Ever since sharing it, my mind keeps returning to this post that went viral this spring. The topic of “High-Functioning Eating Disorders” struck a chord with my audience, being viewed by 185k+ people in instagram land, making me believe it deserves an entire blog post of its own. Let’s get into it!

What is a “High-Functioning Eating Disorder”?

In the world of mental health, the term “high-functioning” is often used to describe someone who is (seemingly) able to maintain work/school responsibilities, social life, family life, and personal time, all the while experiencing mental health struggles beneath the surface. Thus, a high functioning eating disorder is one that isn’t (yet) interfering much with the sufferer’s daily life, or it doesn’t appear to be, anyways. 

How would you imagine someone with an eating disorder would approach food? Is it someone who has panic attacks around food? Is it someone having mental breakdowns in front of the mirror? Is it someone who is visibly underweight? Is it someone who compensates after they eat? 

But what about the person who seems to have it all together? 

• The ones who maintain stellar performances at work and school —- 4.0 anyone?
• The ones who do eat in front of other people (or come up with pretty believable excuses to skip meals). 
• The ones who maintain a “normal” or “idealized” body weight —- not physically emaciated 
• The one who stays calm, cool, and collected (and gets things done) 
• The one who never misses a workout + eats super “clean” — all in the name of health. The one who is praised for their superior levels of “self-discipline” 

As one client of mine so pointedly put it, “….on paper, everything is okay”. She looked up – her eyes were filled with fear. I knew exactly where she was going to go next. Her brain was not okay. She was not okay. She went on to tell me how burdened she felt mentally and emotionally to make the “right” decisions with food —- for her health, for her weight, for her well-being. 

But this was more than just wanting to be healthy. This sort of obsession was deteriorating her mental and physical health. 

This is the reality of a high functioning eating disorder: on the outside, everything seems – and even “looks” – okay. 

A person with a high functioning eating disorder might even be the “picture of health.”

But on the inside, they:

• Can’t stop thinking about food and their bodies (weight), calories, and exercise
• Ignore, suppress, and block out hunger
• Never feel good enough in their bodies – immense anxiety, guilt, and shame surround all of their eating experiences. 
• Feel irritable, moody, hangry, and tired all the time —- exhausted. 
• Often experience stomach aches/discomfort, they might be cold often, and their hair might be falling out. 

Deep down, they know something is wrong, and yet, they don’t feel like they can change, or a part of them doesn’t care, because in some ways, this whole thing seems to be working, and no one else seems to think there is a problem with what they are doing. In fact, these people are praising the ones with eating disorders for being “so athletic”, “so self-disciplined”, or “looking so good”, inadvertently fueling the eating disorder.  

Why High Functioning Eating Disorders are Overlooked: 

High functioning eating disorders are overlooked. They glide under the radar of parents, partners, friends, family members, co-workers, coaches, and even medical professionals. There are several factors that cause those suffering to go unnoticed: 

Weight Bias

…..In Research & Diagnosis

Weight bias has long shaped how eating disorders are studied and diagnosed. Until 2013, to be diagnosed with anorexia, you had to meet the threshold of “body weight less than 85% of that expected”. (1) Today, despite removing specific weight criteria from the anorexia diagnosis, the DSM-5 still includes “severity specifiers” (mild, moderate, severe, and extreme) that are all based on BMI thresholds, despite limited support of such specifiers. (2) A BMI greater than 17 kg/m2 is considered to be “mild” anorexia by these standards.

Hard stop. These criteria are absolutely insane considering the reality that fewer than 6% of people with eating disorders are medically diagnosed as “underweight” !!!! (3)

Conversely, 94% of people in the entire world who suffer from eating disorders don’t meet these weight thresholds !!!! Let that sink in. 94%.

Make it make sense. 

People with eating disorders are historically characterized by acts of denial and minimization for their symptoms….honestly, who can blame them given these thresholds???

Not surprisingly, these diagnostic criteria (and screening tools based on these criteria) miss a lot of people. And we are just talking about Anorexia here. “OSFED” may capture those who suffer from “Atypical Anorexia”, however, awareness and education on these categories are still significantly lacking.

