What does uncertainty mean to women with anorexia nervosa? An interpretative phenomenological analysis
Abstract
Objective The objective of this study was to explore the construct of intolerance of uncertainty in patients with anorexia nervosa through focus groups. Method Nine women with anorexia nervosa participated in three focus groups in an in-patient, rehabilitation and day care setting. Focus groups probed participants' experiences of uncertainty and the meaning to them of uncertainty on a physical, behavioural, cognitive and emotional level. Results Data were analysed using Interpretative Phenomenological Analysis (IPA). Patients experienced uncertainty as stressful and wanted to avoid this at all costs. Prominent sources of uncertainty were fear of negative evaluation by others and feelings of being imperfect. Uncertain situations led participants to feel anxious and 'out of control', resulting in a strong desire for control which manifested in extreme organising and planning. Discussion Results suggest that treatment strategies aimed at increasing tolerance of uncertainty in people with anorexia nervosa could be beneficial.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
High intolerance of uncertainty is observed in anorexia nervosa.
“high IU is observed in AN (for an overview, see Kesby, Maguire, Brownlow, & Grisham, 2017; Sternheim, Konstantellou, Startup, & Schmidt, 2011)”
From Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa? (2020) · cites this paper as Sternheim, Konstantellou, Startup, & Schmidt, 2011
Cites
Smith, J. A. (1996) · Psychology & Health · doi:10.1080/08870449608400256 · Cited by 2,380 · see citing works
The intolerance of uncertainty scale: psychometric properties of the English version
Buhr, K., & Dugas, M. J. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00092-4 · Cited by 1,391 · see citing works
Generalized anxiety disorder: advances in research and practice
(2005) · Choice Reviews Online · doi:10.5860/choice.42-3716 · Cited by 1,073 · see citing works
Schmidt, U., & Treasure, J. (2006) · British Journal of Clinical Psychology · doi:10.1348/014466505x53902 · Cited by 890 · see citing works
Self-citationInterpretative phenomenological analysis
Smith, J. A., & Osborn, M. (2004) · Doing Social Psychology Research · doi:10.1002/9780470776278.ch10 · Cited by 696 · see citing works
An introduction to reading and appraising qualitative research
Kuper, A., Reeves, S., & Levinson, W. (2008) · BMJ · doi:10.1136/bmj.a288 · Cited by 519 · see citing works
A systematic review and meta-analysis of set-shifting ability in eating disorders
Roberts, M., Tchanturia, K., Stahl, D. R., Southgate, L., & Treasure, J. L. (2007) · Psychological Medicine · doi:10.1017/s0033291707009877 · Cited by 502 · see citing works
The co‐morbidity of eating disorders and anxiety disorders: a review
Swinbourne, J. M., & Touyz, S. W. (2007) · European Eating Disorders Review · doi:10.1002/erv.784 · Cited by 448 · see citing works
Intolerance of uncertainty and social anxiety
Boelen, P. A., & Reijntjes, A. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2008.04.007 · Cited by 436 · see citing works
Health, community and development: towards a social psychology of participation
Campbell, C., & Jovchelovitch, S. (2000) · Journal of Community & Applied Social Psychology · doi:10.1002/1099-1298(200007/08)10:4 · Cited by 424 · see citing works
Developing an Interpretative Phenomenological Approach to Focus Group Data
Palmer, M., Larkin, M., de Visser, R. O., & Fadden, G. (2010) · Qualitative Research in Psychology · doi:10.1080/14780880802513194 · Cited by 378 · see citing works
The use of focus group methodology — with selected examples from sexual health research
Robinson, N. (1999) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1999.00966.x · Cited by 361 · see citing works
Intolerance of Uncertainty and Intolerance of Ambiguity: Similarities and differences
Grenier, S., Barrette, A.-M., & Ladouceur, R. (2005) · Personality and Individual Differences · doi:10.1016/j.paid.2005.02.014 · Cited by 328 · see citing works
Anxiety in the eating disorders: Understanding the overlap
Pallister, E., & Waller, G. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.07.001 · Cited by 315 · see citing works
A meta-analysis of CBT for pathological worry among clients with GAD
Covin, R., Ouimet, A. J., Seeds, P. M., & Dozois, D. J. A. (2008) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2007.01.002 · Cited by 293 · see citing works
Herpertz‐Dahlmann, B., Hebebrand, J., Müller, B., Herpertz, S., Heussen, N., & Remschmidt, H. (2001) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00756 · Cited by 255 · see citing works
Jordan, A. L., Eccleston, C., & Osborn, M. (2007) · European Journal of Pain · doi:10.1016/j.ejpain.2005.12.012 · Cited by 201 · see citing works
