People who are outwardly functional who have an eating disorder constantly question how sick they really are. Our society is littered with fad diets, the constant pressure for thinness and value judgments around weight. These realities make it hard for someone to clearly see their eating disorder.
The glamorization of restricting, seeming universality of over-exercise or purging and the creation of diets using herbal laxatives have even normalized symptoms themselves. It feels like the norm to obsess over every meal and over any weight change, no matter how small.
The distinction between food and weight obsession and an eating disorder seems like a fine line to the person with a functional disorder. The significant restricting, regular binging and purging or any other symptoms can seem to fit into some version of the distorted norms of food and weight in today's culture.
Under the surface, the constant intrusive thoughts of the eating disorder, in addition to daily symptoms, clearly define the circumstances of a functional eating disorder as opposed to someone overly focused on food and weight.
Initial attempts at treatment need to introduce and reinforce the concept that a functional eating disorder is indeed an eating disorder and just as serious. Any words that mitigate the severity confirm the denial and pave the way for longer periods without treatment. The message that this eating disorder is real and serious needs to be consistent and clear.
For someone who has not been in much treatment, it's also important that the message is kind and compassionate. The diagnosis needs to convey that starting treatment will feel liberating since a functional eating disorder feels very much like a prison, even if that path is arduous and long. The compassion also counters the internal, punitive thoughts that dominate someone in this situation who feels trapped in a cycle of misery.
Balancing firmness about the diagnosis with compassion allows this person to engage for the first time with the possibility of a new way out of their dilemma. Although that feeling is precarious, it opens the door to the key of any successful eating disorder therapy: hope.