When junior Jessica Wright, whose name has been changed to protect her privacy, visited her cousin during spring break, she was shocked to see her in a nearly emaciated state. Standing at 5 feet 9 inches, her cousin weighed 90 pounds. Though Wright said her parents knew that her cousin had been battling anorexia for a few months, they were worried about telling her since Wright herself had overcome the same eating disorder just over a year ago.

“I think eating disorders happen by accident,” Wright said, recalling her freshman year. “I am extremely into sports, so I was exercising a lot and I was also trying to lose weight. When I didn’t exercise, I would freak out and eat a lot less. It pretty much spiraled down from there.”

Wright said little things she did, like cutting certain food out of her diet, added up.

The summer following her freshman year, Wright attended a sleep away camp where she remembers eating nothing but salad for two weeks straight.

“She would always say that she ate but she hardly ate anything,” junior Karen Smith, a friend of Wright whose last name has been changed to protect Wright’s privacy, said. “She wouldn’t bring food to school and she wouldn’t eat full meals.”

Kaiser Permanente Psychiatrist Annie Hempstead said that some people are predisposed to anorexia because of other psychological factors. “People who struggle with severe anxiety and the tendency to obsess are more at risk for anorexia nervosa than for other eating disorders.” Hempstead said. Teenagers who have bulimia tend to have more mood fluctuations and be depressed, she said.

Wright’s parents intervened the summer after her freshman year. After finding out her she had 5 percent body fat—the normal amount of body fat for teenage girls is 22 to 25 percent, according to The American Heart Association—she saw a pediatrician and a nutritionist for the next five months.

Because Wright’s doctors had set a goal weight for her to reach in order to begin playing sports again, she said she recovered in a fairly short amount of time. “My case was actually a pretty quick turn around,” Wright said. “I feel like a lot of people have a harder time, and it takes years for them to get over [their eating disorder].”

However, not everyone has such motivation to overcome his or her disorder. Wright said her cousin has the most extreme case that she has ever seen, and Wright thinks it may stem from stress. “It’s kind of a control issue,” she said. “You don’t want to eat more food just because other people want you to. You feel like the one thing you have control over is what you eat.”

Wright’s cousin, whose case of anorexia began about eight months ago, goes to an anorexia clinic three times a week, sees a nutritionist and is taking antidepressants.

Wright is worried about the fact that her cousin will be going away to college in the fall.

Adolescent Counseling Services Site Director Roni Gillenson said that peer pressure in college may cause students’ eating disorders to heighten. “I think if an eating disorder goes undiagnosed, it can most likely worsen in college because there are new challenges and unfamiliar surroundings,” she said. “Another risk is when joining a sorority where girls may be similar in their coping skills, there may be a group consensus and the girls think it’s normal.”

Hempstead said that other pressures in the first year of college may also cause a person with an eating disorder or another health issue to relapse. “For students with mental health issues, there is a risk that their symptoms will increase, especially in the first year of college,” Hempstead said. “The freshmen year can be a great year, but leaving home and all the adjustments can create stress. Stress can increase symptoms, so it is very important to have a safety net. This must include mental health services at college, whether through student health, or through another nearby health plan.”

However, if a person with an eating disorder has not recovered by the time they leave for college, Hempstead said, they should attend a college close to their home. “If someone has a severe eating disorder and is in the early stages of recovery, sometimes it is advisable that the student attend a school close to home, so that he or she can continue in their treatment with a therapist, nutritionist and physician who understand how to help,” Hempstead said.

According to Gillenson, if a person has an eating disorder, it may be an ongoing issue that he or she must be attentive to for the rest of his or her life. However, Wright says that though she still thinks about her weight, she does not think she will relapse. “They say that once you have an eating disorder it never goes away, and I think there’s a lot of truth in that,” Wright said. “Sometimes I look at pictures and think about how much skinnier I was then, but I never think I’ll go back to the state I was in.”

Smith, Wright’s friend, agrees that Wright had a good recovery. “She kind of balanced everything out,” she said. “She has it under control and she knows she can’t go back to how she used to be.”