Thirty female subjects were followed up an average of 4.6 years after being hospitalized for anorexia nervosa. Insight into illness, symptoms, and treatment was rated for index hospitalization and assessed at follow up using the Schedule for Assessment of Insight. In addition, subjects were interviewed and assessed for level of function, symptoms of eating disorders, and the presence of significant psychopathology. The Insight Rating at index hospitalization was correlated with the Global Insight Score at follow up and with EAT score at follow up. Subjects with longer lengths of stay and greater increase in Body Mass Index during index hospitalization had higher levels of insight at both times of measurement. At followup, both Global Insight Score and assessment of subjects' ability to acknowledge illness were correlated with a variety of positive outcome measures, suggesting that insight may be an important therapeutic factor to consider in assessment and treatment of anorexia nervosa.