Difficulty with Uncertainty: How It Presents in Eating Disorders and What We Can Do About it

Eating disorders (EDs) are serious illnesses whose treatment, particularly with children and adolescents, requires sophisticated integration of skills and techniques from the armamentarium of evidence-based treatments targeting EDs and associated symptoms. Especially difficult to treat are cognitive impairments, because they are both disease specific (e.g., cognitive distortions related to the body itself) and more general (e.g., difficulties with uncertainty). This paper discusses cognitive impairments in EDs that involve difficulty coping with uncertainty and the associated implications on emotional and behavioral functioning. A set of skills to assess and increase adaptive coping with uncertainty is discussed in depth. Clinicians are strongly encouraged to target cognitive difficulties such as intolerance of uncertainty in ED treatment, as they can otherwise significantly interfere with one of the strongest predictors of successful outcomes - behavior change.