BY: Katherine Schaumberg, PhD

DATE: 13 September 2017

In recent years, one concept that has received support as a risk factor for many psychological difficulties, including some eating disorders, is “intolerance of uncertainty.” People typically prefer to know the outcome of events, and we often go to great lengths to be sure that nothing bad will happen and that everything will turn out as we had hoped. Unfortunately, life is often unpredictable and even when we think we know what will happen, it is impossible to be 100% sure. Two recent scientific articles were published both reporting that intolerance of uncertainty is often elevated in individuals with eating disorders. This suggests that scientific investigations of psychological treatments that directly address intolerance of uncertainty could be a useful area for future research^(1,2).

Checking up on things may relieve distress in the short term; in many instances, double checking and reducing uncertainty can help us in our daily lives. For instance, we may feel more comfortable going to a party if we know who will be there when we show up.  Or we may feel more comfortable going to a restaurant if we review the menu online first. Sometimes, however, it is very difficult to be certain, and a desire for certainty can interfere with relationships and work. While seeking out reassurance may be helpful in the short-term, it also has the potential to get in the way of the life that we want to live. Using the party scenario, if we were uncertain about who will be at a party, we could ask the host for a list of everyone that is coming. Even if the host begrudgingly gave you the list, it is possible that some of them will not attend as planned or that uninvited guests will show up. Constantly checking with your friend about who will be at the party could eventually interfere with your relationship with that person.

On average, individuals who struggle with anxiety and eating disorders have greater intolerance of uncertainty than their peers; however, tolerating uncertainty is a skill that can be learned and practiced. One way to practice tolerating uncertainty is to write down ways in which you seek reassurance, double check, procrastinate, or avoid situations entirely. You can then rank those behaviors according to anxiety and pick small items to practice tolerating uncertainty in your daily life. This might mean something like going to a party without knowing who else might show up, seeing a movie without looking at the reviews, or going to a restaurant without checking the menu first. Notice what comes up in your mind, including uncomfortable thoughts, feelings, and sensations. Practicing tolerating uncertainty will most likely be uncomfortable, but this practice may also open doors to valuable life experiences and relationships.

1. Brown M, Robinson L, Campione GC, Wuensch K, Hildebrandt T, Micali N. Intolerance of Uncertainty in Eating Disorders: A Systematic Review and Meta-Analysis. Eur Eat Disord Rev 2017
2. Kesby A, Maguire S, Brownlow R, Grisham JR. Intolerance of Uncertainty in eating disorders: An update on the field. Clin Psychol Rev 2017;56:94-105.