Insight in anorexia nervosa: psychometric properties of the Italian version of the Schedule for the Assessment of Insight in Eating Disorders (SAI-ED)

Background People with anorexia nervosa (AN) show a peculiar impairment of insight regarding their condition, often manifesting a denial of extreme emaciation and sometimes hiding or under-reporting socially undesirable abnormal eating patterns. Objectives In this study, a recently devised semi-standardized interview was applied to a sample of patients diagnosed with AN to investigate their degree of insight and its clinical correlates. Methods The Schedule for the Assessment of Insight in Eating Disorders (SAI-ED), as prepared by Konstantakopoulos and co-workers, was translated and adapted to Italian and applied to a sample of patients diagnosed with anorexia nervosa based on the Structured Clinical Interview for DSM-5 (SCID-5). Results The Italian version of the 8-item SAI-ED showed acceptable reliability. Major components of insight were impaired in patients with AN, who showed good awareness of symptoms but less awareness of illness and treatment engagement. Impaired insight was associated with a lower current body mass index. Conversely, insight was positively associated with levels of depression. The association of the scores on the awareness of illness and symptoms subscale with the therapists’ rating of adherence to treatment provides evidence of the internal validity of the SAI-ED. Conclusions The Italian version of the SAI-ED is a reasonably reliable, valid, and usable tool for the multidimensional assessment of some critical components of insight.