Research for eating disorders has been historically and remains to be underfunded (4) and the funds that are received typically go towards researching the version of anorexia described above, which does not capture the experience of the majority of people who are suffering. This results in many people experiencing delay or misdiagnosis, difficulty accessing care, or worse, being overlooked entirely.  

….in Society and Culture

If you’ve been influenced by western society/pop culture at all, when you think of the term “eating disorder” you picture a young, white woman who is visibly unwell (whatever that means) —- emaciated even. This depiction does not properly represent the people IRL who struggle with these symptoms.

Eating disorders are not weight disorders. Although eating disorder behaviors can impact a person’s weight, a person’s weight does not define whether or not a person suffers from this condition. The majority culture does not understand this. Most people who suffer from eating disorders “don’t look like they have an eating disorder” by this standard, which makes it much easier to suffer in silence. 

…in Healthcare 

Medical professionals receive very little education on eating disorders in their training, typically receiving less than 2 hours of scheduled lecture time. (5) And even so, many of them are trained using the DSM-5 criteria for eating disorders, and are not taught how to critically engage with eating disorder presentations IRL. 

As discussed above, many people—including healthcare providers—still associate eating disorders ONLY with extreme thinness or visible physical decline. In my own journey, I personally saw 3 medical doctors (yes, MD) before my eating disorder was detected. Many of my clients will comment that their pediatrician or primary care doctor will make remarks such as, “you seem really healthy, everything looks great” (aka labs are normal), when they are incredibly sick. Most of the time, I am convinced these folks are missed solely because they aren’t “underweight”.

Wellness Culture

Wellness culture can quietly fuel high-functioning eating disorders under the guise of “clean eating,” “gut healing,” or “biohacking.” 

Author, journalist, and anti-diet dietitian Christy Harrison defines wellness culture as “A set of values that equates wellness with moral goodness, and posits certain behaviors—and a certain type of body—as the path to achieving that supposed rectitude.” 

Some people can crash diet, hopping on and off the latest diet trends, and be relatively unaffected. However, those vulnerable to developing eating disorders can end up following allllll of the latest health and wellness trends with good intentions, walking away with a very small (restrictive) list of acceptable foods. These trends from wellness culture can transform into rigid routines that cannot, under any circumstances, be broken, all in the name of “health”.

The person tied up with wellness culture may fly under the radar because:

1.  You are doing all of the “right” things —- following the right protocols, doing the research, staying informed, and taking care of your health (or so it seems).
2. And it’s really hard to provide any sort of pushback when a person’s logic is, “I have to do this for my health”. The lines can quickly blur between what is being done for health vs what is being done out of fear. 

And many times, the person suffering doesn’t even realize what is happening until they reach a breaking point.

If this is you – we can help! Click here for more information about nutrition counseling services.

TL;DR:

• High-functioning eating disorders often go unnoticed because on the outside, everything seems — even “looks” okay. The person with the high functioning Ed is often praised for being “so athletic”, “so self-disciplined”, or “looking so good”, which inadvertently fuels the Ed.
• Societal Misconceptions about Eating Disorders and Weight contribute to underreporting, delayed diagnosis and lack of treatment/support. The vast majority of people with eating disorders do not fit the stereotypical mold. 
• The Health Care System often fails these clients too due to lack of training on eating disorders (they don’t know how to ask the right questions) and internalized weight bias (they think a person is fine if they aren’t “underweight”) 
• Wellness culture can normalize rigid, disordered behaviors under the guise of health, making it hard to recognize when something is wrong, especially for peeps who are “good” at the whole “wellness” thing. 

If you see yourself or someone you love in this article, you are not alone. High-functioning eating disorders don’t always disrupt life in obvious ways—until they do. If you remember anything from this post, I hope it’s this: You do not need to wait until literally you cannot function to seek help for your eating patterns and behaviors.

Recovery from a high functioning eating disorder is possible with appropriate treatment and support —and it begins with being honest about what’s really going on beneath the surface. Just because you are surviving this way doesn’t mean you have to keep living this way. If you are being impacted, no matter how “well” you are doing on the outside, you deserve proper care & support.

Click here for more information about nutrition counseling services.