Assessing schema modes for eating disorders and their association with personality traits: validation of the English version of the short form of the schema modes inventory for eating disorders (EN-SMI-ED-SF)

Susan Simpson; Alessandro Alberto Rossi; Stefania Mannarini; Dorothy Tait; Gianluca Castelnuovo; Giada Pietrabissa

doi:10.1186/s40337-025-01446-0

Assessing schema modes for eating disorders and their association with personality traits: validation of the English version of the short form of the schema modes inventory for eating disorders (EN-SMI-ED-SF)

J Eat Disord. 2025 Nov 11;13(1):258. doi: 10.1186/s40337-025-01446-0.

Authors

Susan Simpson^{1

2}, Alessandro Alberto Rossi^{3

4}, Stefania Mannarini^{5

6}, Dorothy Tait⁷, Gianluca Castelnuovo^{8

9}, Giada Pietrabissa^{8

9}

Affiliations

¹ NHS Forth Valley Eating Disorder Service, Larbert, Scotland, UK.
² Department of Justice and Society, University of South Australia, Adelaide, Australia.
³ Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy. a.rossi@unipd.it.
⁴ Center for intervention and Research on Family studies-CIRF, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy. a.rossi@unipd.it.
⁵ Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy.
⁶ Center for intervention and Research on Family studies-CIRF, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy.
⁷ Child and Adolescent Mental Health Service, NHS Western Isles, Glasgow, Scotland.
⁸ Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS Istituto Auxologico Italiano, Verbania, Italy.
⁹ Department of Psychology, Catholic University of Milan, Milan, Italy.

Abstract

Background: Schema Therapy is an integrative psychotherapy model with a growing evidence base in the successful treatment of eating disorders (ED). To specifically assess schema modes in ED, the Schema Mode Inventory for Eating Disorders - Short Form (SMI-ED-SF) was developed but its English adaptation is still lacking.

Objective: The aim of this study is to evaluate the psychometric properties of the English version of the SMI-ED-SF (EN-SMI-ED-SF) within a community sample and to explore its relationship with ED conditions and personality traits.

Method: An observational design was used, recruiting participants from the general population and specialized clinics for ED treatment. A confirmatory factor analysis was performed to test its factorial structure. A multivariate analysis of variance was conducted to ascertain differences between ED conditions on the dimensions of the EN-SMI-ED-SF. Lastly, the relationship between schema modes and personality traits was explored.

Results: The EN-SMI-ED-SF demonstrated excellent fit indices, with robust validity and reliability for measurement of schema modes. Maladaptive schema modes were systematically higher in ED compared to non-ED individuals, and adaptive schema modes were lower in ED groups compared to non-ED individuals. Whereas maladaptive schema modes showed the strongest positive correlations with neuroticism, adaptive modes were strongly correlated with psychological flexibility.

Discussion: The EN-SMI-ED-SF demonstrated robust psychometric properties, indicating its validity and reliability for assessment of schema modes. The results provide strong evidence for the role of schema modes in ED pathology, and their association with key personality correlates and the protective function of psychological flexibility.

Keywords: Early maladaptive schemas; Eating behaviors; Eating disorders; Personality traits; Schema modes; Schema modes inventory; Schema therapy.

Plain language summary

Schema Therapy is an emerging therapy model in the treatment of eating disorders. The short Schema Mode Inventory for Eating Disorders was adapted to measure the ‘modes’, or cognitive-emotional self-states, as they apply to individuals with eating disorders. This study explored the psychometric properties of this measure in a community sample. The association between schema modes and specific eating disorder conditions and personality traits was investigated. The Schema Mode Inventory for Eating Disorders was found to be a reliable and valid measure. Maladaptive schema modes were higher for people with eating disorders compared with those with no eating disorder. Demanding and Punitive Critic Modes were significantly higher amongst participants with an eating disorder, particularly those with Anorexia Nervosa, highlighting their strong adherence to unrealistic internalized standards and self-criticism. The Eating Disorder Overcontroller, which manifests as body-focused over-control, was strongest in Anorexia and Bulimia Nervosa. Detached Protector and Detached Self Soother were higher for participants with binge eating. Maladaptive schema modes were strongly associated with neuroticism. Adaptive modes were associated with greater psychological flexibility, indicating the value of strengthening the Healthy Adult and Happy child modes within treatments for eating disorders to facilitate adaptive self-regulation of emotionality and psychological flexibility.