High Functioning vs. Low Functioning…What’s The Scale?

So going back to this post near the end, I questioned just how functional I really was. A lot of times, you hear the terms “High Functioning” or “Low Functioning” when professionals (or even lay people) refer to those with psychiatric or neurological disorders. Most commonly, it is heard in the realm of discussion of “Spectrum Disorders” such as Autism Spectrum Disorder or I would even go further to say “Bipolar Spectrum Disorder” even though it is not commonly referred to as such. But since it has been classified so finely (cough, cough) by the DSM-IV and the ICD into little boxes, I would think that “obviously” shows a spectrum of behaviour. What a lot of professionals need to bear in mind, however is that, due to the nature of these disorders being part of a spectrum, those beholden to them (I don’t want to call us “sufferers”…let’s not make us look more weak and pitiful, thank you) will invariably end up shifting throughout the very spectrum of the behaviour defined.

Is that clear? I hope so. Put it this way, if you’re “labelled” BPI, that doesn’t mean that you will never experience a mixed state or an extended period of depression lasting for months on end or that your cycling patterns won’t change and you won’t end up an ultradian cycler–the type that I ended up being. I was diagnosed BPII which apparently is “incapable” of cycling as fast as ultradian and I still carry the BPII diagnosis/label but guess what? As the years went by, I was cycling so fast that I was manically jibber-jabbering away and running around my apartment like I was on speed for 15 minutes and then suicidally in tears with no energy about 15 minutes later. Supposedly if you’re BPII, that can not happen. Well, tell my brain that.

It’s the same thing with Autism. So, if a child is diagnosed at the ripe old age of two or three with Autism, they receive therapy and then perhaps the diagnosis changes to PDD-NOS, are they no longer autistic? Well, that might depend on if you’re applying for funding to continue therapy for your child (and that’s a whole other issue…) And what about Asperger’s Syndrome? There are people that are still debating whether or not that’s part of the “higher functioning” part of the Spectrum or another separate disorder all it’s own.

Okay, so the “functionality” thing. I understand that we all have “to classify things” in order to make sense of our existence and all of that sort of thing. But I find it difficult to apply the high/low functionality label to something that can be constantly in flux. Things can trigger all of us with psych/neuro disorders. I mean, what about “medium functioning?” I’ve never heard of that. I kind of think we all might be somewhere around there because half the time, no one knows just how they’re going to be from one day to the next! And it can’t just be based upon IQ, how we get around in the world, ability to hold jobs etc…is it really that simple? Because again, all of those things aren’t necessarily static.

Am I over thinking this? Is the label whore getting tired of being labelled?

I would be considered “high functioning.” But compared to what? I am gainfully employed. Okay, I get up every day and I go to work. I am intelligent? What else? Beyond that, there are cracks in my exterior. You may not see them but they are there. Luckily, I work in a very lax environment so I have the luxury of showing up in a baseball cap and jeans! That works very well when I don’t feel like showering. Which happens frequently. I know, that sounds awful, doesn’t it!? Feel free to gasp aloud. So how functional is that? Ooh…personal hygiene is suffering! Look out…that’s a sign!

On the weekends, I spend a gross amount of time in bed (or on the couch.) Not sleeping because we all know how that situation is. No, I just need to rest and don’t feel like doing much. My job isn’t stressful but after a week of working I’m drained. Uh oh…maybe she’s not so “high functioning…?”

I’m not really a social person. Well, I *can* be but I need some encouragement. Once I get into the groove I can do it but you generally have to get the cattle prod out (to get me off the couch, remember?) Did all that hypomanic euphoria (and subsequent disappearance thereof) permanently clip my social butterfly wings? I just don’t have the energy anymore. Hmmm…the functionality meter is dipping…

What makes me social? Booze! If there’s one thing that will give me a taste of the “good ol’ days” it’s a drink of anything alcoholic. But it’s the Sword of Damocles, that’s for sure–in a lot of ways. It’s not good for my head, it’s not good for my relationship…it’s just not good at all. Well, it is but it has a price. So I try and keep that at a minimum. I have a long self-medication history so it’s a slippery slope. Okay…so functionality’s a coin-toss with this one. Just my cross to bear…

So in the end, I still don’t know how “functional” I am. But I do know one thing. With Bipolar and pretty much all of the other disorders out there where triggers can make them worse, you can go from functioning quite well to being barely able to take care of yourself at all in no time flat. Been there, lived through it.

