Psychometric performance of the Intuitive Eating Scale-2 in females with anorexia nervosa: An examination of factor structure and Item Response Theory.

The Intuitive Eating Scale-2 (IES-2) is widely used to assess intuitive eating (IE) behaviors, attitudes, and beliefs, yet its application in anorexia nervosa (AN) remains unclear. Given the disrupted interoceptive awareness and heightened cognitive control over eating in AN, it is less certain how IE constructs apply during acute stages of this disorder. This study evaluated the factor structure and item-level performance of the IES-2 in a clinical sample of 150 adolescent and adult females diagnosed with AN, upon admission to a residential treatment facility. Confirmatory Factor Analysis supported a first-order factor structure, suggesting that the four subscales should be treated independently rather than combined into a total IE score, contradicting the original scoring approach. Item 12 ("I am able to cope with negative emotions (e.g., anxiety, sadness) without turning to food for comfort") demonstrated poor factor loadings on the Eating for Physical Rather than Emotional Reasons subscale. Item Response Theory further indicated that item 12 had poor discrimination across levels of the latent trait, supporting its removal. These findings indicate that certain subscales, particularly those assessing emotional eating, may not capture relevant eating behaviors in adolescents and adults with AN. We recommend scoring IES-2 subscales separately and reconsidering the inclusion of item 12 to enhance measurement accuracy in AN. Refining the IES-2 for clinical ED populations may improve its utility in tracking recovery and treatment outcomes.