High Functioning Eating Disorders
Are you the friend who has it all together? Does it seem to you that since you know others have it worse, you can’t possibly need help?
If you’re reading these posts in order, this post is a very interesting juxtaposition to last week’s on the neurobiology of recovery with Dr. Jeffrey DeSarbo, where we scratched the surface on Severe and Enduring Eating Disorders (SEED). In contrast to that, this week we’re discussing what it looks like when someone actually functions very well in their daily life, but still suffers from an eating disorder.
The interesting thing about high functioning eating disorders is that I’d say it accounts for a large majority of eating disorders.
Because despite popular belief, you really can’t tell if someone has an eating disorder just by looking at them. Or maybe you know that already because I say it all the freaking time.
Read on to learn what high functioning eating disorders really are, and how to know when it’s time to get help.
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Eating Disorders on a Continuum
To understand high functioning eating disorders, we’ll first look at someone’s relationship with food as a continuum. On one side of the continuum, you have someone who has a completely healthy relationship with food. On the other end would be someone with an eating disorder. The entire continuum in between is considered disordered eating: where people have a complicated relationship with food in a variety of different ways.
Healthy Relationship with Food ------------Disordered Eating------Eating Disorder
Then, if we then look at the eating disorder as its OWN continuum, then high functioning eating disorders would be on one side, and medically compromised/SEED would be on the other. The rest of the eating disorders would fall on the continuum.
High Functioning Eating Disorders ----------Eating Disorders--------Medically Compromised/SEED
It’s Impossible to Tell By Looking
There’s so many different things happening under the surface of someone’s eating disorder: the level of severity and frequency of symptoms, things you can see physically, and medical complications, to name a few. We as a society tend to create a narrative about whether or not someone has an eating disorder based on what we see.
I’ve said it a million times, and I’ll say it again: You cannot POSSIBLY tell whether someone has an eating disorder by looking at them.
If someone looks severely malnourished, it’s very possible this person has anorexia nervosa. It’s also possible they have some other medical condition going on.
But guess what? It’s even MORE possible that someone who looks “healthy and normal” is the person whose relationship with food might be complicated. You just can’t tell!
When we look at someone who appears malnourished and assume those are the only people who could have eating disorders… we are really narrowing our understanding of what an eating disorder is.
Medical Complications
The same goes for medical complications. People experience medical and physical complications on a continuum. Maybe someone has osteopenia but not osteoporosis. Maybe someone’s heart rate is a tad low and someone else’s is dangerously low.
And just because someone has NO medical complications, that doesn’t mean they don’t have an eating disorder (triple negative there, I know 🙃)
So when you hear about someone who was hospitalized for an eating disorder, or they had a heart attack or osteoporosis at the age of 23… those are very serious cases, but also, we’re looking at a very tiny percentage of people with eating disorders. These are the people who fall on the “severe” end of the continuum, and when we ONLY look at these people, we leave out EVERYBODY else.
What’s Going on Outside
It’s easy to get stuck focusing only on how someone looks on the outside.
For example, if I see someone’s body changing, or they’re hospitalized, if they’re isolating themselves, if their mood is worse, or they’re doing poorly in school… all of these outside indicators really don’t give us the full picture of what’s going on internally. These may be red flags but the absence of red flags doesn't mean there isn’t anything wrong.
A HUGE aspect of diagnosing an eating disorder is the level of distress someone feels internally. Some question I might ask to assess this would be:
What are your thoughts like?
How much time do you think about food?
How much is thinking about this upsetting to you?
What’s your stress level like?
What’s your relationship with food like?
What is your anxiety like?
What are your obsessions like?
If you answer all of those questions in a way that indicates a high level of distress, to me, that’s VERY significant in diagnosing an eating disorder.
Now, am I saying you definitely have an eating disorder if you answered all those questions in concerning ways? No. What I AM saying is that there are ways to tell whether someone has an eating disorder… by figuring out what’s going on internally, not externally.
High Functioning Eating Disorders
The idea that someone can have an eating disorder and be high functioning is actually quite common. Probably more common than you think.
People can have eating disorders for decades without really knowing they have an eating disorder. These people may be perfectionists and great at whatever they do. They get straight As in school, they graduated from college with honors, and they excel in their workplace. They may always be surrounded by friends.
These presentations are so the opposite of what people expect to see with eating disorders (someone who isolates, someone who is cognitively impaired, etc.).
Someone might look amazing to you – the seemingly “right” weight and with a great life – but they may be internally struggling. And when we exclusively assume the people who appear really sick are the only ones with eating disorders, we’re excluding everybody else – which is a large percentage of the population who struggle with disordered eating.
If You Don’t Seem “Sick Enough”
When someone doesn’t look “sick,” it can be easy for them to assume they don’t have a “real” eating disorder or it’s not “that bad.”
And sure, you can make the argument that there’s always going to be someone sicker than you. But that doesn’t mean anything about the level of care you need or deserve.
No matter where you’re at, it’s almost always going to feel like it isn’t bad enough to receive more care. And if it feels like that – like you don’t deserve more support – then know that’s the eating disorder talking.
There’s always going to be someone who is sicker than you. Point is, where you are right now, if you have a complicated relationship with food and it’s upsetting you, you deserve any and all support that you’re willing to receive.
Reason Enough to Get Help
It’s so important to have this conversation because the majority of people I’m going to talk to in my career will be people with high functioning eating disorders. They’ll feel like they’re doing great: they have an awesome job, family, and no depression, so it must not be bad enough to get support, right?
They don’t fit the mold for what a lot of people think an eating disorder should look like but that narrow understanding of what eating disorders are is not based in reality.
So if YOU have a complicated relationship with food and it’s bothering you, then that’s reason enough to get help.
End of story.
If you want to get therapy, go get it. If you want to meet with a dietitian, meet with them. Get your labs done. Check in with a doctor. If you want to meet with a therapist 3 times a week, then do it!
There’s always going to be someone else who’s sicker than you. But honestly, that’s irrelevant. And it really doesn’t mean you don’t deserve or shouldn’t get help.
Tweetable Quotes
“You cannot possibly tell whether someone has an eating disorder by looking at them.” – Rachelle Heinemann
“Part of a really, really big aspect of diagnosing an eating disorder is the level of distress it causes in someone.” – Rachelle Heinemann
“When we exclusively call the people who are really, really sick to be the only ones with eating disorders, then we’re excluding everyone else – and again, that’s a large percentage of the population of people who struggle with any form of eating disorders or disordered eating.” – Rachelle Heinemann
“There’s always gonna be someone who is sicker than you. Point is, where you are right now, if you have a complicated relationship with food and it’s upsetting you, you deserve any and all support that you’re willing to receive.” – Rachelle Heinemann
Resources
Understanding Disordered Eating Episode 68: The Neurobiology of Recovery with Dr. Jeffrey DeSarbo
Information on Virtual Therapy and Individual Therapy
More From Rachelle
Hey there! I’m Rachelle, the host of the Understanding Disordered Eating Podcast. As a Licensed Mental Health Counselor, I work with clients to make sense of life’s messy emotional experiences.
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