An examination of intolerance of uncertainty as a maintenance factor for eating disorder symptoms

Abstract

This program of research examined the role of intolerance of uncertainty as a possible maintenance factor for eating disorder symptoms. A series of three studies was conducted to address these aims, and included the use of qualitative, correlational, and experimental methodologies. The first study utilised one-to-one, semi-structured interviews to investigate the lived experience of uncertainty for women with eating disorders. The study obtained in-depth accounts from five women undergoing treatment in an eating disorder inpatient unit. The findings highlighted the frequent and intense experience of uncertainty for women with eating disorders, which was identified as pervasive across both disorder-specific and non-specific contexts. Patients described numerous, typically maladaptive strategies employed to cope with uncertainty, which included engagement in a range of eating disorder behaviours, thus lending preliminary support to a potential role of intolerance of uncertainty for symptom maintenance. In addition, patients described their experience of uncertainty as more intense following onset of the eating disorder, and also reported an exacerbation in eating disorder symptoms due to their experience of uncertainty. The second study examined the interrelationships between intolerance of uncertainty and eating disorder symptoms in a community-based sample of adult women. The study found intolerance of uncertainty specific to eating and weight to show an association with a range of eating disorder attitudes and behaviours, including dietary restraint. Preliminary support was found for a proposed model specifying intolerance of uncertainty specific to eating and weight as a mediator of the relationship between shape and weight concerns and dietary restraint, however causality could not be inferred from the correlational data. As such, the third and final study comprised the first known research to specifically test the causal effects of intolerance of uncertainty on eating disorder symptoms using an experimental methodology. The study consisted of a university-based sample of adult women, and sought to temporarily induce a high or low general intolerance of uncertainty. The experimental paradigm was informed by previous research by Rosen, Knauper, and Sammut (2007), as well as dissonance theory and dissonance-based interventions (Festinger, 1957; Stice, Mazotti, Weibel, & Agras, 2000). A high intolerance of uncertainty was found to predict heightened negative affect in response to an instance of eating-related uncertainty, however intolerance of uncertainty did not predict eating- or weight-related variables. On the basis of these results, a general intolerance of uncertainty was proposed as a distal factor in the eating disorders context, prompting increased negative affect in response to uncertainty. If sufficiently intense, this negative affect may prompt eating disorder symptoms over time, however this successive pathway requires further investigation. The research highlights the potential utility of including intolerance of uncertainty as a factor for consideration in current eating disorder maintenance models, and in the assessment and formulation of eating disorder symptoms. Due to the preliminary nature of the current research, the importance of replication is emphasised and a number of specific directions for future research are presented.