Emotional Theory of Mind and Emotional Awareness in Recovered Anorexia Nervosa Patients
Oldershaw, A., Hambrook, D. G., Tchanturia, K., Treasure, J. L., & Schmidt, U. H. (2009) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181c6c7ca · Cited by 197 · see citing works
Self-citationPathologic fear conditioning and anorexia nervosa: On the search for novel paradigms
Strober, M. (2004) · International Journal of Eating Disorders · doi:10.1002/eat.20029 · Cited by 160 · see citing works
Intolerance of uncertainty correlates with insula activation during affective ambiguity
Simmons, A., Matthews, S. C., Paulus, M. P., & Stein, M. B. (2008) · Neuroscience Letters · doi:10.1016/j.neulet.2007.10.030 · Cited by 150 · see citing works
Strober, M., Freeman, R., Lampert, C., & Diamond, J. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20429 · Cited by 149 · see citing works
Reflecting on the Use of IPA with Focus Groups: Pitfalls and Potentials
Tomkins, L., & Eatough, V. (2010) · Qualitative Research in Psychology · doi:10.1080/14780880903121491 · Cited by 133 · see citing works
Social comparison and submissive behaviour in eating disorder patients
Troop, N. A., Allan, S., Treasure, J. L., & Katzman, M. A. (2003) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608303322362479 · Cited by 126 · see citing works
Anderluh, M. B., Tchanturia, K., Rabe‐Hesketh, S., Collier, D. A., & Treasure, J. L. (2008) · Psychological Medicine · doi:10.1017/s0033291708003292 · Cited by 120 · see citing works
Worry and Rumination in Anorexia Nervosa
Startup, H. M., Lavender, A., Oldershaw, A., Stott, R. B., Tchanturia, K., Treasure, J. L., & Schmidt, U. H. (2012) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465812000847 · Cited by 106 · see citing works
Self-citationShared Temperament Risk Factors for Anorexia Nervosa: A Twin Study
Wade, T. D., Tiggemann, M., Bulik, C. M., Fairburn, C. G., Wray, N. R., & Martin, N. G. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31815c40f1 · Cited by 106 · see citing works
Evaluation of intolerance of uncertainty: development and validation of a new self-report measure
Gosselin, P., Ladouceur, R., Evers, A., Laverdière, A., Routhier, S., & Tremblay-Picard, M. (2008) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2008.02.005 · Cited by 104 · see citing works
Crane, A. M., Roberts, M. E., & Treasure, J. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20419 · Cited by 98 · see citing works
Influence of overanxious disorder of childhood on the expression of anorexia nervosa
Raney, T. J., Thornton, L. M., Berrettini, W., Brandt, H., Crawford, S., Fichter, M. M., Halmi, K. A., Johnson, C., Kaplan, A. S., LaVia, M., et al. (2008) · International Journal of Eating Disorders · doi:10.1002/eat.20508 · Cited by 97 · see citing works
Krain, A. L., Hefton, S., Pine, D. S., Ernst, M., Xavier Castellanos, F., Klein, R. G., & Milham, M. P. (2006) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2006.01677.x · Cited by 94 · see citing works
The development of the P‐CAN, a measure to operationalize the pros and cons of anorexia nervosa
Serpell, L., Teasdale, J. D., Troop, N. A., & Treasure, J. L. (2004) · International Journal of Eating Disorders · doi:10.1002/eat.20040 · Cited by 88 · see citing works
Comparing views of patients, parents, and clinicians on emotions in anorexia
Kyriacou, O., Easter, A., & Tchanturia, K. (2009) · Journal of Health Psychology · doi:10.1177/1359105309340977 · Cited by 82 · see citing works
Poor social comparison and the tendency to submissive behavior in anorexia nervosa
Connan, F., Troop, N., Landau, S., Campbell, I. C., & Treasure, J. L. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20427 · Cited by 73 · see citing works
Anorexia Nervosa’s Meaning to Patients: A Qualitative Synthesis
Espíndola, C. R., & Blay, S. L. (2009) · Psychopathology · doi:10.1159/000203339 · Cited by 70 · see citing works
Re-appraising HIV Testing among Scottish Gay Men: The Impact of New HIV Treatments
Flowers, P., Knussen, C., & Duncan, B. (2001) · Journal of Health Psychology · doi:10.1177/135910530100600605 · Cited by 70 · see citing works
Follow-up care for childhood cancer survivors: A focus group analysis
Earle, E. A., Davies, H. A., Greenfield, D., Ross, R. J. M., & Eiser, C. (2005) · European Journal of Cancer · doi:10.1016/j.ejca.2005.08.028 · Cited by 69 · see citing works
Dunne, E. A., & Quayle, E. (2001) · Journal of Health Psychology · doi:10.1177/135910530100600606 · Cited by 64 · see citing works
Konstantellou, A., & Reynolds, M. (2010) · Eating Behaviors · doi:10.1016/j.eatbeh.2010.01.003 · Cited by 49 · see citing works
Self-citationBinge eating before the onset of dieting: A distinct subgroup of bulimia nervosa?
