"High Functioning"

BipolarChic asked about being taken seriously if you're high functioning, a question I felt I couldn't answer since I don't consider myself to be in that category. As a result, I'm curious as to how you define "high functioning".

I exclude myself because I no longer am able to work in the career for which I prepared, as well as only managing part time at a very simple job.

For me to be high functioning I would expect to be able to perform as any other member of society, even if occasionally struggling with mania and depression, even if occasionally hospitalized.

I think that's my internalized definition. What's yours?

Same.
In my mind it's still being able to work and keep up relationships even when you are in turmoil.


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I don't know but I think I have always been considered that even when I went long periods of not working.

Can fully function in daily life. Can blend in with the average person. Has friends, relationships, and a job.

I don't think I'm high function (no job, little money, no relationship)

But I do have (friends, volunteering with 2 organisations, classes I go to, therapy, looking after myself)

If I couldn't do the positives in my life I wouldn't be functioning. So if I wasn't looking after myself etc I wouldn't be functioning.

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I used to be high-functioning until I had a nervous breakdown. I had a high-stress job and plenty of friends. Now I'm not, and I don't know when or if I will be again. Since my job was my identity it was really difficult.

I consider myself high-functioning, because even when I'm at my worst, I'm typically able to put on my 'game face' and get done what needs to get done. I'm still employed at a challenging job with a lot of self-supervision (it's really hard, sometimes, to stay on task and motivated, but when push comes to shove I get my work done). I maintain lots of friendly acquaintances as well as a small number of close friendships. I do a pretty decent job of parenting and assist my kids with managing both school and extracurricular responsibilities. I also run the house without burning it down when my husband is working hard during his busy season (like right now - he's been gone 10 days and will probably not be back for another 2-3 weeks) - while he's gone, meals/laundry/cleaning still happen and none of our 7 pets (chickens, dogs, cat) or 2 kids are the worse for wear.

All that said, in the few instances where I've shared my dx, people have been totally shocked because I hold it together so well on the outside. Even when I'm horribly depressed, I feel like I don't have any option but to persevere and get my 'jobs' done in life. Being able to muster up whatever it is that lets me do that is what I think makes me high functioning. It feels like it will kill me, sometimes, and only a very few people (2, maybe 3) in my life can see any of the inner toll that participating in my life is taking during those periods.

It's an interesting term.

Great question.

Within Bipolarchic's thread, I did reply; however, not because I can work or do much at all. I have serious physical disabilities and serious c-PTSD and mood-related issues. The point I had tried to make is: Doctors/others often do not initially take my requests for help very seriously because of my ability to articulate, etc. This is mistaken for "high functioning," esp if they do not read my chart/history.

Most of us are rated by our pdocs/therapists on a "Global Assessment of Functioning" for the past year.

Here's an explanation of scoring for adults and children, if interested:

https://www.omh.ny.gov/omhweb/childs...unctioning.pdf

Since I've been repeatedly exposed to disability reviews which have included the use of this scale, I tend to think in terms of this scale.


WC

I think I was high functioning.

Don't know what I'd be considered now though.

I can relate to this, Fharriage. (((( hugs ))))

I was in very high stress work, too. (Emergency services.)
Lots of friends. Avid athlete. Traveled a lot, etc. Nothing phased me.

My initial disability was physical/medical (autoimmune); however, the rest came crashing in shortly thereafter, as I was exhausted and had no more reserves for keeping up my defenses of any type.


WC

I don't think I'm high functioning either, besides a psychical disability, I have my mental health issues, so no job, on SSI, can barely get out of bed most days, don't get dressed except on days when I have appointments (Wednesdays usually), only really eat sleep and shower most.days, some days I don't even do that. So no I don't consider my high functioning at this time...

I consider myself high functioning: job, wife, house , friends, animals, baby on the way.

Where this issue comes into play for me is when seeing any other health care professional besides my pdoc, especially a physician. When the asked about conditions I say bp and they immediately ask, " have you actually been diagnosed?" like they don't believe me.

I can only assume this is because of the prevalence in this area of people creating reasons to be prescribed anti-anxiety meds and abuse them.

My psychiatrist and therapist think I am doing great because I still have a full time job in the medical field. I have been married 23yrs and have 2 adult children and an 8yo. I am active in my church and occasionally will run half-marathons.
The thing is although I know how blessed I have been I would welcome a head on car crash or a quick spreading cancer. I constantly feel guilty for things I have or have not done. And my favorite way to spend my time is sleeping. So doing well on the outside means nothing to me. It's a show. And it is harder and harder to get up and play that part.

I'm moderate functioning... 2 degrees, full-time job

I just don't have any friends in RL or a relationship. I'm not good with either of those things, and I don't think I'm really capable of having a relationship anyways. (Mood is too unstable and my mood swings are pretty bad.) I'm also living with my parents because I'm not capable of living on my own right now. I'm too unstable for that.

On top of everything I've said, my unstable moods have been getting me in trouble at work, and my medication isn't helping all that much.

I think "high functioning" implies you're able to live a "normal" life -- e.g., relationship, job, friends, home, etc. (Basically what manicminer said)

I think functioning levels can vary a lot based on whether someone is having an episode or certain symptoms. Actually, the ironic part for me is that I can often be most productive during hypomania and really excel in the workforce, but my symptoms still cause a lot of issues in all other areas of my life. There are times when I can be considered "high functioning" but very much struggling with the symptoms. I also have periods of time where I may appear low functioning, especially when depressed or in a mixed state and needing time off from work. This is why I really do not like the terms "high functioning" and "low functioning," because they do not fully capture what is going on with the person's Bipolar symptoms. I even hear mental health professionals are moving away from those terms too for that very reason.

