Assessing belief-related insight in eating disorders: Italian validation of the Brown Assessment of Beliefs Scale (BABS)

Purpose Insight in eating disorders (EDs) is a multidimensional construct including illness awareness, symptoms recognition, treatment engagement, and the conviction associated with disorder-related beliefs. The Brown Assessment of Beliefs Scale (BABS) assesses awareness and beliefs, but a validated Italian version is unavailable. This study aimed to validate the Italian version of the BABS and examine its psychometric properties and clinical correlates in a sample of patients with EDs. Methods One hundred and forty patients with anorexia nervosa-restrictive subtype, binge-eating spectrum disorder and otherwise specified feeding or eating disorders were recruited. Participants completed the BABS and measures of eating disorder psychopathology (EDE-Q, EDI-2), binge-eating severity (BES), and depressive symptoms (BDI-II). Confirmatory factor analysis (CFA) tested the dimensional structure and the measurement invariance across diagnostic groups. Reliability and convergent validity were examined. Results CFA supported a unidimensional structure of the BABS with excellent model fit (CFI = 1.00, TLI = 1.00, RMSEA = 0.00, SRMR = 0.030). Configural, metric, and scalar invariance across diagnostic groups were confirmed. The scale demonstrated good internal consistency ( ω = 0.81). BABS showed low but significant positive correlations with EDE-Q weight concern ( r = 0.21), binge eating severity ( r = 0.20), and EDI-2 body dissatisfaction ( r = 0.29). No significant associations emerged with depressive symptoms or other eating-related measures. Conclusion The Italian version of the BABS demonstrates good psychometric properties and measurement invariance across ED diagnostic categories. It provides a reliable tool of belief-related insight and delusionality in EDs, capturing a specific cognitive dimension associated with weight concern, binge eating symptomatology and body dissatisfaction rather than with depressive symptoms or eating-related psychopathology. Level of Evidence III Evidence obtained from well-designed cohort or case–control analytic studies.