Isabel, ’07, pauses for a second, fiddling with the half-melted ice in her cup, considering the question.

“No, sorry. I don’t think I should tell you that,” she says after a few seconds.

We’ve been talking for almost half an hour now, and this isn’t the first time she has abstained.

“I don’t want to share–basically, I don’t want to share because I don’t want to trigger anyone who’s reading the article.”

The list of potential “triggers,” however, is murky at best. It starts with her weight and specifics about how she would restrict herself, but even Isabel is unsure where it should end.

“I’m very hypersensitive about it,” she explains. “I want you to understand–I want a lot of people to understand–that it’s just weird what things (can set people off), things you wouldn’t expect…” Her voice trails off.

“Eating disorders are very competitive.”

We’re sitting outside Temple Coffee. The patio is crowded with people enjoying the sun while the wind keeps the heat tolerable.

No one gives our table a second glance. And, even if they did, it’s doubtful that any of the Sunday morning coffee drinkers would find my companion unusual.

She looks like any other vivacious 22-year-old in sunglasses and a sundress. She’s thin, but not painfully so.

Looking at Isabel today, no one would guess that, just 11 months ago, she was so severely underweight that she was partially hospitalized for anorexia nervosa, a disease she had long been in denial about.

Thinking back now, Isabel admits that, what started as “disordered” eating habits in high school, spiraled into anorexia nervosa when she was a college student at Yale in 2007-11.

“(Yale’s) a very high-stress environment. Everyone is super competitive, but mostly with themselves, so it wasn’t like everyone was judging each other. But it was definitely like ‘We’re all going to the gym, and we’re all eating salads for lunch.’ That was just life,” Isabel said.

Amid this, Isabel, a theater studies major, had the added pressure of what she describes as a “body-conscious profession.”

She recalls a summer acting class she took in New York City where, listening to casting directors and agents, she caught a glimpse into the business side of acting.

“It was just like ‘you’re a product we need to sell,’” Isabel said.

This new mentality shook her.

“There was a belief that if I’m thin, people will like me; if I gain weight, people will think I’m weak or a failure,” she said.

Though she turned a blind eye to her own anorexia, it wasn’t as though Isabel was uneducated about the disease itself.

Isabel knew a person with an eating disorder while she was in high school.

As most eating disorders develop between the ages of 14 and 16, it’s not uncommon for high schoolers to have one.

An anonymous poll of 80 SCDS high-school students found that 4 percent have had or are currently struggling with anorexia nervosa or binge eating disorder (a mental illness characterized by recurrent episodes of binge eating).

No one polled had ever suffered from bulimia nervosa, a disorder characterized by recurrent binge-eating episodes followed by purging to prevent weight gain.

Around 8 percent of students were unsure if they had or had ever struggled with anorexia, bulimia or binge eating disorder.

And 31 percent admitted to having tried to lose weight to improve their looks.

These statistics put Country Day above average. According to the organization ANRED (Anorexia Nervosa and Related Eating Disorders), less than 1 percent of the female population has anorexia, while 4 percent have bulimia nervosa. Half of all anorexics also develop bulimia or bulimic patterns.

On average, only 10 percent of people with either disorder are male. However, at Country Day, two boys reported they had or previously had an eating disorder, while only one girl did. Four girls admitted to being uncertain about whether they had or previously had an eating disorder.

At Yale, Isabel once again met people with obvious eating disorders, including her roommate, who struggled with anorexia and bulimia throughout college.

In fact, helping her with the disorder became a “major” part of Isabel’s life freshman year, and she joined Eating Concerns Help and Outreach (ECHO) to support her. Junior and senior year Isabel was president of the organization, but still didn’t think she had an eating disorder, even though several times people (including her roommate) tried to warn her that she was too thin.

But Isabel continually refused to hear it. “(My roommate) would start crying (because I wouldn’t listen), and then I would start yelling at her to leave me alone,” she said.

Isabel’s eating habits continued to strain friendships, creating conflicts that ended some, pushing her deeper into her anorexia.

By the end of senior year, her disorder had taken over her life.

