Elle survives the initial attacks on their hometown of Shepherd's Glen, and assists Alex on his journey.
Alex meets Elle outside the Shepherd's Glen Police Station, where he finds her stapling fliers to the missing persons board. While pleased and surprised to see Alex after so long, she expresses some negativity and faint anger in regards to him leaving so abruptly. Elle gives Alex a radio before he heads off, showing that even though he'd been gone for quite some time, she still wanted to renew their friendship.
Elle appears a second time just outside of the police station after Alex is released from police custody by Deputy Wheeler. When Alex saves her by fighting off a Siam, Elle suggests they might be safer underground, as they are surrounded by monsters in the parking lot. Once inside the sewers, Alex discovers Elle's younger sister Nora has gone missing along with the countless other Shepherd's Glen citizens. Alex assures Elle they will find Nora and Joshua, Alex's missing brother, before they head off in search of a way out of the sewers. Elle goes missing before they can find a way out, leaving behind her radio and smeared blood, leaving Alex to fear the worst.
Elle is not seen again until after Alex escapes the sick "Hell House" version of his home. Elle takes a boat ride with Alex and Wheeler to Silent Hill, where they hope to find answers about the dismal state of Shepherd's Glen. She gives Alex her locket, but before they can dock the boat, Order Soldiers capture Elle and Wheeler and Alex is knocked into the water.
Elle is last seen being terrorized by Curtis Ackers with his saw in the underground part of the Church of the Holy Way, known as the lair. Alex saves her by killing Curtis, and she assists him in finding Wheeler in the underground, where Alex tells her it is probably best for her to find a way out of the area. If Alex does not save Elle from Curtis, he will kill her with his saw.
If the player receives the Good ending, Alex is seen coming out of the sewers at the same time Elle makes her way onto the road. After several hugs and a brief conversation, Elle assists Alex out of Silent Hill.
If the player receives the UFO ending, Alex and Elle are beamed into an alien spaceship while Wheeler witnesses the whole scene.