The purpose of this study was to develop a Decisional Balance (DB) measure of readiness for change in anorexia nervosa. A total of 246 women with anorexia nervosa completed a 60-item DB scale. A 3-factor solution provided the best fit for the DB data, which reduced the scale to 30 items. Two of these, namely Burdens and Benefits, resembled the pro and con factors found in previous research. The third factor, Functional Avoidance, was unique to the decisional balance literature; it included items reflecting the ways that anorexia nervosa provides a way to avoid dealing with aversive emotions, challenges, and responsibilities. The DB demonstrated good internal consistency and acceptable test–retest reliability. This measure could be used to help us better understand the shifts that occur as individuals with anorexia nervosa develop a desire to change. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.