Haiman, C., & Devlin, M. J. (1999) · International Journal of Eating Disorders · doi:10.1002/(sici)1098-108x(199903)25:2 · Cited by 45 · see citing works
Obsessive‐compulsive beliefs and magical ideation in eating disorders
Lavender, A., Shubert, I., de Silva, P., & Treasure, J. L. (2006) · British Journal of Clinical Psychology · doi:10.1348/014466505x53579 · Cited by 42 · see citing works
Manipulation de l'intolérance a l'incertitude et inquiétudes.
Grenier, S., & Ladouceur, R. (2004) · Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement · doi:10.1037/h0087216 · Cited by 41 · see citing works
Dugas, M. J., Francis, K., & Bouchard, S. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070802473221 · Cited by 26 · see citing works
The use of the Pros and Cons of Anorexia Nervosa (P-CAN) Scale with children and adolescents
Serpell, L., Neiderman, M., Haworth, E., Emmanueli, F., & Lask, B. D. (2003) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(02)00464-6 · Cited by 22 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Einstein, D. A. (2014) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12077 · Cited by 223 · see citing works
Intolerance of uncertainty in eating disorders: a systematic review and meta-analysis
Brown, M., Robinson, L., Campione, G. C., Wuensch, K., Hildebrandt, T., & Micali, N. (2017) · European Eating Disorders Review · doi:10.1002/erv.2523 · Cited by 173 · see citing works
“The Beads Task is a probabilistic behavioural task requiring the participant to draw coloured beads until he or she is ‘certain’ from which of two jars the beads originate (Huq et al., 1988; Jacoby et al., 2016; Sternheim et al., 2011b).”
BackgroundInfluentialSchmidt, U., Wade, T. D., & Treasure, J. (2014) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.28.1.48 · Cited by 159 · see citing works
Self-citationStanghellini, G., Castellini, G., Brogna, P., Faravelli, C., & Ricca, V. (2012) · Psychopathology · doi:10.1159/000330258 · Cited by 117 · see citing works
Oldershaw, A., Startup, H. M., & Lavender, T. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00219 · Cited by 114 · see citing works
Self-citationWorry and Rumination in Anorexia Nervosa
Startup, H. M., Lavender, A., Oldershaw, A., Stott, R. B., Tchanturia, K., Treasure, J. L., & Schmidt, U. H. (2012) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465812000847 · Cited by 106 · see citing works
Self-citationSternheim, L. C., Startup, H. M., & Schmidt, U. H. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.03.020 · Cited by 102 · see citing works
Self-citationA meta-analysis of circulating BDNF concentrations in anorexia nervosa
Brandys, M. K., Kas, M. J., Elburg, A. A. V., Campbell, I. C., & Adan, R. A. H. (2011) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2011.562244 · Cited by 85 · see citing works
Intolerance of uncertainty in eating disorders: an update on the field
Kesby, A., Maguire, S., Brownlow, R., & Grisham, J. R. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.07.002 · Cited by 83 · see citing works
Understanding catastrophic worry in eating disorders: Process and content characteristics
Sternheim, L. C., Startup, H. M., Saeidi, S., Morgan, J. F., Hugo, P., Russell, A., & Schmidt, U. H. (2012) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2012.05.006 · Cited by 65 · see citing works
Self-citationSmith, V., Chouliara, Z., Morris, P. G., Collin, P., Power, K., Yellowlees, A., Grierson, D., Papageorgiou, E., & Cook, M. (2014) · Journal of Health Psychology · doi:10.1177/1359105313520336 · Cited by 61 · see citing works
“Similarly, Sternheim et al. (2011) found that individuals with AN expressed high levels of intolerance for uncertainty.”
BackgroundAbnormal social reward responses in anorexia nervosa: an fMRI study
Via, E., Soriano-Mas, C., Sánchez, I., Forcano, L., Harrison, B. J., Davey, C. G., Pujol, J., Martínez-Zalacaín, I., Menchón, J. M., Fernández-Aranda, F., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0133539 · Cited by 56 · see citing works
“Moreover, this response might be also associated with low tolerance to uncertainty and increased perception of lack of control in social relationships in AN patients [73], suggested to be compensated by increased control over eating, body shape and weight [10,27].”
