Uncertainty Meets Disordered Eating and Body Image: A Transdiagnostic Network Study Across Depressive, Anxiety and Anorexia Nervosa Symptoms Including a Control Group

Background and objectives: Intolerance of uncertainty (IU) is a well-established transdiagnostic process in anxiety (ANX) and major depressive disorder (MDD), and has been increasingly implicated in anorexia nervosa (AN). However, most previous research including patients with AN has relied on total or subscale scores from eating disorder measures, which obscures how specific eating attitudes and body dissatisfaction symptoms relate to distinct facets of IU. The primary objective of the present study was to characterize item-level networks linking eating attitudes, body dissatisfaction, and IU in a pooled clinical mental health sample, alongside a control group (CG). Methods: Data were drawn from a sample including individuals with symptoms related to AN (N = 105), MDD (N = 97), and ANX (N = 240), a comorbid group (N = 84) with symptoms of two or more of these conditions, and a CG (N = 842). Separate item-level networks were estimated for clinical and control groups, and network structure and centrality indices were compared. Results: Network analyses revealed distinct organizational patterns between the clinical and control subsamples. Although both networks showed identical diameters, the clinical network exhibited a shorter average path length and higher clustering, indicating stronger local connectivity, whereas the control network showed higher modularity. In the clinical subsample, nodes related to binge eating, post-eating guilt, and IU emerged as the most central and acted as key connectors between clusters. In contrast, the control network displayed a more distributed centrality pattern, suggesting a more integrated and homogeneous network organization. Conclusions: This study provides new evidence to refine our understanding of how IU relates to eating attitudes and body dissatisfaction across diagnostic mental health boundaries. Identifying highly influential psychopathological symptoms across eating, mood, and anxiety disorders, as well as bridge nodes linking these mental health domains, is important for understanding transdiagnostic symptom dynamics. These insights may inform the development of more sensitive screening and diagnostic tools, as well as targeted intervention points to support more personalized and mechanism-focused treatments.