The myth of "high functioning"

I've written on my life as a "high functioning anorexic" before--indeed, for much of my eating disorder, I was almost certainly functional. I finished college and completed two master's degrees. Outside of a seven-month treatment stay and several brief hospitalizations, much of the past 8 years was spent living as an otherwise "normal" person.

See? My eating disorder really isn't that big of a deal!

The problem wasn't just that I peddled such drivel to friends, family, and therapists (I'm fine! I'm not that sick!), I also began to believe my own bullshit. If I wasn't that sick, then why would I need to worry about getting better? I had a full-time job, I was in school, I was just fine, DAMMIT.

The problem is that "high functioning" is a bit of a myth. How well you are functioning isn't always a measure of illness severity; sometimes it's a measure of how well you can hide just how awful things are. My heart was whacked, my digestion non-existent, my body shutting down, and yet I was maintaining a straight-A average in college. Several professors didn't understand how I could be leaving school "when I was doing so well!"

Many times, when exactly how bad the eating disorder, anxiety, and depression really were came out into the open, it usually wasn't because they were suddenly worse. Rather, things started to appear really bad because I began to lose my ability to compensate for my illness. I carefully constructed my life around my eating disorder so that I could protest with all wide-eyed innocence that everything was fine. Sure, I had no life outside of my job and the gym and the online calorie counting guides, but I got to work everyday. No one knew my dirty little secret that I had once been locked in the loony bin, that I had come perilously close to starving myself to death.

Blogger Meggy Wang writes:

Bipolar disorder* is considered a “severe mental illness,” however, and in order to protect myself from feeling like a nutcase, I still call myself high-functioning. As in, yeah, I started having hallucinations when I was a senior in college, but I also graduated with a 3.99 from Stanford.

But lately I wonder whether my own insistence on calling myself high-functioning is both a defense against self-stigma and a defense against perceived external stigma... To define myself as high-functioning, then, is my way of separating myself from what I do not want to be. By doing so, though, I suspect that I’m playing my own major role in stigmatizing mental illness, as people with mental illness get a bad enough rap without divisive factions within. I'm thinking about people of color stratifying via skin tone from dark to light. It's hard enough to be a member of a stigmatized group without having other members claiming to be "better," more "normal," more like the majority. Even if the majority is what I often wish I could be.

Obviously, our mental illness significantly affects our ability to function--if it didn't, we wouldn't have a mental illness. Certainly there are degrees to which a mental illness will affect our lives, and often an increase in illness severity corresponds to a decrease in functioning. Yet being high functioning doesn't indicate a lack of illness severity, either. It just means that you, like me, could compensate really well for the internal havoc of your mental disorder.

Those times when my life crumbled down around me, when I could no longer compensate for the madness and obsessions and compulsions, those were the times when I felt relief. Finally, I thought, I will get the help I need. I can stop hiding just how bad everything really is. Of course, the severity of the situation simultaneously humiliated me, which is why I didn't say anything in the first place.

In the end, we can be united by our common diagnoses and neuroses, or we can use that to split ourselves into a group of the "sick" and "not-sick." This isn't to say that we are our diagnoses, but that whether you're an anorexic sitting on a park bench or Park Avenue, you share the same struggles as me and so many others like me.


Lisa said...

we talked about the same thing today in one of my group therapy sessions. how using symptoms allows us to "move heaven and earth" but we really need to realize that we can't and we don't need to...

and...yes at the height of my eating disorder, my grades in college were the best, i was getting the most accomplished...

but i was slowly killing myself

i really appreciated this post


Tia said...

wow. so true. i have used this label on myself so many times...
Tia @ Dietcolagirl

Carrie Arnold said...

Holy crap, ladies--that was quick!

Thanks for the feedback. ;)

Meggy said...

Carrie: I'm so honored to be quoted in such an amazing post - you're one of my favorite bloggers, and I really admire what you do.

A quick note: would you mind changing the spelling of my name in the post? It's "Meggy," with two g's. Thanks! :)

Alley Cat said...

"How well you are functioning isn't always a measure of illness severity; sometimes it's a measure of how well you can hide just how awful things are."

