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.