When Aurora* ’14 woke up on the floor of the dance locker room, she thought she must have died. Her first instinct was to reach for her thighs.

“Nope,” she thought, “these are still here.” If she had died, she thought, at least she would be skinny.

She had fainted and been unconscious for all of eighth period and had missed her bus. All she had eaten that day was low-calorie Greek yogurt, eight almonds and salad. Although she had fainted before, this was the first time she had blacked out since she had developed anorexia nervosa and bulimia nervosa the year before.

According to a UCLA Eating Disorder Awareness Newsletter published in February, anorexia nervosa consists of three elements: intense fear of gaining weight, restrained eating that negatively impacts a person’s health and a skewed view of a person’s own weight and body image. Bulimia nervosa is an eating disorder in which a person consumes huge amounts of calories and then purges them to prevent weight gain. All of these tendencies fall under one larger umbrella term, school psychologist Kavita Ajmere said. If someone is under-eating, overeating, binging or binging and purging, it is considered an eating disorder.

Fiona* ’15 was under-eating. When her anorexia reached its peak in ninth grade, her typical daily diet consisted of two egg whites for breakfast, one piece of fruit for lunch and grilled chicken for dinner.

While sitting in class freshman year, Fiona twirled her hair with her fingers and a substantial chunk of hair fell out. Although unsure if anyone noticed, she was still embarrassed.

“When you realize [anorexia] has an effect besides the weight loss — when your nails are chipping away and your hair is falling out — that’s the hard part,” Fiona said.

Hair falling out is not an uncommon consequence of an eating disorder, school psychologist Luba Bek said. Other side effects include hair growth all over the body, brittle nails and the loss of menstruation, she said.

Throughout her battle with eating disorders, Aurora experienced all of these, as well as bad breath, dry skin and feeling cold.

These consequences came after Aurora took severe measures due to the negative way she’s viewed her body since third grade. Worrying about weight at this age is not uncommon. According to the UCLA newsletter, 81 percent of 10-year-old girls are afraid of being fat.

In eighth grade, her hatred for her body increased when 54 people called her “fat,” “ugly” and “horrible” on the now-defunct Facebook application “Bathroom Wall.”

“I was so unbelievably hurt,” Aurora said. “It was just so embarrassing.”

The negative thoughts Aurora had about her body were already present, but it was not until preparation for her 15th birthday pool party that she finally acted on them. Leading up to the party, Aurora exercised daily and ate a maximum of 250 calories a day. Two days after her party, while studying for a biology test, she read that eating excess protein could lead to fat storage.

When she came down to breakfast the next day, she refused to consume any form of protein.

Her mother decided to take her to a doctor, and Aurora ended up entering UCLA in-patient treatment. Aurora fought to be transferred into outpatient care.

After transferring to outpatient care, Aurora continued to protest, so her treatment consisted mostly of “The Maudsley Approach,” an intense outpatient treatment in which family members play a dominant role. Her parents monitored all of her meals and stayed with her an hour after eating to make sure she did not throw up.

“It was invasive, frustrating and potentially destructive to the family dynamic,” Aurora said. “It’s good for parents who want a hand in the recovery process.”

Despite her parents’ efforts, she continued to lose significant amounts of weight. By the end of freshman year, her yearbook was filled with comments that pointed out her weight loss and how much better she looked because of it.

“Little did they know I couldn’t participate in the dance show because my heart rate was too low, and [doctors] were scared I would have a heart attack,” Aurora said.

Her dance teacher was unaware of her situation until a phone call from Aurora’s dad. If her teacher had noticed any suspicious behavior and reported it to a school psychologist, she could have prevented her from participating in activities until the school received a doctor’s evaluation, Bek said. Bek said coach or teacher overseeing an athletic activity can do this in severe situations.

In her 14 years of coaching at the school, varsity girls’ basketball coach Melissa Hearlihy (Josh ’12) has never had an athlete have to quit basketball due to an eating disorder. In one case, however, one of her players once took a week off to “regroup,” she said. Throughout her time coaching at the school, she has known of four girls with eating disorders on her team.