BackgroundPatient experiences of uncertainty - a synthesis to guide nursing practice and research
Hansen, B. S., Rørtveit, K., Leiknes, I., Morken, I. M., Testad, I., Joa, I., & Severinsson, E. (2012) · Journal of Nursing Management · doi:10.1111/j.1365-2834.2011.01369.x · Cited by 55 · see citing works
Mental Capacity, Decision-Making and Emotion Dysregulation in Severe Enduring Anorexia Nervosa
van Elburg, A., Danner, U. N., Sternheim, L. C., Lammers, M., & Elzakkers, I. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.545317 · Cited by 55 · see citing works
Self-citationKnight-Agarwal, C. R., Kaur, M., Williams, L. T., Davey, R., & Davis, D. L. (2013) · Women and Birth · doi:10.1016/j.wombi.2013.11.002 · Cited by 51 · see citing works
Proactive and reactive inhibitory control in eating disorders
Bartholdy, S., Rennalls, S. J., Jacques, C., Danby, H., Campbell, I. C., Schmidt, U. H., & O’Daly, O. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.06.073 · Cited by 48 · see citing works
“Individuals with EDs (particularly AN) are highly intolerant of uncertainty (Sternheim et al., 2011b) and studies have revealed intolerance of uncertainty to be positively related to symptom severity (Sternheim et al., 2011a; Sternheim et al., 2015).”
Self-citationLived Experiences of “Illness Uncertainty” of Iranian Cancer Patients
Sajjadi, M., Rassouli, M., Abbaszadeh, A., Brant, J. M., & Majd, H. A. (2015) · Cancer Nursing · doi:10.1097/ncc.0000000000000282 · Cited by 45 · see citing works
“Other studies report spiritual growth due to living with uncertainty(38,39) and positive aspects of uncertainty in disease.(35,36) Further studies are needed to explore these relationships in Iranian patients.”
BackgroundRenjan, V., McEvoy, P. M., Handley, A. K., & Fursland, A. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.03.008 · Cited by 44 · see citing works
The Relationship between Alexithymia and Intolerance of Uncertainty in Anorexia Nervosa
Daga, G. A., Quaranta, M., Marzola, E., Amianto, F., & Fassino, S. (2015) · Psychopathology · doi:10.1159/000381587 · Cited by 38 · see citing works
Phillips, E., Montague, J., & Archer, S. (2016) · Qualitative Research in Psychology · doi:10.1080/14780887.2016.1205692 · Cited by 37 · see citing works
“…including gaining access to a pre-existing homogeneous group with an interest in the topic (Dunne & Quayle 2001), to ensure a broad range of views is integrated (Earle et al. 2005), and because participants were already used to discussing their experiences in a group (Sternheim et al. 2011).”
BackgroundLauriola, M., Mosca, O., Trentini, C., Foschi, R., Tambelli, R., & Carleton, R. N. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00388 · Cited by 37 · see citing works
“…to the view that IU is higher in clinical groups than in control groups across several disorders (Holaway et al., 2006; Gentes and Ruscio, 2011; Sternheim et al., 2011; Carleton et al., 2012), our study showed that both the IUI-A and IUI-B summated rating scores discriminated between clinical…”
BackgroundMethodResultInfluentialTesting a cognitive model of generalized anxiety disorder in the eating disorders.
Konstantellou, A., Campbell, M., Eisler, I., Simic, M., & Treasure, J. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.04.005 · Cited by 37 · see citing works
“…showing that intolerance of uncertainty 8 f Anxie i ( c t t n F w t fi t a b t n t n w p f i d c m ( e F p 4 l n G a R A B B B B C C C C D D D 68 A. Konstantellou et al. / Journal o s an important factor associated with eating psychopathology Konstantellou & Reynolds, 2010; Sternheim et al., 2010).”
BackgroundSelf-citationDoes Intolerance of Uncertainty Affect the Magnitude of Limitations or Pain Intensity?
Donthula, D., Kortlever, J. T. P., Ring, D., Donovan, E. E., Reichel, L. M., & Vagner, G. A. (2019) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000001042 · Cited by 33 · see citing works
Sternheim, L. C., Startup, H. M., & Schmidt, U. H. (2014) · Advances in Eating Disorders · doi:10.1080/21662630.2014.948469 · Cited by 32 · see citing works
“Studies show that high levels of worry, negative beliefs about worry and CA are all associated with high levels of ED pathology in AN patients (Cooper, Grocutt, Deepak, & Bailey, 2007; Sternheim et al., 2011; Sternheim, Startup, Saeidi, et al., 2012; Sternheim, Startup, Pretorius, et al., 2012).”
BackgroundSelf-citationTrastornos de la conducta alimentaria en adolescentes: descripción y manejo
Carolina, L. G., & Janet, T. (2011) · Revista Médica Clínica Las Condes · doi:10.1016/s0716-8640(11)70396-0 · Cited by 31 · see citing works
Pemberton, K., & Fox, J. R. E. (2011) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.794 · Cited by 31 · see citing works
Bryant, E., Aouad, P., Hambleton, A., Touyz, S., & Maguire, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.894178 · Cited by 32 · see citing works
“One participant acknowledged that “[living in institutions] reduces dramatically the amount of uncertainty that I’m faced with, and the chaos]” [(88), pp.”
