An investigation of uncertainty and intolerance of uncertainty and associated factors in anorexia nervosa

Student thesis: Doctoral ThesisDoctor of Philosophy


Anorexia nervosa is a serious and complex mental illness, where little is known of factors implicated in its maintenance. Current effective treatments for adolescent anorexia nervosa have shown promising outcomes, however a significant group of patients still remain unwell. One factor that contributes to a poor treatment outcome is comorbid anxiety. However, there is a lack of knowledge of anxiety related vulnerability factors in individuals with anorexia nervosa. A potentially useful anxiety related factor is intolerance of uncertainty (IU). Theoretically and clinically IU could be associated with eating disorder psychopathology and the need for control, often found in individuals with anorexia nervosa.

This thesis comprises of a conceptual model of IU in anorexia nervosa, four studies that empirically examine IU and associated factors in relation to anorexia nervosa and a proposed future study. The first quantitative study investigates anxiety related factors in adults with anorexia nervosa and healthy controls. The two subsequent qualitative studies explore the meaning of uncertainty for adolescents with anorexia nervosa and their parents. The fourth study examines anxiety related factors in adolescents with anorexia nervosa, similar to study 1, and further investigates whether such factors along with beliefs about having an eating disorder and parental distress moderate/mediate response to treatment.

Findings, suggest that IU and anxiety related factors are elevated in adults and adolescents with anorexia nervosa compared to the normal population and are positively associated with eating disorder psychopathology. Personal accounts from adolescents further reveal that IU is predominately a negative experience, while parents find uncertainty in relation to their child’s illness excessive and a source of distress. Results from the fourth study indicate that ambivalence in adolescents at the beginning of therapy predicts response to treatment. This thesis has brought to the forefront the construct of IU as a possible maintenance factor of anorexia nervosa. Data are discussed in relation to the proposed model of IU in anorexia nervosa and both theoretical and clinical implications are discussed.
Date of Award2014
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorIvan Eisler (Supervisor) & Janet Treasure (Supervisor)

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