Intolerance of uncertainty in eating disorders: an update on the field

Kesby, Alice; Maguire, Sarah; Brownlow, Rachel; Grisham, Jessica R.

doi:10.1016/j.cpr.2017.07.002

Cited by 83Eating Disorders and BehaviorsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesNutrition, Health and Food Behavior

Intolerance of uncertainty in eating disorders: an update on the field

Kesby, Alice, Maguire, Sarah, Brownlow, Rachel, Grisham, Jessica R.·2017·Clinical Psychology Review

DOI 10.1016/j.cpr.2017.07.002

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Abstract

Pathological fear and anxiety regarding food, eating, weight and body shape are at the core of eating disorder (ED) psychopathology. To manage anxiety, patients develop complicated repertoires of ritualistic and repetitive behaviours, which can lead to total functional impairment. Yet the cognitive processes underlying anxiety, fear, and anxiety-driven behaviours in EDs remain poorly understood. Intolerance of Uncertainty (IU) is defined as a tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events. There is substantial evidence that IU is a transdiagnostic process that contributes to the maintenance of anxiety disorders; however, IU may also be relevant to the understanding and treatment of EDs. The current review summarises the growing literature examining IU in relation to ED symptoms, including restriction, bingeing, purging, ritualised behaviours, reassurance-seeking and body checking. Extending from the obsessive-compulsive disorder (OCD) and anxiety disorder literature, we propose that IU provides a novel theoretical and clinical framework from which to understand the anxiety, fixation with rules and rituals, and the cognitively rigid profile that is characteristic of ED presentations. We conclude with suggestions for future research, and discuss IU as a potential treatment target for core features of EDs and comorbid symptoms.

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Intolerance of uncertainty is highly prevalent in individuals with eating disorders.
“As intolerance of uncertainty is highly prevalent in individuals with EDs (Brown et al., 2017; Kesby, Maguire, Brownlow, & Grisham, 2017)”
From Eating disorders in times of the <scp>COVID</scp>‐19 pandemic—Results from an online survey of patients with anorexia nervosa (2020) · cites this paper as Kesby, Maguire, Brownlow, & Grisham, 2017
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 Kesby, Maguire, Brownlow, & Grisham, 2017
Eating disorder stereotyped behaviors play a role in controlling anxiety levels and in managing negative emotions.
“It is well-known that ED-stereotyped behaviors play a role in controlling anxiety levels and in managing negative emotions (Kesby et al., 2017).”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Kesby et al., 2017

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Serotonin Function and Human Anxiety Disordersa
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A pilot case series using qualitative and quantitative methods: Biological, psychological and social outcome in severe and enduring eating disorder (anorexia nervosa)
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Eating behavior among women with anorexia nervosa
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Trait versus situation-specific intolerance of uncertainty in a clinical sample with anxiety and depressive disorders
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What does uncertainty mean to women with anorexia nervosa? An interpretative phenomenological analysis
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Binge eating disorder: To be or not to be in DSM-IV
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Comparing views of patients, parents, and clinicians on emotions in anorexia
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What’s in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder*
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Anxiety in anorexia nervosa and its management using family-based treatment.
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Intolerance of uncertainty mediates the relationship between responsibility beliefs and compulsive checking
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Maintaining change following eating disorder treatment.
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Anorexia nervosa: Towards an integrative neuroscience model
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Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why
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Pathways from uncertainty to anxiety: An evaluation of a hierarchical model of trait and disorder-specific intolerance of uncertainty on anxiety disorder symptoms
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Dissecting the Core Fear in Anorexia Nervosa: Can We Optimize Treatment Mechanisms?
