Executive dysfunction

Medically reviewed by Majesty Purvis
Updated January 22, 2024by BetterHelp Editorial Team

Executive functioning generally refers to mental processes such as working memory, cognitive flexibility, and self-regulation, which enable us to perform fundamental tasks in our day-to-day lives. 

Experiencing executive dysfunction symptoms may be a cause for concern and may impact a person’s ability to complete tasks. Executive dysfunction can be linked to many different conditions or illnesses, including mental health conditions like depression. Read on to learn how to recognize signs of executive function deficits and how they may be related to your mental health.

Learn more about the effects of depression
Executive function skills

Executive functioning refers to the skills that are involved in a wide variety of daily tasks, such as time management and completing tasks. Executive functioning skills can be split into two types: those used for organization and those used for regulation. Organizational functions include attention, planning, verbal working memory, problem solving, and flexible thinking, which are crucial as higher-level executive functions. Regulatory functions involve monitoring internal and external stimuli, exercising self-control, emotional regulation, moral reasoning, and decision-making as it relates to time, money, and other areas of management.

These functions develop from around two years of age in one’s brain (specifically memory-related areas) and are usually fully formed by 30. However, there are individual differences in the rate of this development, which can affect how executive functions develop in adults. Each function plays a crucial role in everyday life, which is why deficits in executive functioning can be challenging or even debilitating, depending on the severity of the issue.

Executive function deficits

Experiencing executive dysfunction means having difficulty with any of the abilities listed above. Signs of executive dysfunction can include:

  • Trouble shifting attention from one task to the next (such as you may see in those who live with attention deficit disorder)
  • Getting distracted easily or having trouble focusing on complex tasks
  • Working memory deficits
  • Frequently daydreaming during conversations at work or school
  • Difficulty with self-motivation (which can be commonly associated with conditions such as executive function disorder)
  • Trouble organizing or planning ahead, perhaps showing up as poor time management skills 
  • Focusing too much on one thing, as executive function skills may be required to switch between priorities 
  • Frequently misplacing school materials or items, which can be associated with a limited or divergent working memory 
  • Experiencing problems with impulse control (snacking when trying to stick to a diet, blurting out thoughts you didn’t mean to, having inappropriate emotional reactions, or struggling to regulate emotions)

Executive dysfunction disorder

People with executive dysfunction may have trouble in only one or two areas, or they may experience difficulty with many or all of them—a condition that’s sometimes referred to as executive function disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), executive dysfunction isn’t considered an official mental health disorder—typically because it’s usually a symptom of some other behavioral disorders, injury, or disease. Still, there are ways to treat executive dysfunction that can lead to significant improvement in daily functioning. It is important to note that a sudden change in cognitive skills could be a result of brain damage, especially in the frontal lobes, or a degenerative brain disease that may be discovered through neurological examination.

Common causes of executive dysfunction

According to the British Medical Bulletin, executive dysfunction can have or be linked to a variety of different causes, including:

  • Traumatic brain injury
  • Toxins (such as carbon monoxide poisoning)
  • Vitamin deficiencies
  • Alzheimer’s or dementia
  • Epilepsy
  • Substance use disorders
  • Bipolar disorder
  • Schizophrenia
  • Obsessive-compulsive disorder (OCD)
  • Anxiety disorders
  • Depression

In general, executive dysfunction is related to damage to or deterioration of some parts of the brain. It can also range widely in severity and duration or frequency based on the main cause. 

Various tools and self-tests can provide valuable insights into an individual’s executive functioning abilities and help clinicians develop a treatment plan. Additionally, these assessments can be repeated over time to chart progress or determine if any changes need to be made to the plan.

Self-test tools

To assess the individual’s executive function, clinicians may use a variety of tools, such as the Behavior Rating Inventory of Executive Functioning (BRIEF) and Comprehensive Executive Function Inventory (CEFI). The BRIEF is administered as an interview or self-report questionnaire that provides information about behavior regulation, emotional control, and problem-solving skills, while the CEFI is a performance-based assessment that measures executive functioning in areas such as cognitive flexibility and self-regulation. 

The Barkley Deficits in Executive Functioning Scale (BDEFS), Montreal Cognitive Assessment (MoCA), and Stroop color and word test are other tools that can help measure executive dysfunction. They provide both qualitative and quantitative information about an individual’s cognitive skills. 