So true, and it's sickening to know our disorder hides that from US for such a period of time. I'd rather have the struggle [i]be for something[/i]--recovery--than have just a constant struggle to compensate, as that will get me nowhere as time continues to pass! I'm so thankful to have hit the realization also. Great entry.

Anonymous said...

Thanks for this post!

You wrote:
"Yet being high functioning doesn't indicate a lack of illness severity, either. It just means that you, like me, could compensate really well for the internal havoc of your mental disorder."

Thank you so much for pointing this out! I sometimes get the feeling that health professionals sometimes are just looking at me on a surface level. I have really good interpersonal skills and can make it seem like everything is fine on the outside. Consequently, if they see me in the waiting room interacting with others and then I go in for a therapy session, I appear like two different people. When I'm in therapy, I appear more like how I truly feel, which is a depressed/anxious person with an ED.

Because of this, I get the feeling sometimes that the health professionals think I'm putting on an act when I'm not!! I'm just good at pretending everything is OK! It doesn't mean that I'm not struggling. My primary counsellor who knows me very well knows that it *isn't* an act, thank goodness!

Cathy (UK) said...

Great post as usual :)

For many years, while anorexic, I thought I was 'high functioning' - because I had earned myself a PhD and I sustained a demanding job. In fact, I considered myself so high functioning that I denied I was sick.

To everyone else my ill health was obvious: for >20 yrs of my life my BMI had remained below 16 (sometimes as low as 13) and I wandered around with a blue nose, blue fingers and sunken cheeks. I only began to believe that I was sick when I went into heart failure, had chronic fatigue, osteoporotic fractures and my immune system was 'shot'. Yet, I looked for other explanations for this physical illness. My starved brain found it difficult to make a link between my longstanding AN and a failing physical body.

When I first started to recover and was re-feeding, off work and not allowed any exercise I complained to my psychiatrist that he was treating me like an invalid. I didn't think of myself in that way; I truly believed I was high functioning.

It is only now, 5 years into recovery, weight restored and eating + exercising sensibly that I can see, with hindsight just how sick and deluded I was. When I recently joined Facebook and uploaded my photo, people from days gone by who found me (or vice versa) couldn't believe how different I looked. Someone even said "you have a face" (as opposed to a skull with skin on). And that's really nice, bcause I much prefer the healthier me.

Even so, I still struggle with co-morbid difficulties that pre-dated my AN, were instrumental in its development and will always be with me. I am just learning to manage these difficulties through a means aside from AN.

No longer do I consider myself 'high functioning'...

Melissa said...

Thanks for writing this. It resonates a lot with my experience, though I haven't been able to articulate it so well before. I guess the other thing it reminded me of was how divided as a person I started to feel, and how corrosive that experience was for me. Even the well functionning bit felt lesser as I was acutely aware of what was going on underneath. I don't know whether that makes sense; but, for me, one of the advantages of being open and moving into recovery has been the space to bring myself together again.

Great post, as ever.

EvilGenius said...

I relate a lot to this too...especially telling yourself that level of functionality is an indication of severity. for me it definitely wasn' some of the worst points of my eating disorder 'functioning' became a compulsion too so I intensified the drive to keep up with my A levels/lectures/younameit. like you I had no life outside of that because all I could dredge up the energy for was forcing myself to do those things...and that was an exercise in denial...I had to do it because that meant I was 'ok'. obviously this is an element of the disorder for some people and not others...but like you I think 'high functioning' is a misleading term to describe it. even lazing around doing nothing but meet friends and read this summer I am better 'functioning' now than I ever was while getting top grades at school when I was anorexic.

Cammy said...

I am so glad you wrote about this. I was having a conversation with my boyfriend the other day about having a rough time right now, and the issue of there ever being an end to it came up. He said that he knew I didn't think I'd ever be 100% free, but "Don't you think you can still be happy and healthy?" I think people who haven't experienced an ED have no idea of the crushing weight (no pun intended) of the disorder that is such an unbearable load, even when it's well under the surface. If you have an eating disorder, your not functioning like you should be as a holistic person, because people don't come with internal, isolated compartments.

Anonymous said...