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Intolerance of uncertainty and obsessive-compulsive symptom expression
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Severe and Enduring Eating Disorder (SEED): Management of Complex Presentations of Anorexia and Bulimia Nervosa
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Extinction theory & anorexia nervosa: Deepening therapeutic mechanisms
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Developing scales measuring disorder-specific intolerance of uncertainty (DSIU): a new perspective on transdiagnostic
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A further assessment of decision-making in anorexia nervosa
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Cognitive factors predicting checking, procrastination and other maladaptive behaviours: prospective versus inhibitory intolerance of uncertainty
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Intolerance of uncertainty and metacognitions in a non-clinical sample with problematic and normal eating attitudes
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Cognitive-behavioral treatment of generalized anxiety disorder among adolescents: A case series
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Risk factors for maladaptive eating patterns in college women
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A qualitative study of the investigation of reassurance seeking in obsessive–compulsive disorder
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Genetic Association of Recovery from Eating Disorders: The Role of GABA Receptor SNPs
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Stomaching uncertainty: Relationships among intolerance of uncertainty, eating disorder pathology, and comorbid emotional symptoms
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Abnormal eating behavior in video-recorded meals in anorexia nervosa
Gianini, L. M., Liu, Y., Wang, Y., Attia, E., Walsh, B. T., & STEINGLASS, J. E. (2015) · Eating Behaviors · doi:10.1016/j.eatbeh.2015.06.005 · Cited by 40 · see citing works
A pilot investigation of cognitive therapy for generalized anxiety disorder in children aged 7–17 years
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The Relationship between Alexithymia and Intolerance of Uncertainty in Anorexia Nervosa
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Testing a cognitive model of generalized anxiety disorder in the eating disorders.
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Using neuropsychological feedback therapeutically in treatment for anorexia nervosa: two illustrative case reports
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Cognitive flexibility mediates the relation between intolerance of uncertainty and safety signal responding in those with panic disorder
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Anxiety-related processes in anorexia nervosa and their relation to eating disorder pathology, depression and anxiety
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Cognitive Change During Treatment of Compulsive Checking
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Domain-Specific Intolerance of Uncertainty in Socially Anxious and Contamination-Focused Obsessive–Compulsive Individuals
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Mussell (1997) · doi:10.1002/(sici)1098-108x(1997)21:4

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The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: a meta-analysis
McEvoy, P. M., Hyett, M. P., Shihata, S., Price, J. E., & Strachan, L. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2019.101778 · Cited by 271 · see citing works
Eating disorders in times of the <scp>COVID</scp>‐19 pandemic—Results from an online survey of patients with anorexia nervosa
Schlegl, S., Maier, J., Meule, A., & Voderholzer, U. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23374 · Cited by 258 · see citing works
Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research
Schaumberg, K., Reilly, E. E., Gorrell, S., Levinson, C. A., Farrell, N. R., Brown, T. A., Smith, K. M., Schaefer, L. M., Essayli, J. H., Haynos, A. F., et al. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101952 · Cited by 121 · see citing works
“Specifically, increased anxiety in EDs may enhance uncertainty regarding one’s weight trajectory and recovery (Kesby et al., 2017), and ED symptoms may serve as a way of coping with uncertain situations (M.”
Background
Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention
Cooper, M., Reilly, E. E., Siegel, J. A., Coniglio, K., Sadeh-Sharvit, S., Pisetsky, E. M., & Anderson, L. M. (2022) · Eating Disorders · doi:10.1080/10640266.2020.1790271 · Cited by 209 · see citing works
“Research suggests ED behaviors may function to reduce anxiety and distress associated with uncertain situations or outcomes (for example, restricting to reduce the risk of potential weight gain; Brown et al., 2017; Kesby et al., 2017).”
Background
Orthorexia and Orthorexia Nervosa: A Comprehensive Examination of Prevalence, Risk Factors, Diagnosis, and Treatment
Horovitz, O., & Argyrides, M. (2023) · Nutrients · doi:10.3390/nu15173851 · Cited by 98 · see citing works
“Additionally, the influence of stress and life transitions may trigger the onset or escalation of these disorders, as the perceived need for control over one’s diet and health may intensify during times of uncertainty [43].”
