Intolerance of Uncertainty in Eating Disorders: A Systematic Review and Meta‐Analysis

Abstract

Intolerance of uncertainty is an empirically supported transdiagnostic construct that may have relevance in understanding eating disorders. We conducted a meta-analysis and systematic review of intolerance of uncertainty in eating disorders using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We calculated random-effects standardised mean differences (SMD) for studies utilising the Intolerance of Uncertainty Scale (IUS) and summarised additional studies descriptively. Women with eating disorders have significantly higher IUS scores compared with healthy controls (SMD = 1.90; 95% C.I. 1.24 to 2.56; p < 0.001). Post hoc meta-analysis revealed significant differences when comparing women with anorexia nervosa with controls (SMD = 2.16; 95% C.I. 1.14 to 3.18; p < 0.001) and women with bulimia nervosa with controls (SMD = 2.03; 95% C.I. 1.30 to 2.75; p < 0.001). Our synthesis of findings suggests that intolerance of uncertainty may represent a vulnerability and maintenance factor for eating disorders and potential target of cognitive, behavioural, interoceptive and affective symptoms. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Food vs money? Effects of hunger on mood and behavioral reactivity to reward in anorexia nervosa

“…Furthermore, a wide range of research has shown intolerance of uncertainty (IU) among patients with eating disorders (Brown et al, 2017), stating, for instance, that uncertainty is strongly avoided (Sternheim, Konstantellou, Startup, & Schmidt, 2011) in AN. Intolerance to uncertainty (IU), as any broad concept, may have different definitions, depending on the context in which the term is used.…”

“…Accordingly, IU influences affective, cognitive and behavioral responses to uncertain situations (Heimberg, Turk, & Mennin, 2004). IU in anorexia nervosa and other eating disorders has been evidenced mostly by means of self-reported questionnaires (Brown et al, 2017), and not more directly via behavioral measures . Still, compared to healthy controls, AN cared more about being successful in choices with uncertainty .…”

Doubt and fear of self in bulimia nervosa

“…These findings are consistent with results found in previous research with OCD samples (Aardema et al, ; Nikodijevic et al, ). Furthermore, in a recent meta‐analysis on the topic of intolerance of uncertainty, a construct that is related to doubt but is conceptually different, Brown, et al () reviewed several articles pointing to differences in decision‐making under conditions of uncertainty. These findings are in line with those of the present study.…”

Mental contamination: Relationship with psychopathology and transdiagnostic processes

“…In a large analogue sample, intolerance of uncertainty was found to mediate the relationship between perfectionism and OCD (Reuther et al, 2013). It is also elevated in people with eating disorders (Brown et al, 2017).…”