magazine about anorexia and recognized her daughter's symptoms.

"My parents sat me down in the hotel and said 'If you don't start eating again you're going to die,"' Elizabeth recalls. "It was beneficial in that they realized what was going on and it had a name. That's a very scary thing to hear. I had just thought I'm going to get skinnier and skinnier and happier and happier."

Recovery entails a lot more than just gaining the weight back, she says.

"It's not about the food. The food is a symptom of everything else," she says. "Food is always going to be a part of everybody's life. Built into recovery is learning how to eat normally without attaching undue significance to the food."

Now a counselor at ECHO, Elizabeth says that counseling has helped her as well as the callers with whom she speaks.

"It has helped me reflect a lot," she says. "I feel I have a solid foundation of knowledge of eating disorders from a clinical and theoretical standpoint. It's also about being around a group of people who are very receptive to your various foibles."

Control

For one junior, now an ECHO counselor, anorexia began around age 15, when she started dieting along with some of her close friends. Reflecting on her experience, she says her desire to achieve played a large role in developing her disorder.

"When you're in high school there's a pressure to perform, to be good at everything you do," Jane says. "You need control of your life, you need to feel you're living up to what everyone expects from you."