How executive dysfunction can be related to depression

Isolating the exact cause of executive dysfunction can be challenging in some behavioral therapy cases. There are many possible contributing factors, and some can be congenital or undiagnosed, making the main source harder to isolate. However, a brief review of research does show that those who have depression or people with ADHD are likely to experience some level of executive dysfunction as a symptom, which might be linked to the prefrontal cortex.

What is depression?
Depression is more than feeling sad. It’s a mental illness that can be chronic and persistent, and it can negatively affect the way you think, feel, and behave. There are several different types of depression and many different ways it can affect a person. To be diagnosed with depression, an individual must experience several of the following symptoms for at least two weeks:
  • Loss of interest in previously enjoyed activities
  • Significant fluctuations in appetite or weight
  • Significant fluctuations in sleep
  • Problems with planning or completing goal-directed activities
  • Lack of energy
  • Feelings of worthlessness, hopelessness, or guilt
  • Trouble thinking or making decisions

As you can see, some of the symptoms of depression overlap with executive dysfunction symptoms. However, that doesn’t mean that someone experiencing executive dysfunction has depression. There can be other factors at play, as outlined in a previous section. That’s why a mental health professional would need to take an overview of your situation and learn more about what you’re feeling to decide if depression may be the root cause. 

Executive dysfunction and depression

If you've noticed the symptoms of executive dysfunction manifesting in your daily life and you've noticed some symptoms of depression as well, there may be a link. Speaking with a medical professional or a therapist can be a helpful first step in determining the underlying cause of executive dysfunction and exploring potential treatment options if the cause is mental-health related.

Therapy is one of the best treatment methods for depression and some other causes of functioning difficulties, with cognitive-behavioral therapy (CBT) being especially effective for inhibition control and improving emotional regulation. CBT is based on the concept that our thoughts and our behaviors are very closely linked, so it aims to help individuals learn to recognize and shift any unhelpful or flawed patterns of thinking. Over time, this type of therapy may help improve coping strategies, decrease symptoms of depression, and improve an individual's self-awareness. It may also help improve their ability to control impulses and self-monitor in social interactions.
Learn more about the effects of depression

Treatment options for depression

Connecting with a mental health professional is typically the recommended first step for those who are experiencing symptoms of depression and executive function skills issues. In some cases, therapy or pharmacological management in the form of medication may be recommended. When seeking therapy for mental health concerns like this, the most important thing is to find a provider and a format that you feel most comfortable with. For those who prefer to receive mental health support or treatment from the comfort of their own home, online therapy is one available option. 

Studies have shown online cognitive behavioral therapy (CBT) to actually be slightly more effective in treating certain mental illnesses than the face-to-face modality, though both are recognized as valid treatments. One literature review of 17 studies on the topic, likely including experimental psychology research, suggests that online CBT is more effective than traditional, in-person therapy for reducing symptoms of depression, specifically. It also notes that virtual CBT can be less expensive than in-person therapy. CBT may also help executive dysfunction.

If you’re interested in trying online therapy, consider a platform like BetterHelp. After filling out a brief questionnaire, you can get matched with a licensed mental health professional who suits your needs and preferences. If you prefer face-to-face therapy, you can search for providers who are located near you and specialize in the areas in which you need support, such as interference control. Regardless of the format you choose, a therapist can help you manage symptoms of depression or executive dysfunction.

Below, you’ll find reviews of BetterHelp counselors who have helped people in similar situations.

“Negin is incredible! She has created a safe space for me to be vulnerable and tell my struggles with anxiety, depression, and life in general. She is very authentic and will be honest and kind with you about the hard stuff. So thankful to have been matched with her!”

“She is a wonderful human being, both understanding and insightful. Her expertise is reflected by how she approaches situations presented to her, and she offers concise help in tackling the root of my issues. I highly recommend her to anyone who is struggling with anxiety, depression, or any other issues that you may be facing.”

Someone experiencing executive dysfunction will have trouble with certain fundamental daily tasks. This symptom may have any number of causes, but depression is a common one. If you suspect you may have a mental health condition like depression, speaking with a therapist can help.

Depression is treatable, and you're not alone

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