Executive Functions
Executive functions are central cognitive processes that can be impaired in Borderline Personality Disorder and ADHD. Understanding these functions helps to better contextualise certain behaviours.
What Are Executive Functions?
Section titled “What Are Executive Functions?”Executive functions include:
- Planning and problem-solving
- Action control and regulation
- Motivation and emotion regulation
- Attention focus
- Working memory
- Inhibition (suppression of impulses)
- Task management
- Monitoring and encoding of information
These functions govern conscious, complex behaviours in which multiple cognitive aspects must be coordinated.
Neuroanatomical Foundations
Section titled “Neuroanatomical Foundations”Executive functions are primarily coordinated in the prefrontal cortex (frontal lobe).
The Frontal Lobe
Section titled “The Frontal Lobe”The frontal lobes have developed significantly in the course of human evolution and have grown disproportionately compared to other brain regions.
Particularly involved is the anterior cingulate cortex, located in the medial frontal cortex. It has extensive connections to:
- Frontal, parietal, and temporal lobes
- Entorhinal association areas
- Amygdala (almond-shaped nucleus)
Impairments of Executive Functions
Section titled “Impairments of Executive Functions”When executive functions are impaired, the following areas are affected:
1. Working Memory
Section titled “1. Working Memory”- The ability to hold and manipulate mental objects in the mind
- Placing mental objects in a temporal context (past and future)
- When impaired: difficulty keeping information “online”
2. Regulation of Affect and Arousal
Section titled “2. Regulation of Affect and Arousal”- Separating affect from response behaviour
- Enables “reasonable” action
- When impaired: emotions directly dictate behaviour
3. Internalisation of Speech
Section titled “3. Internalisation of Speech”- Conscious inner verbal description and reflection
- Enables self-instruction
- When impaired: inability to follow one’s own or social rules
4. Behavioural Planning and Synthesis
Section titled “4. Behavioural Planning and Synthesis”- Finding creative responses to situations
- Selecting from one’s own behavioural repertoire
- When impaired: rigid, inflexible reaction patterns
The Core Problem: Impulse Inhibition
Section titled “The Core Problem: Impulse Inhibition”Essential to the executive system is that the instinctive, emotional behavioural response is initially inhibited.
This inhibition:
- Prevents irrelevant distractions from dictating our behaviour
- Allows us to pick up the thread again after pauses
- Means: “Stop, look, listen, think before you act”
- Makes goal-directed learning and behaviour possible
Effects of Impaired Executive Functions
Section titled “Effects of Impaired Executive Functions”Behavioural Level
Section titled “Behavioural Level”- Lack of drive and impaired planning ability
- Disrupted goal-directedness and purposefulness of activities
- Faulty situational assessment
- Problems with daily structure and scheduling
- Impaired ability to learn from mistakes
- Difficulties with flexible adaptation to change
Emotional and Social Level
Section titled “Emotional and Social Level”- Loss of drive and interest
- Emotional indifference (affective indifference)
- Aggression and socially maladaptive behaviour
- Lack of empathy
- Lack of appropriate distance in social situations
- Inability to stop actions once the goal has been reached
Three Subtypes of Frontal Lobe Syndrome
Section titled “Three Subtypes of Frontal Lobe Syndrome”Depending on the affected brain region, three subtypes are distinguished:
1. Dysexecutive Subtype
Section titled “1. Dysexecutive Subtype”- Following damage to dorsal prefrontal structures
- Focus: planning and organisational problems
2. Disinhibited Subtype
Section titled “2. Disinhibited Subtype”- Following damage to orbital structures
- Focus: disinhibition, impulsivity
3. Apathetic Subtype
Section titled “3. Apathetic Subtype”- Following damage to medial structures
- Focus: lack of drive, indifference
Relevance for Borderline and ADHD
Section titled “Relevance for Borderline and ADHD”Similarities
Section titled “Similarities”Both ADHD and Borderline Personality Disorder show impairments of executive functions, particularly:
- Impulsivity
- Emotion regulation problems
- Attention difficulties
Differences
Section titled “Differences”| Aspect | ADHD | Borderline |
|---|---|---|
| Cause of impulse control disorder | Biochemical (dopamine, noradrenaline) | Structural-psychodynamic |
| Emotional instability | Reactive, situational | Deep, identity-related |
| Relationship problems | Secondary (due to symptoms) | Primary (core symptom) |
| Self-image | Generally stable | Chronically unstable |
Therapeutic Approaches
Section titled “Therapeutic Approaches”Understanding executive functions has practical implications:
For Affected Individuals
Section titled “For Affected Individuals”- Use external aids for structure (calendars, lists, routines)
- Self-instruction training: consciously use inner speech
- Mindfulness exercises: create a pause between stimulus and response
In Therapy
Section titled “In Therapy”- Skills training for emotion regulation (e.g. DBT)
- Cognitive techniques to improve planning
- Where appropriate, medication support (particularly for the ADHD component)