Academic journal article Journal of Eating Disorders

Predicting Intolerance of Uncertainty in Individuals with Eating Disorder Symptoms

Academic journal article Journal of Eating Disorders

Predicting Intolerance of Uncertainty in Individuals with Eating Disorder Symptoms

Article excerpt

Author(s): Lot C. Sternheim[sup.1,4], Martin Fisher[sup.2], Amy Harrison[sup.2,3] and Rosamond Watling[sup.2]

Plain English summary

Studies show that people with eating disorders (ED) do not tolerate uncertainty about the future well and that uncertainty makes them feel anxious. To understand whether personality traits and attachment styles contribute to this intolerance of uncertainty (IU) in people with EDs, our study included a group of people with ED symptoms and a group without ED symptoms. We found that the ED group had higher levels of IU than people in the non-ED group. Also, we found that the ED group reported more insecure attachment styles and less extraversion and openness personality traits. Lastly, we found that in the ED-group, higher insecure attachments and lower extraversion contributed to higher IU, and that insecure attachment contributed to higher IU in the non-ED group. This study suggests that people with EDs may benefit from learning to tolerate uncertainty and that future research should examine possible treatments targeting IU for people with ED and ED symptoms.


Eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED), have the highest mortality rates of all mental health disorders [1, 2], treatment interventions are suboptimal, relapse rates are high and 20% of patients become chronically ill [3-5]. Given the complexity of these potentially life-threatening disorders, a multi-faceted and interdisciplinary approach to understanding EDs is required. Indeed, the integration of genetic factors with biological and social-psychological models is needed to enhance current knowledge [1]. Not only are comorbid symptomatologies (e.g. anxiety, depression) inherent to EDs [6], most individuals with EDs experience difficulties across various life domains (i.e. work/school, interpersonal relationships and general cognitive functioning such as emotion processing [7-9]. This indicates that alongside identifying ED-specific symptom manifestations like weight, diet and exercise [10], it is important to study more general psychological vulnerabilities and transdiagnostic processes contributing to the development and maintenance of EDs.

A growing body of theoretical and empirical research suggests that individuals with EDs display and report psychological inflexibility (for a theoretical review see Merwin and colleagues [11]). Cognitive rigidity, a need for control and structure [12, 13] and high levels of perfectionism [14, 15] found in individuals with EDs are associated with more severe symptoms and are thought to hinder treatment [16]. Intolerance of uncertainty (IU) is a cognitive factor suggested to contribute to this inflexibility.

Intolerance of uncertainty

IU is defined as "a dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications and involves the tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events" (p.216) [17]. Originally studied as a predictor of worry and general anxiety disorder (GAD [18]), in the last decade researchers have recognised IU as a predictor for a wide range of psychopathologies, including anxiety and depression [19-21], obsessive-compulsive symptoms [22], emotional problems [23, 24] and psychosis [25]. The literature on IU and its associated psychopathologies is fast growing, providing evidence for cognitive, behavioural and neural correlates of IU [26]. For example, those with high IU display attentional biases towards uncertain/ambiguous stimuli [27], display abnormal decision making processes (such as an increase in requirement for evidence before making decisions) [28], and perform poorer on basic behavioural tasks such as typing [29]. Moreover researchers have identified possible neural correlates (e.g., the amygdala, vmPFC, DLPFC, anterior cingulate cortex, and orbitofrontal cortex) [30]. …

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