I talked with my therapist about this. High functioning means you are able to care for yourself, eat shower etc. I believe no alcohol/ drug issues but honestly not certain. It also includes being able to hold down a job, not necessarily the one you want or trained for, but any job. How I look at it, most people do not know I am bipolar. i am generally able to hide it. So when I am struggling I am not taken seriously because it does not look like anything is wrong.

I agree they should not define people in terms of high and low functioning. I should not have to drop out of work stripe naked and run down the street screaming the aliens are coming in order to be helped. If they don't believe me they can stop taking my money!!!!!

I am in a similar boat. Two degrees, friends, I can't relate to and never a long lasting relationship. Full time job. Right now I am doing ok at work. Could not say this a year ago. Living with my dad. Mood is too unstable. I fluctuate and relapse way too often to even consider some kind of romantic relationship. This is despite medication. Oh and I decided to look at fb tonight. It always makes me extra cheery. I don't think they look at relationships as a part of high functioning. They deem it important and will work with you, but I don't think it is part of it. And that's what upsets me. There are many who can't work but have a relationship. In reverse you are not taken seriously.

Wild_Coyote, I'm SO GLAD you posted that!!!

I can barely function in life, but I always LOOK okay. Because I am articulate, because I can hold conversations and have social skills, doctors mistake that for 'high-functioning.' I just had an interview two weeks ago with an assessor for Medicaid disability, and within 15 minutes of meeting me, she had already said I have borderline personality disorder. As I walked out of the one hour appointment, she told me, "You seem really smart and capable," which sounds like a good compliment but ISN'T when you've been trying to explain how totally incapable you are of functioning and how upsetting it is to you to not be able to do more.

First off, I don't care if she has a PhD - NO ONE can diagnose a personality disorder in 15 minutes.

Second, it left me so upset. This has happened to me over and over, and it hurts when people who are supposed to help instead totally invalidate my darkest times. My therapist says it's because I never look as bad as I feel. I look like I could pop up and plan a dinner for 150 people at church, but I can barely leave the house sometimes. Since I look better than I feel, providers assume I'm lying about how badly I'm doing and assume I'm trying to manipulate him.

This has been so, so, SO upsetting for me over time to keep getting the inaccurate BPD diagnosis just because I look fine on the outside and the PhDs trust only what they see and what they think instead of listening to me.

For the original question -
I consider high-functioning as able to meet normal responsibilities in life - able to hold a full-time job or do school full-time, able to maintain some close friendships or family relationships, able to physically take care of self like showering and eating, (since I'm a mom) able to watch the children full-time, (since I'm a housewife) able to take care of the home like keeping it reasonably clean. Like someone else said - being able to blend in with normal people.

What do you all think about the role upbringing has in all this? From the time I was very young, I understood that my job was to make myself (and my family/parents, by extension) appear perfect. I got very good at surface presentation. I developed the skills of not demonstrating my real self or my emotions - I was early labeled 'too sensitive' and 'over-dramatic' just for expressing myself naturally. I learned that I had to have the capable mask on for the outside world, even though I was in great pain internally.

As an adult, I don't really know if I can switch that off. Even if I'm in the depths of my depression, if there's a 'public showing' of myself somehow (school meeting, work call, whatever), the mask automatically goes into place. It's so ingrained, I don't know if I could undo it if I tried. And my internal state is often so unpredictable that I have no intention of trying to change this.

I do notice that when I put the mask on and present the 'highly functioning' person on the outside when it doesn't match what's truly going on for me, I pay for it later, sometimes severely. Like, if I was a 5/10 on a scale of depression or anxiety severity and had to function publicly somehow, afterward I would be more like a 7-8/10.

And there it is! Thank you. you just gave The perfect example. You look OK so they assume you are. So despite the fact that you're stating I am not well they are judging you based on surface level. Anyone can neglect their hygiene and their overall appearance! Anyone can purposely do a bad job so they get fired over and over again.

My thoughts exactly

NoIdeaWhatToDo - exactly.

I felt it was my job growing up to reflect well on my parents and grandparents and my religion, so I tried to look perfect. Now it's so ingrained that I can't turn it off even when I'm super depressed. I have people tell me all the time, "But you look fine." "You're always smiling when I see you." It's not intentional. I couldn't make myself look ultra depressed even if I wanted to.

It means providers don't believe me. Some people around me probably think I'm making it up. My friends are mostly confused about it because they never, ever see the dark parts. Even my family doesn't see it.

Though, I purposely keep a lot of the suffering inside because I feel like I'm already suffering enough; I don't want to put any more suffering on people around me by telling them how badly I'm doing.

I keep a lot of suffering inside, too, thinking I am "protecting" others.
My family has had a lot of trauma and tragedy. I keep a lot of my stuff to myself. They also have some real limitations in their abilities to "be there" for others due to their own histories.


WC

For those of us who are currently high functioning, do you ever worry that there will be a time when this may change? I know I do. Currently I am able to work 50+ hours a week and take at least 2 classes while also having somewhat of a social life.