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. The study was registered at https://clinicaltrials.gov/ (NCT06177262). This study looked at how people with eating disorders understand their illness and treatment needs. We used a questionnaire called the SAI-ED to measure this kind of understanding, also known as "insight." We translated the SAI-ED into Spanish and tested it with 103 people diagnosed with anorexia or bulimia. The goal was to see if the Spanish version works well and gives reliable results. Our findings show that the Spanish SAI-ED is a useful and trustworthy tool. It helped us see that insight is not just one single thing. Instead, it has different parts: how much a person agrees they need treatment, how aware they are of their eating disorder behaviors, and how they see their body and weight. These results can help professionals better understand how each person experiences their illness and adjust treatment to fit their needs more closely. This kind of assessment may also support people in gaining more awareness of their difficulties and improve their motivation for recovery..