Background
Eating disorder pathology and compulsive exercise during the <scp>COVID</scp>‐19 public health emergency: Examining risk associated with <scp>COVID</scp>‐19 anxiety and intolerance of uncertainty
Scharmer, C., Martinez, K., Gorrell, S., Reilly, E. E., Donahue, J. M., & Anderson, D. A. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23395 · Cited by 79 · see citing works
Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review
Miniati, M., Marzetti, F., Palagini, L., Marazziti, D., Orrù, G., Conversano, C., & Gemignani, A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.663376 · Cited by 61 · see citing works
Interoception and Its Role for Eating, Obesity, and Eating Disorders
Herbert, B. M. (2020) · European Journal of Health Psychology · doi:10.1027/2512-8442/a000062 · Cited by 59 · see citing works
Keep your interoceptive streams under control: An active inference perspective on anorexia nervosa
Barca, L., & Pezzulo, G. (2020) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-020-00777-6 · Cited by 54 · see citing works
“, 2000) – is now considered a transdiagnostic vulnerability factor of different pathologies (Kesby et al., 2017) and of emotional disorders on the whole (Shihata et al.”
Background
Mediating effect of intolerance of uncertainty in the relationship between coping styles with stress during pandemic (COVID-19) process and compulsive buying behavior
Çelik, S., & Köse, G. G. (2021) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2021.110321 · Cited by 47 · see citing works
“Studies show that the IU level is directly related to different psychopathologies such as anxiety, depression, and panic disorder (Dugas and Ladouceur, 2000; Kesby et al., 2017).”
Background
Treatment outcome reporting in anorexia nervosa: time for a paradigm shift?
Murray, S. B., Loeb, K. L., & Grange, D. L. (2018) · Journal of Eating Disorders · doi:10.1186/s40337-018-0195-1 · Cited by 42 · see citing works
“, shape and weight disturbance, to include other more transdiagnostic mechanisms such as intolerance of uncertainty and even purported endophenotypic features such as cognitive rigidity [12, 13].”
Affect and worry during a checking episode: A comparison of individuals with symptoms of obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, body dysmorphic disorder, illness anxiety disorder, and panic disorder
Hartmann, A. S., Cordes, M., Hirschfeld, G. H. F., & Vocks, S. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.132 · Cited by 36 · see citing works
Mediating the relationship between neuroticism and depressive, anxiety and eating disorder symptoms: The role of intolerance of uncertainty and cognitive flexibility
Clarke, E., & Kiropoulos, L. A. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100101 · Cited by 36 · see citing works
The calorie counter-intuitive effect of restaurant menu calorie labelling
McGeown, L. (2019) · Canadian Journal of Public Health · doi:10.17269/s41997-019-00183-7 · Cited by 32 · see citing works
‘In an otherwise limitless world, I was sure of my limit.’† Experiencing Anorexia Nervosa: A phenomenological metasynthesis
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
“The need for control is well-established in AN and is associated with high degrees of intolerance of uncertainty (30, 88, 106).”
BackgroundSelf-citation
Functional connectivity of the anterior insula associated with intolerance of uncertainty in youth
DeSerisy, M., Musial, A., Comer, J. S., & Roy, A. K. (2020) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-020-00780-x · Cited by 28 · see citing works
Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa?
Sternheim, L., Danner, U., van Elburg, A., & Harrison, A. (2020) · Brain and Behavior · doi:10.1002/brb3.1588 · Cited by 24 · see citing works
“Results do suggest a specific role for IU, which corroborates IU as a transdiagnostic factor, relevant to AN (Kesby et al., 2017).”
Background
Altered Reinforcement Learning from Reward and Punishment in Anorexia Nervosa: Evidence from Computational Modeling
Wierenga, C. E., Reilly, E. E., Bischoff‐Grethe, A., Kaye, W. H., & Brown, G. G. (2021) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617721001326 · Cited by 25 · see citing works
“Clinically, AN is characterized by increased sensitivity to uncertainty (Kesby, Maguire, Brownlow, & Grisham, 2017).”
Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample
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
“…a relationship between elevated IU and difficulties with decision making (Carleton et al., 2016c; Luhmann, Ishida, & Hajcak, 2011), our results support the notion that IU may represent a vulnerability factor for the inflexible cognitive profile seen in AN (Kesby et al., 2017; Merwin et al., 2011).”
Self-citation
Identity formation and psychopathological symptoms in adolescence: Examining developmental trajectories and co-development
Raemen, L., Claes, L., Palmeroni, N., Buelens, T., Vankerckhoven, L., & Luyckx, K. (2022) · Journal of Applied Developmental Psychology · doi:10.1016/j.appdev.2022.101473 · Cited by 24 · see citing works
Could repetitive negative thinking interfere with corrective learning? The example of anorexia nervosa
Reilly, E. E., Lavender, J. M., Berner, L. A., Brown, T. A., Wierenga, C. E., & Kaye, W. H. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22997 · Cited by 22 · see citing works
“…by a temperamental profile involving aversion to novelty, elevated sensitivity to punishment, and intolerance of uncertainty (Brown et al., 2017; Harrison, O'Brien, Lopez, & Treasure, 2010; Kaye, Wierenga, Bailer, Simmons, & Bischoff-Grethe, 2013; Kesby, Maguire, Brownlow, & Grisham, 2017).”
Cannabis use among early adolescents and transdiagnostic mental health risk factors
Moreno-Mansilla, S., Ricarte, J. J., & Hallford, D. J. (2021) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104521994637 · Cited by 23 · see citing works
“However, this research seems crucial, given that IU may also be related to cannabis use for the same purposes, and an underlying transdiagnostic predictor of different mental disorders (Gillet et al., 2018; Kesby et al., 2017).”
Background
Intolerance 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
“…some empirical and theoretical work that has suggested that purging and exercise behaviors may function to increase certainty (e.g., related to future weight gain) or regulate negative affect secondary to more general uncertainty (Brown et al., 2017; Kesby et al., 2017; Konstantellou et al., 2019).”
Blind versus open weighing from an eating disorder patient perspective
Froreich, F. V., Ratcliffe, S. E., & Vartanian, L. R. (2020) · Journal of Eating Disorders · doi:10.1186/s40337-020-00316-1 · Cited by 19 · see citing works
“The rationale for blind weighing includes the desire to minimise anxiety and distress that may result from patients seeing their weight (especially when it increases), reduce the patients’ focus on the specific number on the scale, and expose patients to weight uncertainty [3, 5].”
Background
Temporal Processing of Joyful and Disgusting Food Pictures by Women With an Eating Disorder
Gagnon, C., Bégin, C., Laflamme, V., & Grondin, S. (2018) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2018.00129 · Cited by 17 · see citing works
“…with AN and those of anxious individuals in terms of worries/ruminations, intolerance of uncertainty, fear conditioning, avoidance strategies and reassurance seeking rituals (e.g., Pallister and Waller, 2008; Steinglass et al., 2011; Startup et al., 2013; Guarda et al., 2015; Kesby et al., 2017).”
