The concept of a functional eating disorder is a novel idea and even somewhat controversial. I realize in writing the last post, I did not explain this clearly enough and will do so here.
Unless someone is very medically ill, a person can live and function to some degree with an eating disorder. The rigid structure of food, the persistent, intrusive thoughts and the significant limitations around food all have a significant impact on daily life. However, many of these people continue to have a career, friends and relationships.
Chronic mental illnesses, especially ones with significant medical effects, typically interfere with these aspects of daily life much more. But people with eating disorders can compartmentalize their experience and suffering for extended periods of time. Moreover, the shame around the illness engenders secrecy and lying from the start so continuing to hide becomes second nature. And most other people just don't know what to look for and never recognize the telltale signs of the illness.
Several aspects of the illness distinguish the person with a functional eating disorder.
The first is no hospitalizations which has two components. One is that the eating disorder symptoms have not caused the need for immediate medical attention or become too severe to successfully hide. The second is the person is lucky enough for her body to be resilient despite significant eating disorder symptoms. Two people can have essentially identical eating disorders, and one has been in treatment for years while the other has never had more than therapy. The first will not be functional and the second can be.
The second component is that there are no significant cognitive or emotional effects of the illness. Some people find that their mind is not clear enough in the illness to complete school, hold down a job or maintain relationships while others do not have that difficulty. Again this discrepancy is based on biological differences and how each person brain reacts to starvation or binging.
The last distinction is based on personal circumstance. Each person's life presents choices. If the choice to be functional is necessary, for example to escape family intrusion or to pursue personal goals, then that person will work to become functional despite the eating disorder symptoms. The effect is not recovery but simply a change in symptoms to maintain the cognitive ability m to hold down a job.
The next post will compare the reality of someone with a functional and non-functional eating disorder and the third post will discuss more differences related to treatment and recovery.