Executive dysfunction is a symptom you may not have heard of; it’s not widely advertised, but it plagues a lot of people with both bipolar disorder and ADD. There’s more stuff online connecting it to ADD/ADHD than bipolar, but everyone I’ve chatted with online confirms having problems with cognitive functioning.
So what is executive dysfunction anyway? Wikipedia has a great article on the subject, and there’s not a whole lot I can add to that. Essentially, it’s an abnormal reduction in cognitive capacity, linked primarily to prefrontal cortex damage or underdevelopment – isn’t it great to learn that you basically have brain damage? Yeah, not so much, though now I’m super-curious as to what my brain looks like! Everyone has occasional problems with executive functioning, but it’s a lot worse for people with certain neurologically-based illnesses. The resulting issues, sometimes called dysexecutive syndrome, include difficulties with organizing, focus, memory, impulse control, and goal-directed behavior. The latter is especially problematic when manic, since increases in goal-directed behavior are typical, particularly for me. That means that not only am I driven to do more stuff, I also don’t do it as well as I might under other circumstances. Cue massive problems with task completion and time management…
I also found a good write-up on related ADD symptoms from the perspective of a developmental impairment, which can result in people being labeled as lazy or incompetent when they really just lack the skills to perform to normal standards. This article has a nice description of the problem behaviors. I really relate to all the issues related to activation, problems with shifting focus, all the emotional regulation problems, the effort-related challenges with sleep in particular (one of the surprise benefits of Lamictal was elimination of these problems!), and action with respect to regulating the pace of my work.
If you prefer a more academic view of issues with executive dysfunction as relates to bipolar disorder, there are a slew of Medline abstracts of studies on the topic. So it’s not an unknown issue, but rather something you might not hear about. In practice, mental health professionals always seem to focus on the primary symptoms of depression and mania to the exclusion of the persistent problems with executive dysfunction, which can actually have a bigger impact on day-to-day living (in my opinion, having continually struggled with these issues when not plagued by mood swings) and are severely exacerbated by mood episodes.
OK, so my brain is just plain shrunken and atrophied when it comes to the parts that control executive function. That’s massively disappointing, especially for people who are otherwise really, really smart. Ego-wise, that really smarts. (Yeah, bad pun, but I couldn’t resist!) Another worrisome aspect of this is that for people with bipolar disorder, it often leads to employment problems (per one of the Medline abstracts) because these challenges are so pervasive and have such a strong effect on work tasks. On the other hand, there’s a bit of good news: usually adults with ADD have less problems with this over time because they learn compensatory strategies and as children, their brains are simply maturing more slowly – up to 30% more slowly. I was actually told once that even if I had ADD, I didn’t need treatment because I had learned to compensate. That wasn’t at all true, except for the learning to compensate part, and that was mostly just working about three times harder than everyone else to achieve the same results. In fact, my work habits were so overdeveloped that once I was actually treated for ADD, I really outshone everyone else because the only way I knew how to work was to an extreme.
The benefits of my medications aren’t limited to just controlling attention problems and reducing mood episodes in severity and frequency. They can also help attenuate reduced cognitive function. Since getting to an effective therapeutic level on mood stabilizers, I am no longer having the problems I used to with sleep. I am somewhat better about getting started on tasks and organizing them effectively, though really, a lot of that has to do with extensive practice. The meds do seem to reduce my persistent indecision about where to start on tasks because prioritizing is so hard for me. Obviously the emotional problems are much, much better, and my ADD meds make a huge inroad on the issues with focus. Regulating my work pace is actually much better as well, though I’ve always attributed that to mood swings – I work (very) fast when manic, and (very) slowly when depressed. Now that I’m mostly stable, I work at a pretty good and consistent clip. It was one of the biggest areas of improvement for me, besides the relief from depression.
I’m curious what other people have encountered with respect to executive dysfunction. I seem to be fairly lucky with respect to minimal memory issues because although my short-term memory has never seemed particularly good, I have amazing recall on weird little details – but perhaps that’s symptomatic too? I really wouldn’t know how my memory compares to “normal” because it just is what it always has been, like so many other things that I can’t really evaluate effectively.