Background
Personality disorder traits, obsessive ideation and perfectionism 20 years after adolescent-onset anorexia nervosa: a recovered study
Gárriz, M., Andrés-Perpiñá, S., Plana, M. T., Flamarique, I., Romero, S., Julià, L., & Castro-Fornieles, J. (2020) · Eating and Weight Disorders · doi:10.1007/s40519-020-00906-7 · Cited by 10 · see citing works
Back to the future: Progressing memory research in eating disorders
Forester, G., Johnson, J. S., Reilly, E. E., Lloyd, E. C., Johnson, E., & Schaefer, L. M. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.24045 · Cited by 13 · see citing works
Understanding relations between intolerance of uncertainty and body checking and body avoiding in anorexia nervosa
Bijsterbosch, 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
Intolerance of uncertainty moderates the relationship between high personal standards but not evaluative concerns perfectionism and eating disorder symptoms cross-sectionally and prospectively
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
Examining anxious temperament in anorexia nervosa: Behavioural inhibition and intolerance of uncertainty and their contribution to trait anxiety in adolescents with anorexia nervosa
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
Escape the uncertainty by Internet gaming: A serial mediation model of intolerance of uncertainty and Internet Gaming Disorder
Xu, X., Cao, M., Chen, Q., Xu, F., & Zhou, Z. (2024) · Personality and Individual Differences · doi:10.1016/j.paid.2024.112917 · Cited by 12 · see citing works
RETRACTED: Intolerance of Uncertainty Scale-12: Psychometric Properties of This Construct Among Iranian Undergraduate Students
Vadivel, B., Azadfar, Z., Talib, M. A., Mutlak, D. A., Suksatan, W., Abbood, A. A. A., Sultan, M. Q., Allen, K., Patra, I., Hammid, A. T., et al. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.894316 · Cited by 11 · see citing works
Retracted
A qualitative exploration of the lived experiences of Body Dysmorphic Disorder
Brennan, S. N., Rossell, S. L., Rehm, I. C., Thomas, N., & Castle, D. J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1214803 · Cited by 10 · see citing works
The moderating effects of intolerance of uncertainty and social connectedness on college students’ addictive behaviors and mental health symptoms during the COVID-19 pandemic
Wojtaszek, J. A., & Saules, K. K. (2024) · Journal of American College Health · doi:10.1080/07448481.2022.2082848 · Cited by 9 · see citing works
“16 As already discussed, previous studies have made connections between IU, psychological distress, and various symptoms and behaviors 12,16,17 and the impacts are consistent with what we have observed in past epidemics and natural disasters.”
BackgroundResult
The role of intolerance of uncertainty in the acquisition and extinction of reward
Morriss, J., Biagi, N., Lonsdorf, T. B., & Andreatta, M. (2021) · European Journal of Neuroscience · doi:10.1111/ejn.15173 · Cited by 9 · see citing works
Understanding 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
Intolerance of uncertainty and neural measures of anticipation and reactivity for affective stimuli
Wiese, A. D., Lim, S.-L., Filion, D. L., & Kang, S. S. (2022) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2022.11.010 · Cited by 9 · see citing works
How deep is your thought? The relations between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa
Bijsterbosch, 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
“A number of studies reported significantly higher degrees of IU in AN compared to those with other types of eating disorders or healthy controls [10, 39, 64], however research examining IU in children and adolescent girls is scarce [43].”
Background
Broad and Narrow Transdiagnostic Risk Factors in Eating Disorders: A Preliminary Study on an Italian Clinical Sample
Iannattone, 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
Revisiting the Postulates of Etiological Models of Eating Disorders: Questioning Body Checking as a Longer-Term Maintaining Factor
Opladen, V., Vivell, M.-B., Vocks, S., & Hartmann, A. S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.795189 · Cited by 7 · see citing works
Reinforcement Learning and Decision Making in Anorexia Nervosa
Wierenga, C. E., Brown, C. S., & Reilly, E. E. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01643-3 · Cited by 6 · see citing works
“Dimin - ished certainty in exploiting what they learned may reflect their uncertainty in the task contingencies given that AN is often characterized by increased sensitivity to uncertainty [81], although this was not directly tested.”
Exploring the relationship between proactive inhibition and restrictive eating behaviours in severe and enduring anorexia nervosa (SE-AN)
Bartholdy, 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
“People with AN are reported to be less tolerant of uncertainty than healthy individuals [13, 14] and therefore, may exercise proactive inhibition more strongly in the context of uncertainty.”