“I report it to the authorities,” Hearlihy said. “I usually start with the school psychologists and the trainers.”

Fiona, an athlete, found the trainers to be the most helpful resource on campus. One day, when she had a horrible headache she assumed was due to lack of sleep, Fiona sought relief in the trainers’ office in Taper Gymnasium. The trainer began asking Fiona questions about her recent diet. The trainer told Fiona she had been consuming an unacceptably low amount of calories for her body weight.

Until this conversation, Fiona was in complete denial about how little food she was eating.

“When you have an actual sports medicine person explain to you how many calories your body burns, it takes away some of the fear of eating more,” Fiona said.

During training season, Hearlihy recommends that her athletes eat approximately 2500 to 3000 calories a day. She noted that this can vary depending on an individual’s metabolism.

“I think that more than counting calories, what’s important is the type of food they’re eating,” Hearlihy said.

She is primarily concerned with protein consumption. Hearlihy directs her athletes to consume calories 30 minutes after exercising. Food like chocolate milk is good after a work out, she said, because it has protein that a body can easily absorb.

Aurora continued dance at the Upper School, but she did not interact closely enough with teachers and trainers who could have directed her towards healthier calorie consumption.

Aurora arrived at the Upper School 50 pounds lighter than she had left the Middle School. In 10th grade, her struggle to maintain a healthy body weight only worsened.

“It was kind of me against a body image-obsessed school,” Aurora said. “The only part that made me decide not to switch schools was Peer Support.”

After feeling abandoned by her friends, and spending most of her time with her family and doctors, Aurora found in Peer Support a place where she could reconnect with people her own age.

“These people just saw me as a person, not as the girl with the eating disorder,” Aurora said.

Unlike Aurora, Fiona did not find a haven in Peer Support. Fiona worried that her group members would pity her, so she left after two weeks. Peer Support interfered with her homework too much, and she considered it unhelpful.

“They might start to think of me as Fiona that anorexic girl, which I don’t want,” she said.

Neither girl found the school psychologists to be a helpful outlet. At both the Middle School and the Upper School, Aurora was sent against her will to the school psychologists. She does blame herself for not trying to meet with them more, but she thought that the few times she did meet with them were disappointing.

“It just seemed very formulaic,” Aurora said. “They were looking for red flags, they were looking for trigger warnings, but they weren’t really asking me about how I was doing.”

Aurora called the psychologists’ style “matter-of-fact.” She found the approach to be unsuccessful for her, but recognized it may be helpful to others.

Fiona has never had the desire to visit the school psychologists.

“I’m the kind of person who likes to work out my issues,” she said.

She does, however, have a therapist outside of school whom she greatly trusts. Fiona’s entire family sees the same therapist, so she feels more comfortable having that connection.

“A search for a counselor, a search for someone you trust, is a process,” Bek said. “It’s like dating.”

Bek believes it is important for a person to discover someone he or she feels comfortable talking to, even if they are not yet ready to admit they have a problem. This is one reason why she is happy to see several counselors on campus. She also views this as a necessary asset of the school because of a conflict called dual relationships, when a student recognizes an adult on campus as both an academic teacher and a therapist.

“This is not a relationship that should exist,” Bek said.

It is more awkward for the student than the teacher, she said. She always refers her students to other counselors on campus unless they are completely adamant about seeing her.

In the past year, Aurora has talked to her out-of-school psychiatrist about instances with her teachers that have contributed to her distorted perception of her body.

Recently in her history class, Aurora’s teacher presented students with a photograph of a fertility goddess. Aurora described the sculpture as having specially carved cellulite on its thighs. Her teacher, repulsed by the image, said he was unsure of who would find the image beautiful.

“I knew it,” Aurora said. “My dad was lying to me the whole time, the doctors were lying to me the whole time. No one finds fat to be beautiful.”

While in her dean’s office a couple of months ago, Aurora’s curiosity took over. As her dean was pulling up her junior year comments, Aurora glimpsed at one. Her teacher mentioned that she had gained weight and how this can often put stress on a teenager. Aurora could not believe that a teacher would so directly remark on her weight gain.

