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Anorexia Nervosa Luisel Ramos was an Uruguayan model who was born in 1984. On August 2, 2006, at 9:15 p.m., Ramos died of heart failure while participating in a fashion show during Fashion Week in Montevideo, Uruguay. Ramos had felt ill after walking the runway and subsequently fainted on her way back to the dressing room. She died at the age of only 22. Ramos's father told police that she had gone "several days" without eating. She was reported to have adopted a diet of lettuce leaves and Diet Coke for the three months before her death. At the time of her death she had a body mass index (BMI) of about 14.5 due to having weighed little more than 98 lb (44 kg) despite being 5 ft 9 in (1.75 m) tall! The psychiatric disorder, Luisel had been suffering from is Anorexia Nervosa. More pathetic was that, only after 6 months of her death, on February 13, 2007, Luisel's 18-year-old sister Eliana Ramos, also a model, died at her grandparents' home in Montevideo of an apparent heart attack. She was also suffering from the same disorder. Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight (less than 85% of that expected) and body image distortion with an obsessive fear of gaining weight. More than 90% of cases occur in females. The prevalence among males is approximately one-tenth that among females. The disorder typically begins in mid to late adolescence (14-18 yrs). The disorder appears to be far more prevalent in industrialized societies, probably most common in United States, Canada, Europe, Australia, Japan, Newzeland and South Africa. There are two types of Anorexia Nervosa- Restricting and Binge-eating type. Restricting type describes presentations in which weight loss is accomplished primarily through dieting, fasting or excessive exercise. During the current episode, the person has not regularly engaged in binge-eating or purging behavior. On the other hand, in Binge-Eating or Purging Type, the person has regularly engaged in binge-eating or purging (or both) behavior. Most individual who binge eat also purge through self-induced vomiting, or the misuse of laxatives, diuretics, or enemas. There is no single cause for anorexia. It stems from a mixture of social, psychological and biological factors. There is evidence of greater concordance in monozygotic than in dizygotic twins, suggesting genetic influences. A recent review of the scientific literature has suggested that anorexia is linked to a disturbed serotonin system, particularly at areas in the brain with the 5HT1A receptor - a system particularly linked to anxiety, mood and impulse control. Professor Chris Fairburn, of the University of Oxford and his colleges have created a 'transdiagnostic' model, in which they aim to explain how anorexia is maintained. Their model is based on the idea that there are some core types of psychopathology which help maintain the eating disorder behavior. This includes clinical perfectionism, chronic low self-esteem, mood intolerance (i.e. inability to cope appropriately with certain emotional states) and interpersonal difficulties. Disturbed relationship, high levels of hostility, chaos, and isolation and low levels of nurturance and empathy are reported in families of children presenting with eating disorders. Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialized nations, particularly through the media. A classic study by Garner and Garfinkel demonstrated that those in professions where there is a particular social pressure to be thin (such as models and dancers) were much more likely to develop anorexia during the course of their career. Female athletes involved in running and gymnastics, ballet dancers, male body builders and wrestlers are also at increased risk. The Internet has enabled anorexics to communicate and support each other, with much lower risks of rejection by mainstream society. Some people affected by anorexia have formed online communities that reject the medical view and argue that anorexia is a 'lifestyle choice'. Such websites could encourage young women to develop or maintain this eating disorder. The physical consequences of anorexia is the same as those of starvation. Extreme weight loss, delayed puberty, stunted growth and delayed physical development, Endocrine disorder leading to cessation of periods in girl, electrolyte imbalances, reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia, tiredness, weakness, abnormal heart rhythms, kidney damage & convulsions, thinning of the bones (osteoporosis), bowel problems, swelling of hands, feet and face (due to fluid disturbances), pallid complexion and sunken eyes, dry skin, dry or chapped lips, thinning of the hair, decreased libido; impotence in males, headaches , brittle fingernails- all may be the complications of anorexia nervosa. Death may occur due to infections, starvation, electrolyte imbalance and suicide. Aims of treatment are to restore patients nutritional status and establish healthy eating patterns, treat medical complications, correct core dysfunctional thoughts related to the eating disorder, enlist family support and provide family counseling. If body weight is extremely low, weight loss is rapid, serious electrolyte or metabolic abnormalities occur, then the patient has to be hospitalized. Alongside the drugs used for the treatment of medical complications, Psychotropic medications like antidepressants or anti-anxiety medications are most frequently used after weight has been restored but may begin earlier when indicated. They help maintain weight and normal eating behaviors as well as treat associated psychiatric symptoms. Psychosocial Treatments are required both during hospitalization as well as after discharge. Commonly used models include dynamic expressive-supportive therapy and cognitive behavioral techniques (which include planned meals and self-monitoring, exposure and response prevention). Group therapy, support groups may be useful as adjunctive treatment and for relapse prevention. Family therapy and marital therapy is helpful in case of dysfunctional family patterns and interpersonal distress. Though western countries are the prime sufferer of the disorder, now-a-days the rates of anorexia are also increasing, especially in nonwestern countries, where women are exposed to cultural change and modernization. So, the girls of our country is not free from the risk of developing this eating disorder.