One difference between someone with a functional and non-functional eating disorder is glaring. A person who is functioning can regularly use the relatively well parts of their life to deny the severity and even existence of the eating disorder. People who are not functional with their illness may also be in denial about how sick they are, but the medical severity means this denial is more akin to delusion and thus represents a different aspect of eating disorders.
To understand the importance of this difference, one must have more clarity about the role of denial in eating disorders. The persistence of thoughts about restricting food, weight loss and the inherent focus on body all dominate the internal world of someone with an eating disorder. However, the reality of an eating disorder is that this mental state is the norm: it's often hard to believe others live any differently and almost impossible to imagine what that alternative feels like. It is much harder to normalize one's life experience when someone has been in and out of hospitals.
A functional eating disorder makes it easy to think that there isn't much difference between this way of eating and normal eating. These people still struggle with many of the same professional and personal issues as people without eating disorders. They think about food and weight, like many people. It's just that their thought processes are very different and all encompassing.
Over time these thoughts begin to blend into reality and become an overall philosophy of daily life. Moments of increased struggle may break through the denial temporarily and highlight how real the eating disorder is, but the desire to fit into a more normal framework, despite ample evidence to the contrary, trumps any urge to seek help.
The mindset of someone with a functional eating disorder demands a very different approach to begin to change. The first and most important step is to break through the hardened wall of denial, not to counter the power of the eating disorder thoughts. More on this next post.