Introduction
During the Covid-19 pandemic, the morbidity of anorexia increased both
in its scope and in its severity. This article argues that a
psychoanalytic perspective can contribute to the understanding of the
increased morbidity of anorexia.
On March 11, 2020, the World Health Organization declared COVID-19 a
worldwide pandemic. COVID-19 has had (and continues to have) a drastic
impact on the world’s population and provision of health services. To
slow the spread of COVID-19 and to ease the burden on the health care
system, governments implemented restrictions and quarantines.
Regulations related to social distancing and restrictions on
individuals’ social lives forced billions of people to reorganize their
daily lives. Early on, these restrictions began to affect mental health
(Holmes et al., 2020).
Recent clinical reports and preliminary research publications have
indicated that anorexia is on the rise, both regarding prevalence and
illness severity (Agostino et al., 2021; Fernandez-Aranada et al., 2020;
Haripersad et al., 2021; Schlegl et al., 2020). Studies from the last
two years have shown that the rate of referrals for hospitalization due
to anorexia has doubled (Asch et al., 2021; Goldberg et al., 2022;
Springall et al., 2022) or even tripled since the COVID-19 outbreak
(Matthews et al., 2021).
These findings have raised questions regarding the unique influences
that the pandemic imposed on individuals with anorexia and those at risk
for developing it. The reasons for the increase in prevalence and
severity of Anorexia Nervosa during COVID-19 are not yet clear. Several
contributing factors have been reported: Disruption of daily activities,
social isolation, reduced access to the usual support networks and to
health care services (Haripersad et al., 2021; Brown et al., 2021;
Schlegl et al., 2020) and increased exposure to messages triggering the
illness, on the internet (Branley-Bell and Talbot, 2020). In addition,
it was found that anorexic individuals tried to reduce anxiety and
depression caused by the pandemic by increased participation in sport,
thus exacerbating anorexic symptoms (McCombie et al., 2020).
Research conducted thus far has indicated that the COVID-19 pandemic and
its social consequences have had a unique and adverse impact on the
health of individuals with anorexia. According to our knowledge, no
psychoanalytic explanation has been offered for the increase in anorexia
during this period. Thus, this article will offer a psychoanalytic
understanding of the intensification of the anorexic symptom following
the outbreak of COVID-19.
In this article, we will suggest that a tendency to internal
prohibitions that relies on an underdeveloped and fragile self in
anorexic individuals resulted in an increased severity of the anorexic
symptomology during the period of the pandemic. Specifically, we will
argue that the encounter between an external reality saturated with
restrictions and prohibitions and the anorexic internal reality
intensified the anorexic symptomology. As a first step, we will
introduce several key concepts and ideas regarding the experience of an
internal prohibition from the psychoanalytic viewpoint, as well as the
connection between this experience and anorexia.