Movement Toward Dimensional Symptom Models of Comorbid Obsessive–Compulsive Disorder and Eating Disorders
Levinson, C. A., Kapadia, A., Sandoval-Araujo, L. E., Vanzhula, I. A., & Machry, K. (2025) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-081423-020831 · Cited by 6 · see citing works
Modeling and controlling the body in maladaptive ways: an active inference perspective on non-suicidal self-injury behaviors
Laura, B., Maisto, D., & Pezzulo, G. (2023) · Neuroscience of Consciousness · doi:10.1093/nc/niad025 · Cited by 9 · see citing works
Behavioral 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
“Desire for predictability is mostly associated with the anticipation of uncertain situations, while uncertainty paralysis represents a freezing behavior in the face of uncertainty (Kesby et al., 2017).”
Background
Earthquake fear, doomscrolling, anxiety and intolerance of uncertainty: A longitudinal serial mediation study
Özmen, M. (2025) · Journal of Health Psychology · doi:10.1177/13591053251387438 · Cited by 5 · see citing works
“For example, individuals with high intolerance of uncertainty are likely to experience psychological disorders such as anxiety and depression (Comer et al., 2009; Dugas and Ladouceur, 2000; Kesby et al., 2017).”
Eating disorder symptoms and corresponding evidence-based treatments: a narrative review
Ortiz, A. M. L., Peters, A. S., Webber, K. T., Butler, R. M., Fitterman-Harris, H. F., & Levinson, C. A. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-025-01485-7 · Cited by 4 · see citing works
“It has been identified as both a risk and maintenance factor for EDs [31, 37, 147].”
“Holding the line”—relationship building and challenges when nursing adults with a severe eating disorder
Brinchmann, B. S., Moyo, K. R., & Stavnes, K. A. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01155-0 · Cited by 4 · see citing works
Longer-term consequences of increased body checking in women at risk for eating disorders–a naturalistic experimental online study
Geiger, G., Opladen, V., Vivell, M.-B., Vocks, S., & Hartmann, A. S. (2024) · PLoS ONE · doi:10.1371/journal.pone.0316190 · Cited by 4 · see citing works
Do perfectionists show negative, repetitive thoughts facing uncertain situations?
Kummer, K., Mattes, A., & Stähl, J. (2023) · Current Psychology · doi:10.1007/s12144-023-04409-3 · Cited by 4 · see citing works
“One possible framework of explanation for these diverging results is that eating disorders symptoms can be seen as a dysfunctional attempt to reduce anxiety/negative affect and to manage a perceived lack of control through controlling behaviour (Kesby et al., 2017; Renjan et al., 2016).”
Viral Anxiety Should Be Properly Detected and Managed Among Healthcare Workers in Korea During the COVID-19 Pandemic
Park, S. (2022) · Journal of Korean Medical Science · doi:10.3346/jkms.2022.37.e178 · Cited by 4 · see citing works
The role of intolerance of uncertainty on body dissatisfaction and compulsive exercise in female university students: an experimental study
Cuesta-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
“…may be a transdiagnostic feature involved not only in the onset and progression of anxiety processes, but also across several psychological disorders (Carleton, 2016), including body dysmorphic disorder (Summers et al., 2016) and eating disorders (ED) (e.g., Brown et al., 2017; Kesby et al., 2017).”
The psychological effects of blind and open weighing in women with a high drive for thinness: A mixed method inquiry
Froreich, F. V., Vartanian, L. R., Grisham, J. R., & Pinkus, R. T. (2021) · Body Image · doi:10.1016/j.bodyim.2021.09.002 · Cited by 3 · see citing works
Self-citation
Eating 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
Psychometric properties and correlates of the German version of the Fear of Food Questionnaire
Meule, A., Schuchardt, P., & Kolar, D. R. (2025) · Current Psychology · doi:10.1007/s12144-025-08707-w · Cited by 5 · see citing works
“This is in line with results from studies that examined the role of these con - structs in fear of food-related conditions such as emeto-phobia and restrictive eating disorders (Brown et al., 2017, 2022; Kesby et al., 2017; van Overveld et al., 2008; Zhao, 2014).”