BackgroundInfluentialSchmidt, U. H., Sharpe, H., Bartholdy, S., Bonin, E., Davies, H. A., Easter, A., Goddard, E., Hibbs, R., House, J., Keyes, A., et al. (2017) · Programme Grants for Applied Research · doi:10.3310/pgfar05160 · Cited by 30 · see citing works
Self-citationNeural Correlates of Intolerance of Uncertainty in Clinical Disorders
Wever, M. C. M., Smeets, P. A. M., & Sternheim, L. C. (2015) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.14120387 · Cited by 30 · see citing works
“for individuals with anorexia nervosa; indeed, the first studies confirmed elevated levels of intolerance of uncertainty in patients with anorexia nervosa.(13,14) Current psychological treatments for anorexia are suboptimal at best, and understanding the neural circuit of intolerance of uncertainty may offer a differe…”
BackgroundSelf-citationPredicting intolerance of uncertainty in individuals with eating disorder symptoms
Sternheim, L. C., Fisher, M., Harrison, A., & Watling, R. (2017) · Journal of Eating Disorders · doi:10.1186/s40337-017-0152-4 · Cited by 30 · see citing works
“Cognitive rigidity, a need for control and structure [12, 13] and high levels of per-”
BackgroundSelf-citationTajadura‐Jiménez, A., Crucianelli, L., Zheng, R., Cheng, C. M., Ley-Flores, J., Mas, M. D. L. M. B., Bianchi‐Berthouze, N., & Fotopoulou, A. (2022) · Scientific Reports · doi:10.1038/s41598-022-24452-7 · Cited by 29 · see citing works
Sternheim, L., Startup, H., Pretorius, N., Johnson-Sabine, E., Schmidt, U., & Channon, S. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.06.029 · Cited by 29 · see citing works
“This is despite the importance people with AN commonly place on judgements of close others (Sternheim et al., 2011).”
BackgroundInfluentialSelf-citationIoannidis, K., Hook, R. W., Grant, J. E., Czabanowska, K., Román-Urrestarazu, A., & Chamberlain, S. R. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.11.004 · Cited by 28 · see citing works
“…research, that obsessional preoccupation with food and food predominance, as well as and intolerance to uncertainty manifesting with deficits in social decision making, planning and action, as well as fear of unduly evaluation from others (Davis and Kaptein, 2006; Sternheim et al., 2011a, 2011b).”
Sternheim, L., Danner, U., van Elburg, A., & Harrison, A. (2020) · Brain and Behavior · doi:10.1002/brb3.1588 · Cited by 24 · see citing works
Self-citationIntolerance of uncertainty in body dysmorphic disorder
Summers, B. J., Matheny, N. L., Sarawgi, S., & Cougle, J. R. (2015) · Body Image · doi:10.1016/j.bodyim.2015.11.002 · Cited by 23 · see citing works
Kesby, A., Maguire, S., Vartanian, L. R., & Grisham, J. R. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.101492 · Cited by 23 · see citing works
“Considerable evidence attests to the strong psychometric properties of the PSWQ, including good test–retest reliability, convergent validity (Molina & Borkovec, 1994) and excellent internal consistency among HCs (α=0.90) and anxious samples (α=0.93; Brown, Antony, & Barlow, 1992).”
BackgroundResultInfluentialKonstantellou, A., Hale, L. S., Sternheim, L. C., Simic, M., & Eisler, I. (2019) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-019-00652-5 · Cited by 23 · see citing works
Self-citationCognitive processes across anxiety disorders related to intolerance of uncertainty: Clinical review
Haegen, M. V., & Étienne, A.-M. (2016) · Cogent Psychology · doi:10.1080/23311908.2016.1215773 · Cited by 22 · see citing works
Systematic information processing style and perseverative worry
Dash, S. R., Meeten, F., & Davey, G. C. L. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.08.007 · Cited by 21 · see citing works
Konstantellou, A., Sternheim, L. C., Hale, L. S., Simic, M., & Eisler, I. (2021) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-021-01256-8 · Cited by 20 · see citing works
Self-citationIntolerance of Uncertainty and Eating Disorder Symptoms Over the Course of Intensive Treatment
Reilly, E. E., Perry, T. R., Brown, T. A., Wierenga, C. E., & Kaye, W. H. (2021) · Behavior Therapy · doi:10.1016/j.beth.2020.09.002 · Cited by 19 · see citing works
“…individuals with restrictive EDs reported using dietary restriction as a coping mechanism for dealing with uncertainty (Konstantellou et al., 2019; Sternheim et al., 2011), and one other study suggests that IU is related to increased engagement in ED-relevant and general safety behaviors (Waller…”
Food vs money? Effects of hunger on mood and behavioral reactivity to reward in anorexia nervosa
Piccolo, M., Milos, G. F., Bluemel, S., Schumacher, S., Mueller‐Pfeiffer, C., Fried, M., Monique Ernst, D., & Martin-Söelch, C. (2018) · Appetite · doi:10.1016/j.appet.2018.12.017 · Cited by 17 · see citing works
Garcia, D., Granjard, A., Lundblad, S., & Archer, T. (2017) · PeerJ · doi:10.7717/peerj.3801 · Cited by 16 · see citing works
Sternheim, L. C., & Harrison, A. (2018) · Cogent Psychology · doi:10.1080/23311908.2018.1441594 · Cited by 16 · see citing works
Self-citationSocial perception in people with eating disorders
Renwick, B., DeJong, H., Kenyon, M., Samarawickrema, N., Loomes, R., Watson, C., Ghelani, S., & Schmidt, U. H. (2013) · European Psychiatry · doi:10.1016/j.eurpsy.2013.03.004 · Cited by 15 · see citing works
“004 relationships [42] and those with AN have impaired social problem-solving abilities [43].”