She struggled to complete schoolwork or memorize lines for plays, and eventually stopped enjoying most of her activities.

“I was unaware of anything else that was going on. It was so time-consuming,” she said. “It takes up a lot of mental space to be constantly thinking about it.”

But her disorder didn’t reach this stage overnight.

“It was a very gradual process of slowly taking foods out of my diet until I was basically just eating fruits and vegetables,” Isabel said.

Isabel wouldn’t go into too much detail about her diet, afraid someone might copy how she restricted herself. However, she uses breakfast as an example of how her anorexia developed.

“I used to eat granola and yogurt and a banana, and then I would move to All Bran,” Isabel said.

“My senior year I didn’t have any cereal; I would just have yogurt and a piece of fruit. And slowly the yogurt went away, and slowly bananas were too scary and I was just eating grapefruit.”

Isabel also exercised obsessively.

The summer she acted in New York, for instance, she “compulsively” walked the island of Manhattan on the weekends.

“I would just walk up and down, all day, just walk miles and miles and miles a day.”

She also worked out at odd hours, even leaving for the gym in the middle of events.

By graduation, Isabel had lots of people worried, but she remained unreceptive to help.

Finally, just after graduation, Isabel was forced to begin to confront her disease.

She had applied for a fellowship to travel to India and use theater for “social justice.”

“My master (the head of my residential college at Yale) called me up and said, ‘Well, you know I’d love to give this to you, but I don’t think you’re healthy enough,’” Isabel said.

“That was a really big wake-up call for me.”

She returned home to Sacramento, planning to visit her parents briefly before moving down to Los Angeles to start her acting career.

Isabel’s behavior when she got home shocked her parents. According to Susan, Isabel’s mother, Isabel never displayed any signs of anorexia in high school.

Looking back, however, she remembers that Isabel has always been driven, a perfectionist, and “a bit of a people-pleaser,” personality traits which all made her more susceptible to anorexia. Anorexics also tend to have trouble with anxiety and dealing with change or conflict.

The earliest warning signs Susan remembers were from the end of Isabel’s junior year at Yale.

“Her eating habits were getting a little weird,” Susan said. “She was getting a little more particular, but I don’t think I ever equated it to anorexia.”

But when Isabel arrived home after graduation, “there were huge red flags.”

Isabel was restricting calorically, but what was most concerning for Susan was Isabel’s obsessive, intensive exercising.

“She would go to the gym in the morning with nothing to eat. I would say, ‘You can’t go work out; you haven’t had any breakfast. You have to eat something,’” Susan said.

“She’d eat like four pieces of granola and say, ‘No, I ate.’”

After contacting friends who’d had children with eating disorders, Isabel’s parents sent her to Summit Sacramento, a center for the treatment and prevention of eating disorders, to be medically evaluated.

Isabel was found to be severely underweight; she was 21 percent below her ideal body weight (her exact weight is something else she won’t reveal). To qualify as anorexic a person must be at least 15 percent below the ideal weight for his or her height.

“They told me I was anorexic and that I needed to start a Partial Hospitalization Program (PHP),” Isabel said. “I had to start the next week, and they wouldn’t take me at any lower level of care.”

Isabel entered treatment in June 2011.

She lived at home, but went to Summit seven days a week for 11 hours a day, and was under 24-hour supervision.

At Summit she ate six times a day (three meals and three snacks) and was treated by a team that included a therapist, nutritionist, psychiatrist, family therapists and various doctors.

She had daily medical examinations and was weighed three times a week. (“You took all your clothes off and were weighed backwards.”)

Although Isabel was told PHP would last four to six weeks, she was in the program for almost five months before gaining enough weight to move to a lower level of treatment.

“I think they say it will only be four to six weeks so that we won’t run off,” Isabel said.

She doesn’t remember fighting the process in the beginning; mostly she just felt out of place.

“It was a very surreal experience. I felt like I didn’t belong there,” Isabel said. “I was worried that they would laugh at me, like, ‘You don’t have an eating disorder; you’re not that fit. What are you doing here?’”

