Development and Validation of the Resilience in Eating Disorders Scale (RED-5)

• Carlota Las-Hayas ^[1] ; Odin Hjemdal ^[3] ; Pedro-José Muñoz ^[4] ; Jesús-Ángel Padierna Acero ^[5] ; Luis Beato-Fernandez ^[2] ; Andrés Gómez-del-Barrio ^[6] ; Diana M. Pérez-Valencia ^[1] ; Amaia Pikatza-Huerga ^[1] ; Aitor Almeida ^[1]
  1. [1] Universidad de Deusto

     Universidad de Deusto

     Bilbao, España

     
  2. [2] Hospital Quironsalud Ciudad Real

     Hospital Quironsalud Ciudad Real

     Ciudad Real, España

     
  3. [3] Department of Psychology, Norwegian University of Sciences and Technology, 7034 Trondheim, Norway
  4. [4] Psychiatry Service, Ortuella Mental Health Center, 48530 Bizkaia, Spain
  5. [5] Psychiatry Service, Galdakao-Usansolo Hospital, 48960 Bizkaia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 48960 Bizkaia, Spain
  6. [6] Valdecilla Biomedical Research Institute (IDIVAL), 39011 Santander, Spain; Eating Disorders Unit, Department of Psychiatry, Hospital Universitario Marqués Valdecilla, 39002 Cantabria, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain

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• Localización: Actas españolas de psiquiatría, ISSN 1139-9287, Vol. 54, Nº. 1, 2026, págs. 1-16
• Idioma: inglés
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  • Background: A resilience scale tailored for individuals with eating disorders (EDs) could significantly enhance our understanding and treatment of EDs. Therefore, we developed and psychometrically evaluated a new Resilience in Eating Disorders scale (RED) following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.

    Method: Informed by prior qualitative interviews, the new RED scale underwent an initial pilot test among patients with EDs (n = 52) and field tests among patients with EDs (n = 169), ED-recovered individuals (n = 61), and a normative sample of the general population (n = 349), all aged between 27.9 and 29.8 years and residing in Spain. In this study, the participants completed the RED scale, Resilience Scale-25 (RS-25), Eating Attitudes Test-26 (EAT-26), World Health Organisation Quality of Life Scale – Brief Version (WHOQOL-BREF), and Hospital Anxiety and Depression Scale (HADS). Data were collected at baseline and after 1 year. Alongside machine learning techniques, exploratory and confirmatory analyses were employed to evaluate the reliability, construct validity, convergent validity, known-groups validity, predictive validity and responsiveness of the RED scale.

    Results: The original 52-item version of the RED scale was refined to 44 items following the pilot phase, and ultimately reduced to a 5-item version (RED-5) after field testing and psychometric evaluation. The RED-5 demonstrated strong psychometric properties, with excellent model fit indices (Root Mean Square Error of Approximation (RMSEA) = 0.03, and Comparative Fit Index (CFI) = 0.99) and acceptable internal consistency (Cronbach's alpha = 0.71). Additionally, the RED-5 scale effectively predicted quality of life, anxiety, depression, and ED symptomatology over a 1-year period.

    Conclusions: The RED-5 is a concise, psychometrically robust scale specifically developed to assess resilience in patients with EDs. It significantly predicts ED symptoms and quality-of-life outcomes, making it a valuable tool for both clinical practice and research. The RED-5 allows for quick administration and easy scoring. It provides mental health professionals with a tool to guide resilience-informed assessment and more personalized treatment planning.