BackgroundSelf-citationDrinkwater, D., Holttum, S., Lavender, T., Startup, H. M., & Oldershaw, A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.868586 · Cited by 14 · see citing works
“This paper’s account of the process of acceptance and expression of an authentic and emotional self in intraand interpersonal relationships corroborates suggestions that learning to get alongside rather than avoid anxiety processes, such as emotional uncertainty and self-doubt, is an important step toward reducing rel…”
BackgroundSelf-citationProactive inhibition: An element of inhibitory control in eating disorders
Bartholdy, S., Campbell, I. C., Schmidt, U. H., & O’Daly, O. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.08.022 · Cited by 14 · see citing works
Self-citationBijsterbosch, J. M., Keizer, A., Boelen, P. A., van den Brink, F., & Sternheim, L. C. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00647-1 · Cited by 13 · see citing works
“Several studies reported significantly higher degrees of IU in AN, relative to the control group, as well as strong associations between higher IU and more severe eating disorder symptoms [10, 27, 59].”
BackgroundSelf-citationWard, A., Eng, C., McCue, V. Y., Clyde, N. G. G. A., Stewart, R., Grampian, N., Strain, K., McCormack, B. G., Dukhu, S., Thomas, J., et al. (2018) · International Practice Development Journal · doi:10.19043/ipdj.82.003 · Cited by 13 · see citing works
Brosof, L. C., Egbert, A. H., Reilly, E. E., Wonderlich, J. A., Karam, A. M., Vanzhula, I. A., Steward, T., & Levinson, C. A. (2019) · Eating Behaviors · doi:10.1016/j.eatbeh.2019.101340 · Cited by 14 · see citing works
Sternheim, L. C., Bijsterbosch, J. M., Wever, M. C. M., Elburg, A. A. V., & Frank, G. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.12.035 · Cited by 12 · see citing works
Self-citationHasenack, B., Sternheim, L. C., Bijsterbosch, J. M., & Keizer, A. (2021) · Journal of Experimental Psychopathology · doi:10.1177/2043808721997632 · Cited by 11 · see citing works
“We also expected that AN patients would show higher levels of trait anxiety than HC (Sternheim et al., 2011).”
BackgroundSelf-citationThe role of intolerance of uncertainty and anxiety on compulsive exercise in adolescents
Cuesta-Zamora, C., Ricarte, J. J., Ros, L., Latorre, J. M., & Plateau, C. R. (2023) · Anxiety Stress & Coping · doi:10.1080/10615806.2023.2188204 · Cited by 10 · see citing works
Perceptions of control and disordered eating behaviors during college transitions
Sarra, S., & Abar, C. C. (2020) · Journal of American College Health · doi:10.1080/07448481.2020.1842745 · Cited by 10 · see citing works
“It was found that decreased life satisfaction was associated with graduation concerns of loss and change, as well as career-related concerns.(16) This suggested that those who feel less certain of their career path and less accepting of change will be less satisfied with their life after college.”
BackgroundResultHyde-Smith, C., Carey, H., & Steward, T. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01138-1 · Cited by 10 · see citing works
“As a consequence, they may then engage with ED behaviours to cope with this distress [20].”
BackgroundUnderstanding implicit and explicit learning in adolescents with and without anorexia nervosa
Sternheim, L. C., Wickham, M. I., Danner, U. N., Maddox, T., Filoteo, J. V., Shott, M. E., & Frank, G. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00431-7 · Cited by 10 · see citing works
Self-citationBijsterbosch, J. M., Keizer, A., Boelen, P. A., van den Brink, F., Danner, U. N., & Sternheim, L. C. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00523-4 · Cited by 8 · see citing works
“, the monster under the bed in childhood to more broader psychopathological issues such as the fear of rejection or the fear of being evaluated negatively in puberty [45, 64].”