“It was mortifying,” Aurora said.

But her teachers are not the only ones who have continued to remark on her body at the Upper School. Like in Middle School, so have her peers. Aurora worried that she would be barred from the first party of her senior year because the invitation stated that no ”ugly” people would be let in.

Much to her relief, Aurora was granted admission. This boosted her confidence, and she began to relax about her appearance.

As she circulated the party with a friend, she heard a boy call out, “Hey you.” Aurora turned around and recognized the boy as a classmate she described as “popular, attractive and confident.” They soon  made eye contact.

“No, not you, fatass,” he said.

These comments weren’t new. Two years before, when she shed 15 pounds from her already underweight frame over winter break, Aurora arrived back at school only to be greeted by a boy in her chemistry class telling her how much more attractive she now looked. Comments from boys such as these, Aurora said, contribute to how “extremely difficult” her recovery process, particularly at school, has been.

Students don’t need to have eating disorders to notice these comments. Robert Lee ’14 said he regularly hears boys making similar remarks to the ones that Aurora received.

“When talking about a girl in their grade, the first thing [boys] usually talk about is how she looks, and if she’s pretty or thin or not,” Lee said. “I guess a way boys could improve being more sensitive about the whole issue is just thinking more about the personality before the body.”

However, Lee does not believe this will happen anytime soon.

“There’s been a total sexist and demeaning outlook on women from the start,” Lee said. “I think it will take years and years and years to shift the certain mindset that we have on women.”

Since she’s anorexic, Fiona has felt the consequences of this mindset. Fiona first took notice of how attentive people were to her weight in middle school, when she lost only a few pounds, subsequently feeling encouraged by her classmates to continue to do so.

“Accumulating all of these compliments about how your body looks better, you create an idea in your head that you need to keep losing weight because people like it,” Fiona said.

To curb the onset of mindsets like the ones she and Fiona developed, Aurora said she hopes to see a program, similar to Project 10, a confidential support group for students who are lesbian, gay, bisexual, transgender and questioning, started to offer more support to students at school suffering from eating disorders. She envisions the group to be made up of people who identify along a spectrum of body image ranging from general unhappiness to a diagnosed disorder. She would like it to be a safe-haven for them to discuss any issues that arise from body dissatisfaction.

Bek said a group like this used to exist in the 1990s, run by former school psychologist Sheila Siegel and former physical education teacher Deb Phelps. The group consisted entirely of girls and promised a confidentiality system similar to Peer Support’s.

Bek said it was very successful in the beginning until a few girls put themselves in such dangerous situations that their parents had to be contacted. Hearing about this, many other girls were frightened that their parents too would be contacted, and the group dissolved.

At around the same time, Bek said, a study came out reporting that support groups for eating disorders and education about eating disorders did more harm than good, because people who are prone to unusual eating habits often get ideas from these types of exposure.

“There is a really thin line that one has to walk between educating and encouraging,” Bek said.

Like Aurora, Bek sees Peer Support as one of the most helpful outlets for eating-related issues. Although she admits it to be a particularly difficult subject to educate about and provide help for, Bek believes the school is doing all it can after efforts like teaching in Choices and Challenges and bringing in nutritionists and specialists failed. If an idea of how to improve in these areas were suggested, she is sure the school would be proactive about implementing it.

“Ultimately, your parents are in charge of you,” Bek said. “If they aren’t willing to get you help or they don’t see it as an issue, there is very little we can do as an institution.”

Both Aurora and Fiona have found the most relief in their day-to-day recovery outside of school.

“Through therapy, I’ve realized that it’s not about the food for me, and it’s not about my body,” Fiona said. “It’s about having the control of a number.”

Fiona has also found comfort in self-affirmations. She tells herself every morning that she is healthy and happy.

“I don’t want to live my whole life thinking about calories,” Fiona said. “It won’t be a disease that defines my life.”

Aurora’s outlook on her struggle is not as optimistic. The only reason she does not continue to starve herself, she said, is because her body cannot physically take it.

“That’s the worst part about it,” Aurora said. “I would do it all again.”

*Names have been changed