Objective To identify clinical or cognitive measures either predictive of illness trajectory or altered with sustained weight recovery in adult women with anorexia nervosa. Methods Participants were recruited from prior studies of women with anorexia nervosa (AN‐C) and in weight‐recovery following anorexia nervosa (AN‐WR). Participants completed a neuropsychological battery at baseline and clinical assessments at both baseline and follow‐up. Groups based on clinical outcome (continued eating disorder, AN‐CC; newly in recovery, AN‐CR; sustained weight‐recovery, AN‐WR) were compared by using one‐way ANOVAs with Bonferroni‐corrected post hoc comparisons. Results Women with continued eating disorder had poorer neuropsychological function and self‐competence at baseline than AN‐CR. AN‐CR showed changes in depression and externalizing bias, a measure of self‐related attributions. AN‐WR differed from both AN‐CC and AN‐CR at baseline in externalizing bias, but only from AN‐CC at outcome. Discussion Neuropsychological function when recently ill may be a prognostic factor, while externalizing bias may provide a clinical target for recovery. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.