BackgroundResultInfluentialSelf-citationIannattone, S., Cerea, S., Carraro, E., Ghisi, M., & Bottesi, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116886 · Cited by 8 · see citing works
A tradeoff between safety and freedom: Adults’ lived experiences of ARFID
Fischer, M. M. R., & Starr, R. A. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01071-3 · Cited by 6 · see citing works
“This sample size is also aligned with the recommendation of Turpin et al. [34] and is commensurate with published IPA research on EDs (e.g., [16, 29]).”
ResultBartholdy, S., Dalton, B., Rennalls, S. J., Kekic, M., McClelland, J., Campbell, I. C., O’Daly, O., & Schmidt, U. H. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-024-01165-y · Cited by 6 · see citing works
“Research has shown that people with AN engage in dietary restriction and behavioural avoidance in efforts to reduce the anxiety and negative feelings caused by uncertainty [15–17] and intolerance of uncertainty has been associated with greater AN symptom severity [18–20].”
Self-citationBehavioral Responses to Uncertainty in Weight-Restored Anorexia Nervosa – Preliminary Results
Piccolo, M., Milos, G. F., Bluemel, S., Schumacher, S., Mueller‐Pfeiffer, C., Fried, M., Monique Ernst, D., & Martin-Söelch, C. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02492 · Cited by 6 · see citing works
Varallo, G., Ciaramidaro, A., Baldini, V., Rubichi, S., & Scorza, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14217728 · Cited by 5 · see citing works
“Our results support the notion that IU may represent a cognitive vulnerability also in eating-related disorders [12,52] since it might exert its influence largely through body dissatisfaction.”
Lived Experiences of Primary Caregivers of Children with Dyslexia: A Phenomenological Study
Peries, N., & Indrarathne, B. (2024) · Indian Journal of Psychological Medicine · doi:10.1177/02537176241274145 · Cited by 5 · see citing works
“34 This also allows for the exploration of their views in an integrated manner, giving rise to different perspectives of the experienced event.”
Charbonnier, É., Montalescot, L., Puechlong, C., Goncalves, A., & Vigouroux, S. L. (2023) · Nutrients · doi:10.3390/nu15234938 · Cited by 5 · see citing works
Sourlier, P., Bozzi, S., Kabuth, B., Lamourette, M., & Ligier, F. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00579-w · Cited by 4 · see citing works
“• Preparation: Patients with anorexia nervosa have difficulty in coping with uncertainty [24, 25].”
BackgroundTranslating Experimental Neuroscience into Treatment of Eating Disorders: Two Examples
Schmidt, U. H., Oldershaw, A., & Elburg, A. A. V. (2010) · Current topics in behavioral neurosciences · doi:10.1007/7854_2010_76 · Cited by 4 · see citing works
“However, qualitative studies in patients with AN uniformly highlight that these patients experience emotions and social interactions as highly problematic (Fox 2009: Kyriacou et al. 2009), experience the perceived uncertainty of social interactions as highly stressful ( Sternheim et al. 2010 ) and believe that overcom…”
BackgroundSelf-citationCuesta-Zamora, C., Stokes, C., Ricarte, J. J., & Plateau, C. R. (2024) · Current Psychology · doi:10.1007/s12144-024-06841-5 · Cited by 3 · see citing works
“Given that previous evidence suggests that eating disorder symptoms could be exacerbated when faced with uncertainty (e.g., Sternheim et al., 2011b), it is hypothesised that participants exposed to the Decreasing IU manipulation will see a reduction in their body weight and body shape concerns,…”
Civilotti, C., Franceschinis, M., Gandino, G., Veglia, F., Anselmetti, S., Bertelli, S., D’Agostino, A., Redaelli, C. A., del Giudice, R., Giampaolo, R., et al. (2022) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe12120124 · Cited by 3 · see citing works
“For example, hyperfocusing on food, diet, weight, and body shape; excessive exercise and elimination behaviors; and adopting metacognitive processes, such as rumination, are some of the behaviors that affected individuals use in an attempt to divert attention away from emotional content [12,13].”
BackgroundEating disorder symptoms and control‐seeking behavior
Slanina-Davies, A., Robinson, O. J., & Pike, A. C. (2023) · Brain and Behavior · doi:10.1002/brb3.3105 · Cited by 2 · see citing works
Are you how you eat? Aspects of self-awareness in eating disorders
Coutinho, B. D. M. C., Pariz, C. G., Krahe, T. E., & Mograbi, D. C. (2024) · Personality Neuroscience · doi:10.1017/pen.2024.2 · Cited by 3 · see citing works
Barriers to Engagement in Compassionate Mind Training as Continued Professional Development
Phillips, E., Wood, W., Montague, J., & Maratos, F. A. (2025) · Mindfulness · doi:10.1007/s12671-025-02619-3 · Cited by 2 · see citing works
“A focus group approach was chosen, as focus groups are useful for conducting research with participants who are already used to sharing experiences (Sternheim et al., 2011).”
