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What Does It Mean to Be High-Functioning?

If you met me on the street, you wouldn’t know that I have bipolar disorder. Usually I’m put-together, made up and have a decent amount of social savvy. I’m not alone in this. We have families, jobs and hobbies just like everyone else. There are definitely times that is not the case, but we get along overall. Yes, there are absolutely people who struggle to maintain a “normal” life, and that struggle deepens the more severe the disorder. After all, bipolar disorder is the sixth leading cause of disability worldwide. So how do we know where we fall on the spectrum of functionality and what does it mean to be “high-functioning”?

There is a scale that professionals and researchers use when looking at bipolar disorder and how well a person functions. It can help when considering treatment options, social work and disability needs. It’s called the Functioning Assessment Short Test (FAST). It consists of 24 questions in six categories that give a good look at how we’re coping with life and where we might need help. These categories are:

The questions in this section basically want to know if you can take care of yourself. How well do you do, or would you do, living on your own? They want to know if you can take on the responsibilities of running a household like cleaning and shopping as well as taking care of your person. Are you good at hygiene or do people cover their noses on the subway?

Occupational Functioning
This one seems the most difficult, at least to me. It’s all about work. Can you hold down a job and do it well and efficiently? More than 40% of people with bipolar disorder are out of the workforce. Those that do work miss more than twice the average amount of days due to symptoms related to the illness. The truth is, bipolar disorder is a disability, and many people who have the disorder qualify for disability benefits.

Cognitive Functioning
Questions concerning cognitive functioning include subjects like memory, attention, problem solving and learning. Up to 60% of people withbipolar disorder struggle in at least one of these areas. To make matters worse, it doesn’t just happen during depression or mania, but even between episodes.

Financial Issues
This is pretty straight forward. Can you manage your money on your own and stick to a budget? A classic sign of mania is extravagant spending- clothes, cars, vacations, a lawn-full of plastic flamingoes. There are endless examples of mistakes people make with their money when manic. It’s not surprising that many people with bipolar disorder are in extreme debt, whether due to spending sprees or medical bills.

Interpersonal Relationships
How well you’re faring in this area is dependent on a few factors. Do you have meaningful, satisfying and healthy relationships, whether friendships, family or romantic? During depression, we tend to isolate ourselves. During mania, impulsive speech and behavior can be hurtful. You also have to consider sex. Is your sex life satisfactory? Do your medications or depression hinder you? What about during mania? Are you engaging in risky sex (many partners, no protection) or having affairs due to an overabundant sex drive? All of this is extremely important when it comes to how well you’re functioning.

Leisure Time
Finally, they look at what you do in your spare time. Are you physically active and do you have interests or hobbies that you participate in? Depression can cause you to ignore your passions. Do you love to knit? How long has it been since you touched your needles? That roller derby league you joined, when was the last time you went to practice?


All of this combined gives you and your mental health team an idea of how things are going for you and where you may need help. Keep this in mind next time you go to your appointment. The better you’re doing overall, the more likely you are to be considered “high-functioning.”



LaRae LaBouff,