Tolerating Uncertainty as a Transdiagnostic Construct and Treatment Target in Functional Motor Disorder
Rush, B. K., Traver, K. J., Geissler, E. N., Travis, M., di Ciccone, B. L., Moutvic, M. A., & Chauhan, M. (2025) · Neurorehabilitation · doi:10.1177/10538135251325460 · Cited by 3 · see citing works
“…of transdiag-nostic anxiety disorders (e.g., Panic Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, Obsessive Compulsive disorder), eating disorder (Kesby et al., 2017), pediatric chronic pain (Soltani et al., 2022), and reactions to the COVID-19 pandemic (Bavolar et al., 2023).”
Psychological functioning of patients with type I diabetes: the relevant role of alexithymia and intolerance to uncertainty
Merlo, E. M., Martino, G., Tutino, R., Myles, L. A. M., Hill, S., Alibrandi, A., Lia, M. C., & Minasi, D. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1667103 · Cited by 2 · see citing works
“Although comprehensive reviews by Kesby and colleagues (177) and Brown and colleagues (135) have examined this relationship in broader contexts, studies explicitly addressing these associations in T1DM are still lacking.”
Thalamocortical dysrhythmia and reward deficiency syndrome as uncertainty disorders
Ridder, D. D., & Vanneste, S. (2024) · Neuroscience · doi:10.1016/j.neuroscience.2024.11.002 · Cited by 2 · see citing works
Psychometric properties of the German version of the Eating Pathology Symptoms Inventory
Meule, A., Ertl, S., Forbush, K. T., Mindrup, L. M., Ehrenthal, J. C., & Kolar, D. R. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01253-7 · Cited by 2 · see citing works
“The largest correlation for intolerance of uncertainty was found with the EPSI’s Body Dissatisfac-tion subscale, which is in line with studies that examined intolerance of uncertainty in persons with eating disorders [50, 51].”
Distress Tolerance and Family Accommodation: Associations in Parents of Young People with Eating Disorder BehavioursPreprint
Zinser, J., Hale, L. S., & Jones, C. J. (2022) · Research Square · doi:10.21203/rs.3.rs-2033435/v1 · Cited by 2 · see citing works
The Paradoxical Effect of Repeated Body Checking on Subjective Uncertainty
Linn, M. B. Z., Kalanthroff, E., & Weinbach, N. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24315 · Cited by 1 · see citing works
Effects of Early Weight Trends on Residential Treatment Outcomes Among Adolescents With Anorexia Nervosa
Singh, S., Gorrell, S., Drury, C. R., Duffy, A., Mehler, P. S., Zucker, K., Grange, D. L., Reilly, E. E., & Rienecke, R. D. (2025) · International Journal of Eating Disorders · doi:10.1002/eat.24480 · Cited by 1 · see citing works
Orthorexia Nervosa: A Pathological Pursuit of Healthy Eating
Mahadevaswamy, M., & Nathawat, S. (2025) · Indian Journal of Psychiatric Nursing · doi:10.4103/iopn.iopn_106_23 · Cited by 1 · see citing works
Worry wart: A preregistered, experimental investigation of worry-induced emotional eating and associated psychological characteristics
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
Uncertainty Meets Disordered Eating and Body Image: A Transdiagnostic Network Study Across Depressive, Anxiety and Anorexia Nervosa Symptoms Including a Control Group
Granero, R., Krug, I., & Kiropoulos, L. A. (2026) · Nutrients · doi:10.3390/nu18091370 · Cited by 1 · see citing works
“Growing evidence suggests that IU also plays a meaningful role in eating disorders [24–26], particularly anorexia nervosa (AN) [27].”
