The importance of uncertainty across the stages of an eating disorder: A mixed methods investigation

Abstract Background Intolerance of uncertainty (IU; a bias towards perceiving uncertain situations as negative and frightening) is proposed to contribute to a range of eating disorder (ED) symptoms. The aim of the present study was to investigate the perceived role of uncertainty in relation to different ED stages and thought processes, exploring any differences depending on type of uncertainty (life events versus everyday experiences). Methods Participants with experience of an ED ( n =61) and mental health professionals (MHPs) who treat them ( n =11) completed a bespoke measure comprised of Likert scale items and corresponding open-text questions about how they believe uncertainty influences the development, maintenance, relapse, and thought processes in EDs, and how uncertainty is addressed in treatment. Participants in the ED group also completed the Intolerance of Uncertainty Scale (IUS-12) to assess general IU. Quantitative data were analyzed using correlations and t tests. Open-text responses were analyzed using a hybrid inductive-deductive reflexive thematic analysis. Results Quantitative analyses showed that individuals who have experienced an ED believe that (a) different types of uncertainty play distinct roles in their disordered eating, and (b) uncertainty plays a greater role in some ED stages than in others. MHPs were less likely to distinguish the different roles of uncertain life events versus everyday uncertainty across the different ED stages. The analytical process yielded the following themes: 1) the socio-temporal architecture of uncertainty, 2) cognitive, physical, and emotional experiences of uncertainty, 3) the utility of disordered eating, and 4) asymmetry in clinical practice and patient perception. These themes were observed in both ED and MHP responses, but differences were conceptualized in the theme relating to how uncertainty is addressed in treatment. MHPs were more likely than ED participants to believe that uncertainty was addressed in treatment. Conclusions The present study’s findings highlight the function of disordered eating behaviors in coping with uncertainty, particularly to foster feelings of control. Additionally, findings also highlight the potential for improving ED treatment and understanding by creating predictable treatment environments, informing MHPs about the nuanced role of uncertainty in disordered eating, and explicitly addressing uncertainty in relapse prevention plans.