Stress, Tolerating the Unknown & Eating Disorder Development

Woman standing on river rocks

Eating disorders and not all about food. It is often an underlying issue such as anxiety, depression, mood disorders, or trauma that lead a person to cope with symptoms through disordered eating, unhealthy coping behaviors, and obsessive thoughts and worry about body size, shape, and food.

Often the behaviors are about control within the eating disorder with a sense of if food and body can be controlled, so, therefore, can the emotional pain and thoughts of underlying issues.

Quick Overview of Eating Disorders

It is widely known that there are three types of eating disorders, all with their various subtypes.

Anorexia Nervosa, where a person restricts, fasts, and uses compensating behaviors such as over-exercise to keep weight low and is potentially malnourished from extreme dieting routines.

Bulimia Nervosa is where a person will engage in binge and purge episodes for weight loss or management. Other compensating behaviors can also occur through abuse of laxatives, diuretics, and over-exercise as well.

Binge eating is when a person will engage in episodes of binge eating food without any compensating behaviors.

Intolerance of Uncertainty and Research

When an individual is unable to cope with their environment, past, or well-being, it is typically seen as negatively valenced emotional responding, or in other words, being uncertain about controlling the future leads to anxiety [1].

This is also known as Intolerance of Uncertainty (IU) which can lead to anxiety disorders and can lead to eating disorder in attempts to control the anxiety.

Eating disorder behaviors can be seen as a way to control areas of life that feel uncontrollable, and unpredictable, similar to anxiety coping.

A study which was conducted in Colorado on 70 females, age range from 12-45, with anorexia and bulimia and their Intolerance of Uncertainty levels [1].

Those under the age of 18 were assessed through the DISC Predictive Scales, Clinical Diagnostic Interview Schedule for Children, and an assessment of eating disorders. Those over the age of 18 were assessed with the Structured Clinical Interview for DSM-IV-TR and eating disorders.

Self-assessments were conducted around symptomatology of eating disorders, personality traits, depression, and anxiety. Results showed that for both anorexia and bulimic participants, there was increased anxiety and depression. In the anorexic group, there was fear of gaining weight with a drive for thinness.

Both groups also showed high levels of Intolerance of Uncertainty, emotional dysregulation, and traits of obsessive-compulsive disorder.

Intolerance of Uncertainty is seen significantly in anxiety and depression. In another study, 349 women with eating disorders were compared to a control group of women without eating disorders. The researchers compared the groups against their levels of Intolerance of Uncertainty, insecure attachment styles, extraversion, and openness [2].

The eating disorder group scored higher than the control group, had increased rates of insecure attachment and were less extraverted and open that those women without eating disorders.

Woman struggling with relapse walking on rocksThe researchers also found that insecure attachment and lower extraversion could predict higher Intolerance of Uncertainty within the eating disorder group. The study concluded that the rate of IU within those with eating disorders is factored by personality traits and insecure attachment styles.

In Australia, the ambiguity of control within eating disorders was studied in women with anorexia. Using self-reports, participants rated their perception of control, eating disorder symptoms, and obsessive-compulsive behaviors [3].

The researchers were interested in which type of individual self-control was most strongly connected with eating disorders. They found that indeed eating disorder behaviors were associated with fear of losing control.

Influences on Eating Disorder Development

So we know that there is an inability to tolerate feeling out of control, control over situations, and fear of the unknown in clients with eating disorders. There are various influences that contribute to the etiology of these disorders. Risk factors are influences that can help the eating disorder to develop [4]. They do not cause an eating disorder to happen.

There are risk factors for each eating disorder. For all eating disorders, major influences are body dissatisfaction, and internalization of the thin-ideal, history of dieting behaviors, and lack of social supports.

Included in this is social media, now more than in previous decades is social media instant and worldwide. Our youth are becoming exposed to social pressures of thinness, sexuality, and bullying through social media platforms. This area, however, does need further research as we move forward.

Those with anorexia tend to have lower body mass index, but typically have childhood issues with eating and conflicts around food. There may be a history or current issue with meal time, and/or a sport with an emphasis on thinness or body shape and size.

Individuals who struggle with bulimia is also the thin ideal internalization, social pressures, body dissatisfaction, and dieting behaviors. Other factors can include substance or alcohol use, comorbid mental health concerns, and early onset of puberty.

Biological influences play a role where chemicals within the brain that are responsible for hunger cues, fullness and satiety, appetite control, and digestion may be dysregulated [4].

Psychological factors such as low self-esteem, or feelings of lack of control in one’s life or events, depression and/or anxiety can also influence an eating disorder. Social pressures such as thinness or muscularity and the perfect body are a major impact on a person’s idea of how their body ‘should’ look.

Woman standing by riverIndividuals also struggle with interpersonal relationships with friends, peers, and family. They also have extreme difficulty identifying and expressing emotions, and potential histories of abuse, neglect, or bullying.

Overall, eating disorders develop from many areas of a person’s internal and external world. The feeling that a lack of control with one’s world and environment is a significant part of an eating disorder.

It can provide unhealthy comfort and way to express the pain or avoidance of pain and emotion they may be holding. With treatment, a person is able to explore these areas in a safe, structured environment and begin the healing process.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Frank, G. K., Roblek, T., Shott, M. E., Jappe, L. M., Rollin, M. D., Hagman, J. O., & Pryor, T. (2012, March). Heightened Fear of Uncertainty in Anorexia and Bulimia Nervosa. Retrieved September 06, 2017, from
[2] Sternheim, L. C., Fisher, M., Harrison, A., & Watling, R. (2017, September 01). Predicting intolerance of uncertainty in individuals with eating disorder symptoms. Retrieved September 06, 2017, from
[3] Review, E. D. (2017, February 14). Self-Control and its Connection to Disordered Eating. Retrieved September 06, 2017, from
[4] Factors That May Contribute to Eating Disorders. (n.d.). Retrieved September 07, 2017, from

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on October 12, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on October 12, 2017.
Published on