When I call myself "high functioning", I mean it less as a denial of my illness than an affirmation of it. I do see how it could be a denial, "I'm sick, but barely, which is why I am so functional." I look at it as "I am batsh*t crazy out of my mind, but I obsess over schoolwork to try to keep my mind occupied, from really going off the deep-end, and that is why I seem able to keep myself together." I think we need a better way than level of functioning to help outsiders recognize severity.

Emily said...

Yup, I can relate. The period in my life when I was hiding ED the most was when I was completing my bachelors and masters degrees. I was the BEST student, which made me beleive that living with ED was just my lifestyle choice and that it fully functional. Of course, in my heart I knew that I couldn't keep it up forever.

Now, wanting to live a long life, I am in recovery, and I am more unstable, emotional, and all-over-the-place than ever. This isn't the easiest way to live right now, but it's what has to happen if I want a future.

Yup, I feel ya.


Carrie Arnold said...


The spelling has been fixed. Sorry!

A:) said...

100% true.

In the worst of my AN I held down a 40hr/week physically active lifeguarding job. THEN I went to university and managed to finish with a 4.0 average -- my BMI was 14.5 to 15 for most of this period.

I know indiivduals who at this BMI or lower were in the hospital or having to stay home due to chronic exhaustion/mental distress etc. However, I seemed to be able to keep going like normal.

In some ways, this did make it harder to get help because I didn't see myself as that ill if I wasn't going to the ER every other day. . .

However, the ability to keep my life together also allowed me to stay IN my life and recover slowly without treatment while finishing school and holding down a job, etc. . .

Still, being high functioning is difficult when one compares themselves to individuals that seem to be at death's door in similar physical states. . .

Great post Carrie. Timely too. . .


Ashley @ Nourishing the Soul said...

I love that you brought this topic to light! At the hospital where I work, the terms high- and low-functioning are used hundreds of times a day to describe individuals with mental illness. I use them myself. And yet they really are stigmatizing in their own way. Words are incredibly powerful, which has been the topic on my blog for the past few days, and words have sometimes dangerous result of putting people into boxes from which escape is incredibly difficult. We use such terms because they are "easy" and help us communicate an idea, but we need to come up with alternative ways that don't limit and confine people.

Angela Elain Gambrel said...

I also can really relate to this post. When I first started struggling with anorexia, I was working long days as a journalist and I always used that as an excuse - "See, I'm working 10, 12-hour days, I'm just fine, nothing's wrong with me."
I was in graduate school this winter when I relapsed but was maintaining a 3.85 gpa and again I would insist I was just fine because I was doing so well in my studies. But the rest of my life was (and still is) obsessively counting calories and losing weight. But since I was doing so well in school, and freelancing besides, I was just *fine*.

Until I wasn't and became so sick I had to go back into the hospital. It was a mixture of relief (like you said, I can get some help and finally quit pretending because it is so tiring to act high functioning when in reality I was only high functioning in one area - I was faking my way through life) and embarrassment that yet again I was sick enough to go into the hospital. I hated giving up the facade, and yet was glad to at the same time.

Thanks for writing about this. I still want to say I'm high functioning. But I know I could be functioning a lot better through better nutrition and at a higher weight; I use the label as an excuse when I know I'm not "just fine." Most people don't see the truth; I think most people want to believe we are fine when we are not.

Briony said...

I totally agree with everything you said in this post! I think
the main reason I managed to keep up my grades in the depths of my eating disorder was that the same part of me that drove me to eat less and exercise more drove me to work harder. If anything, I'm finding it harder to function now I'm technically in recovery- before, I was able to ignore the exhaustion and hunger because they were always there, even sort of like/be reassured by them.

I absolutely adore your blog, by the way. You write so well, and I can completely relate to so many of things you write about.

Ems311288 said...

Im finding it really hard to come to terms with my illness. My BMI is a staggeringly low 13.8, yet I fail to see what the problem is. I have been to university, I get up every morning and go out, my brain is still alive (and don't I know it, it never sleeps) -so whats the fuss all about???
I wish I could see what everyone else does, I'm sure it would make recovery a whole lot smoother.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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