On the day she was evaluated, Isabel was asked if she would, hypothetically, eat a ham-and-cheese sandwich.

“I was like, laughing, of course I’d never eat that,” she said. When asked about a grilled cheese sandwich, she remembers saying “No, I’d never eat a grilled cheese.”

“I just believed at that moment that they would never make me eat a grilled cheese.”

After two weeks in the program, however, it hit Isabel that that this wasn’t an option, and she began to fight the process.

This was hard on her parents and brother. According to Susan, Isabel’s treatment has been “an odyssey.”

“With an alcoholic or a drug addict you would take those substances away, but with anorexia you have to eat, so, short of going into a residential facility, the family is on the front line,” she said.

There were family therapy sessions, nutritionist meetings and family meals with a therapist present.

When she wasn’t at Summit, Isabel still had to be under constant supervision, which fell to her family.

“That meant she had to sleep with me,” Susan said. “She had to take showers downstairs where the bathroom door couldn’t be closed.

“She basically had no time she could be alone for the first couple months. If she had that time, she would crunch; she would jog in place; she would do anything to burn calories.”

The process has been emotionally draining for the entire family, and, said Susan, it’s hard to find outside support.

“Telling someone that your child is anorexic–first of all, most people don’t understand it, and, second of all, they’re sort of like, ‘Well, why doesn’t she just eat? That’s the stupidest disease I’ve ever heard of; it’s not even a disease.’”

Gradually, though, Isabel began to gain weight.

Anorexia can have devastating effects on the body, causing many medical issues as the malnourished body enters “starvation mode,” slowing metabolic processes in order to conserve energy.

As Isabel explained it, “The body starts shutting down unnecessary things.”

While she was starving herself, Isabel’s nails stopped growing and her hair began to fall out. She had very dry skin and cold insensitivity. She also suffered from dizzy spells caused by orthostatic hypotension, a condition where blood pressure and heart rate change drastically from when a person is lying down to when they’re standing up.

While this and her other symptoms disappeared as she gained weight, self-starvation has permanently lowered her bone mineral density, giving her osteopenia, the precursor to osteoporosis.

Overall, however, Isabel got off lightly. Other side effects, including heart disease and organ failure, can be deadly. According to Summit, anorexia has the highest death rate of any mental illness.

As her mental and physical health improved, Isabel was able to step down her treatment shifting into an Intensive Outpatient Program in January, when she went to Summit five days a week for three hours at a time.

Now she goes to the treatment center only three days a week for three hours.

In the last few months Isabel feels she has become more accepting of her anorexia and has begun to cope better.

“I know I don’t have to let it control me,” she said.

But she doesn’t believe she will ever fully recover.

“They say it’ll be different, that the thoughts won’t be at the forefront of my brain all the time, but I don’t believe that,” Isabel said. “I think (anorexia) is something you learn to control like diabetes, that you just learn to live with.”

Isabel is committed to improving, though. She is currently working as an actress doing school performances with The B Street Theatre Company.

Though Isabel does not want to give up acting, she is cognizant of the role the profession played in her disorder.

“I try to focus on the art aspect as much as possible,” she said. She also plans to avoid the pressures of the LA and New York City acting scenes for now at least.

According to Isabel, her work at B Street has actually been a great motivator for her. “The idea of passing out (from hunger) in front of children really scares me,” she said.

This and continued support from Summit and her family help keep her on track, though she still struggles “every day, every moment.”

She finds herself constantly besieged by “triggers” in our diet-obsessed culture.

“Everyone talks about exercise, what’s good for you and what’s bad for you. So even if they’re not dieting, maybe they only want to eat organic or vegan or raw foods,” Isabel said.

“It’s just tiring.”

She also has to fight the constant reminders in the media of the thin ideal.

While we are talking, she pulls out a magazine she derides as “disgusting,” and points to the scantily clad, emaciated models on the cover.

“I know this is not attractive; I don’t find this attractive at all,” she says. “But I see that, and I can’t help but think, ‘Oh, I need to lose weight.

“Why don’t my bones stick out like that?’”