And speaking of functionality, I have to go back to work tomorrow. Vacation’s over! I may be a bit absent from blogging as I am going to be swamped. But you never know…I might be able to fit it in. Depends how “high functioning” I am…

  1. mcewen

    PDD with or without the NOS, is open to a great deal of debate and controversy. I try not to concentrate on the ‘label’ and view it merely as a ticket to services.
    Briana Seigal’s [sp?] book gives a good diagramme to illustrate how some clinicians define and categorize autism, which is a good starting point if you’re interested.
    BEst wishes


  2. wolfbaby

    labels gotta love’em don’t ya


  3. Megan

    True I think I as a dianosed aspergers person move up and down the scale. Without my pills I’m really stuck in my own world of repeative thoughts and can’t even do my favorite things. I was once labeled P.D D which was never explained to me the teachers should’ve.
    But now I know my limitations and it helps to tell myself I can’t do things as even other neurotypical artists do. The common highway of thinking and doing isn’t for me. Some advice said by NTs is easier said then done.
    The label doesn’t bother me it’s a brain neuro diversity thing.
    But it bothers me it’s called high functioning because if I was that I wouldn’t be on pills and have help.Also if it’s called high functioning it seems like a hypocrite to the syndrome. Because it’s called a syndrome at all and the difficultys with it. Also it feels hard nonone believes you it exists they think I’m making it up.


  4. Patient Anonymous

    Thanks for your comments, all…very much appreciated. I’m a little “low functioning” today for a variety of reasons. I’d like to squeak out a post to try and share why but yes, I am so freakin’ busy right now just getting back to work after vacation.

    And megan, don’t worry–it definitely does exist and you are not making it up. It sounds to me like you’ve had some challenges and again, I’m sorry for that. I’m not trying to pity you or anything–I hope it doesn’t sound like that. It just really makes me upset when people (NTs) think that those of us that are disordered would actually be “faking” what we all go through to seek attention or whatever else they come up with! Please.

    Yes, PA has been discriminated against because of her illnesses as well. That’s why she is so keen on patient advocacy and advocacy in general.

    Bust the stigma, everyone!



  5. Lynn

    I though the high/low functioning thing was IQ relative to the entire population. With the right education one then had better employability outcomes, but that is more up my employment line than the medical discussions. It is not a short term alternative (for most) but a long term employment objective.

    I have mental illness, learning disability and ADD. The last two statically are linked to higher than normal IQ’s, “normal” being 100 and “normal” for those with learning disabilities or ADD being 115.

    IQ of 115 is the IQ accepted as being required for graduating from University (referred to as College in the US).

    I don’t spell (what is spell check for?) , I don’t know what a NT, PDD or NOS etc is but I’m bright otherwise. I’d rather get a part time job at a higher wage or work from home as a consultant so I wouldn’t have to struggle with showing up every day. Just one alternative, to make work more manageable in the long run.

    And to all a happy life and good career. We all have challenges – some more than others…


  6. Hi Lynn, interesting point you bring up re: IQ tests and functioning. I don’t like IQ tests as I feel they are very biased in lots of ways. I think there are quite a few other people that will agree with me. They don’t take into account other “forms” of intelligence and again, “functioning.”

    Education doesn’t always guarantee employment–certainly not in this day and age anymore. It used to but with demographics and population and the way markets become more competitive–“good jobs” are no longer a guarantee no matter how many framed certificates, degrees etc… you have hung on your wall.

    I agree with your philosophy about finding what is the right fit for *you* and it sounds like you’ve done it? Good for you.

    I am a bit like a lost ship at sea “professionally” and have no clue so…I have unfulfilled dreams of what could have been but now I fear it’s too late. So I just do what I do.

    Thank you for stopping by and posting a comment.


  7. Yes to all of this. I have such trouble with the high or low functioning labels. I, too, work hard to hide my issues…..most of it comes out when I am finally home in my own space.

    I related to almost all of what you wrote.


  8. Hi invisibleemma, thank you for commenting again.

    I also understand the idea completely of having to hide your “issues” at times–definitely when you are “low functioning,” right?

    I refer to it as putting on, or wearing your “Sane Face.” I’m sure if you took a poll amongst all of us nutbars, you’d get an overwhelming response as to how many of us have elevated it to an art form!

    I know I sure have! However, it is very difficult when you are feeling like absolute hell on the inside and you have to be all perky and bloom like a spring garden on the outside. Or even if you can’t manage that much, “simply” do not betray anything that you feel on the inside.


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