L’intolérance à l’incertitude dans le contexte de la douleur chronique
Trudel, P., & Cormier, S. (2022) · Douleurs Évaluation - Diagnostic - Traitement · doi:10.1016/j.douler.2022.02.004 · Cited by 2 · see citing works
Zhang, J. (2024) · Phenomenology and the Cognitive Sciences · doi:10.1007/s11097-024-09975-w · Cited by 2 · see citing works
Martin, M. (2015) · TopSCHOLAR (Western Kentucky University) · Cited by 2 · see citing works
Exposure to the fashion industry: a design student perspective
Brewer, G., & Hunt, C. (2017) · International Journal of Fashion Design Technology and Education · doi:10.1080/17543266.2017.1298159 · Cited by 1 · see citing works
Dixit, U., Barnhart, W. R., Henderson, R. R., Larsen, J. D., Folk, E. G., & Ahlich, E. M. (2025) · Appetite · doi:10.1016/j.appet.2025.108419 · Cited by 1 · see citing works
Zahrayi, T., Saed, O., & Lauriola, M. (2023) · Trends in Psychology · doi:10.1007/s43076-023-00256-0 · Cited by 1 · see citing works
“Emerging evidence supports the involvement of IU in eating disorders (Sternheim et al., 2011), posttraumatic stress (Fetzner et al., 2013), autism spectrum disorders (Boulter et al., 2014), delayed grief (Boelen, 2010), and hoarding behaviors (Wheaton & Ward, 2020).”
Investigating the utility of a self-schema model of perfectionism in understanding anorexia nervosa
Wearne, C. (2014) · The Sydney eScholarship Repository (The University of Sydney)
Behavioral Measurement of Intolerance of Uncertainty in Anxiety Disorders
Jacoby, R. J. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/qwgs-ev68
Haegen, M. V., & Étienne, A.-M. (2016)
Examining the maintaining factors of anorexia nervosa
Aberdeen, P. (2013) · The Atrium (University of Guelph)
Exploring the Role of Counselling in Young Women’s Healing from Disordered Eating
Zurevinski, J. (2016) · University Library - University of Saskatchewan (University of Saskatchewan)
Ioannidis, K. (2022) · doi:10.26481/dis.20220623ki
Body image disturbances following recovery from anorexia nervosa
Engel, M. M. (2024) · doi:10.33540/1671
Analysis of some personality characteristics and emotional state of patients with anorexia nervosa
Pakhomova, S., Chelyshkova, A. K., Pakhomova, E. V., & Barylnik, Y. B. (2024) · Vestnik nevrologii psihiatrii i nejrohirurgii (Bulletin of Neurology Psychiatry and Neurosurgery) · doi:10.33920/med-01-2412-06
Downes, P. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1623166 · Cited by 1 · see citing works
“You can ’ t explain to somebody what the feeling is like; you can ’ t explain it to yourself let alone to somebody else ” [ (66), pp. 15 – 16].”
Koob, G., Becker, C. B., Hazzard, V. M., Varzeas, K. A., Wesley, N. Y., Rowan, M. R., & Stewart, T. M. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01703-w
“The authors of this review suggest that IU could be a mechanism particularly underlying AN symptoms, as patients with this diagnosis more strongly endorse negative beliefs surrounding uncertainty and psychological rigidity relative to BN and other EDs [9, 10].”
Sipilä, A. (2013) · Tampere University Institutional Repository (Tampere University)
- Authors
- Sternheim, L., Konstantellou, A., Startup, H., & Schmidt, U.
- Affiliations
- King's College London (GB)
- Corresponding author
- Sternheim, Lot
- Venue
- European Eating Disorders Review
- Publisher
- Wiley
- Published
- 2010-12-22
- Volume
- 19
- Issue
- 1
- Pages
- 12-24
- ISSN
- 1072-4133 (ISSN-L)
- 1099-0968
- OpenAlex
- W2157967363
- Cited by
- 91
- References
- 43
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 8 · 2023: 5 · 2022: 9 · 2021: 5 · 2020: 4 · 2019: 7 · 2018: 4 · 2017: 10 · 2016: 6 · 2015: 6 · 2014: 5 · 2013: 5 · 2012: 5
- FWCI
- 5.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Eating Disorders Review (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- anorexia nervosa, intolerance of uncertainty, uncertainty, women, fear of negative evaluation, perfectionism, anxiety, perceived control, eating disorder treatment, patient experience
- MeSH terms
- Adolescent, Adult, Anorexia Nervosa, Cognition, Emotions, Female, Humans, Middle Aged, Self Concept, Stress, Psychological, Focus Groups, Uncertainty, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
