Understanding the structure of insight in eating disorders : validation of the SAI-ED in a Spanish clinical sample

This study aimed to evaluate the reliability and validity of the Spanish version of the Schedule for the Assessment of Insight in Eating Disorders (SAI-ED) and to explore the underlying structure of insight in patients with an eating disorder. A total of 103 patients diagnosed with anorexia nervosa or bulimia nervosa according to DSM-5 criteria were recruited from two specialized centers. Participants were assessed with the Spanish version of SAI-ED alongside the validated Spanish versions of the Brown Assessment of Beliefs Scale (BABS), and completed the Eating Attitudes Test-40 (EAT-40) and the Eating Disorder Inventory (EDI). Convergent and discriminant validity, internal consistency, inter-rater reliability and factor structure were analyzed. The Spanish version of the SAI-ED demonstrated good internal consistency (Cronbach's alpha = 0.79), excellent inter-rater reliability (ICC = 0.92), and strong convergent validity with the BABS (rho = -0.57, p < 0.01). Discriminant validity was supported by non-significant correlations with the EDI-Perfectionism score (rho = -0.009, p = 0.929). Exploratory factor analysis revealed a three-factor structure capturing agreement on the need for treatment, awareness of eating disorder behaviors and awareness of body weight concerns. The Spanish version of the SAI-ED exhibits robust psychometric properties, confirming its validity and reliability for assessing insight in patients with eating disorders. The 3-factor structure underscores the complexity of insight in this population, emphasizing its clinical utility for tailoring treatment plans and optimizing intervention strategies.