The Effects of Intolerance of Uncertainty and Perfectionism on Worry: The Mediating Effects of Cognitive Avoidance
김슬기, & Kim, E. (2017) · Korean Journal of Health Psychology · doi:10.17315/kjhp.2017.22.4.009 · Cited by 2 · see citing works
Psychometric properties and correlates of the German version of the Fear of Food QuestionnairePreprint
Schuchardt, P., Kolar, D., & Meule, A. (2024) · doi:10.17605/osf.io/438gn
Meanings of Quality: Semantic-Information Distance and Total Quality Management
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Intolerância à incerteza nos transtornos alimentares
Camargos, S. P. D. S. (2021) · doi:10.14393/ufu.di.2021.648
Attitude to Body-Risk Factor or Health Factor in Psychopathology
Izydorczyk, B., Enea, V., Lipowski, M., & Sitnik‐Warchulska, K. (2022) · Frontiers research topics · doi:10.3389/978-2-88976-289-7
Obsessive-Compulsive Related Disorders (OCRD) Across the Lifespan
Prochwicz, K., Löchner, C., & Grünblatt, E. (2023) · Frontiers research topics · doi:10.3389/978-2-8325-3751-0
الأفكار الاجترارية وعلاقتها بالخوف من التعاطف لدي طلاب الجامعة ذوي اضطرابات الاكل
صادق, ن. ت. ا. ج. (2024) · Journal of Educational Sciences - Qena Faculty of Education · doi:10.21608/maeq.2024.337418
A Qualitative Study on the Feasibility and Acceptability of Concealed WeighingPreprint
Siemers, N., Carrière, K., Gao, X., & Knaüper, B. (2025) · Research Square · doi:10.21203/rs.3.rs-6946872/v1
“What I Mean When I Say I Feel Fat”: A Thin Client and a Fat Client Reimagine Approaches to Body Distress in Eating Disorder Treatment
Rinaldi, K., & Robbins, M. (2025) · Women & Therapy · doi:10.1080/02703149.2025.2532432
“Intolerance of uncertainty is a transdiagnostic feature of anxiety disorders and an important feature of eating disorders (Kesby et al., 2017), as those with EDs search for external sources of certainty regarding their internal needs such as hunger, which they find exceedingly difficult to trust…”
Magical contagion beliefs in psychopathology: A review of cognitive mechanisms and maintaining factors
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Additional file 2 of Blind versus open weighing from an eating disorder patient perspective
Froreich, F. V., Ratcliffe, S. E., & Vartanian, L. R. (2020) · Figshare · doi:10.6084/m9.figshare.12814462
Additional file 1 of Blind versus open weighing from an eating disorder patient perspective
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Relationship between obsessive personality traits and eating disorders
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Exploring the role of intolerance of uncertainty and cognitive inflexibility in compulsive exercise in adolescent female athletes and adolescents with eating disorders
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Identity confusion and somatic symptomatology in adolescents and emerging adults: within-person daily associations and the role of negative affect.
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Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample
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The importance of uncertainty across the stages of an eating disorder: A mixed methods investigationPreprint
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Authors: Kesby, A., Maguire, S., Brownlow, R., & Grisham, J. R.
Affiliations: UNSW Sydney (AU)
The University of Sydney (AU)
Corresponding author: Kesby, Alice
ORCID: Maguire, Sarah
Brownlow, Rachel
Grisham, Jessica R.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2017-08
Volume: 56
Pages: 94-105
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2017.07.002
OpenAlex: W2728447522
Cited by: 83
References: 150
Citations by year: 2026: 8 · 2025: 14 · 2024: 8 · 2023: 8 · 2022: 11 · 2021: 10 · 2020: 13 · 2019: 5 · 2018: 4 · 2017: 1
FWCI: 0.97
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
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: intolerance of uncertainty, eating disorders, anxiety, obsessive-compulsive symptoms, ritual behavior, reassurance seeking, body checking, transdiagnostic mechanisms, treatment goals, comorbidities
MeSH terms: Anxiety Disorders, Feeding and Eating Disorders, Humans, Uncertainty

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Intolerance of uncertainty in eating disorders: an update on the field

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