OCD and Executive Functioning

planeThe first time I heard the term “executive functions” was when I went with Dan to meet his new psychiatrist. The doctor explained that people with obsessive-compulsive disorder typically experience deficits in their executive functioning.

What are executive functions? A search on the Internet yields plenty of information, though much of it is quite technical. One of the easier to understand explanations, which describes executive functions as the air traffic controller of the human brain, can be found here. Some skills associated with executive functions include planning, organizing, managing time, and remembering details. Those with executive dysfunction might find it difficult to focus, concentrate, make decisions, follow through on creative ideas, and shift attention to new information.

Dan struggled with all of the above. I’ve previously written about his trouble focusing and concentrating, which led to his misdiagnosis of ADHD. Decision making was also a big issue for him, as was time management. I always thought of these issues as by-products of his OCD, and that once his OCD was under control, all these other concerns would just melt away.

There’s no question that once Dan’s OCD was quelled, there were noticeable improvements in all areas of his executive functioning. So many of these issues had been interwoven with his OCD. Still, given Dan’s major recovery from severe OCD, the gains he made in areas of executive functioning didn’t quite correlate. They lagged behind. I concluded that this is just who he is and how his brain works.

I have since come across various studies such as these that confirm my belief. In one study, the executive functions of those with symptomatic OCD were compared to those who were in remission. In a second study, the executive functions of those who were symptomatic in the first study were reassessed after they reached remitted status. Results from both studies indicate that the “identified executive function deficits in individuals were stable over time and remained unchanged despite symptom remittance.” So even if someone’s OCD improves, their executive function deficits (if any) remain.

To me, these results serve as a good reminder that we are never dealing with “just OCD.” Really, when evaluating any illness, mental or physical, it is so important to consider the whole person: who they are, what makes them tick. I realize now the improvements I saw in Dan’s “executive functions” were most likely deficits directly caused by his OCD. Thankfully, he has learned to compensate for any shortcomings he might have pertaining to his executive functions, just as most of us do. We all have strengths and weaknesses; our brains are not all “wired” the same. And thank goodness for that!

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20 Responses to OCD and Executive Functioning

  1. Ruby Tuesday says:

    “We all have strengths and weaknesses; our brains are not all “wired” the same. And thank goodness for that!”

    Love this. 😉

  2. Thanks Ruby! Wishing you all the best in 2014.

  3. In my conversations with obsessive-compulsives, I find this to be true for many of them. It’s a different experience than mine … my OCD drove me to perfectionism and all that entailed (valedictorian in high school, summa cum laude in college, the dreadful leaning toward the legalism I HATE). I think my brain has reached its “full point” in the last couple of years, but before that, all my life, I heard, “You have an almost scary memory.” I thought it had something to do with my OCD, but maybe that was always its own separate blessing.

    It’s just interesting to hear how OCD manifests itself so SIMILARLY in some areas across the board, and SO DIFFERENTLY in others. A tricky minx of a disorder. So glad to be on my guard against its wiles now.

  4. This is very interesting. OCD has so many facets and presents in so many different ways. I find that (usually) in my work, I can stay organized, get my work done on time (I NEVER asked for extra time for a school assignment–I would have had to explain my OCD, and I couldn’t do that), etc. In that way, I’ve been a “high functioning” OCDer. But in my personal life, I tend to run late, be unproductive without a colossal effort, and manage my time poorly. Even when my OCD is under good control. So does that sound like it’s just me? Or have I adapted a certain amount to do the stuff that “matters” well and let the rest go? It’s hard to know where OCD begins and ends. Thanks for a thought-provoking post, Janet.

    • Interesting questions you raise, Tina, and I certainly don’t have the answers. What your comment shows, though, is that we are capable of adapting and compensating, at times anyway. I find this subject fascinating and realize we have so much more to learn about how our brains work.

  5. Dasa says:

    Hi Janet, I can only speak for myself, but although I have had OCD since childhood I am exactly the opposite of what a typical OCD person looks like in this article. Time management, decision making, remembering details… these are what I consider my strengths.

  6. 71 & Sunny says:

    This is really, really interesting to me. The research articles were hard to understand and I’m not sure if my situation compares to the results or not. Like Jackie, I was (less so now) extremely perfectionistic and legalistic. I relentlessly drove myself to achieve perfect grades in school too. I was valedictorian at my community college graduation in 2009. I also graduated with an A average from a local university in Jan., 2011. So on the face of things, it looks like I had little in the way of deficits. However, the pressure kept building and building, until I cracked in the Fall of 2009 while finally starting CBT/ERP. Somehow I managed to keep my grade point average at the university while continuing therapy (and cracking!), although I had to work like crazy. But I have definitely noticed since 2009 that my ability to recall basic things like appointments or conversations with others has weakened. Even though my OCD and general anxiety is better, it seems my memory has never quite recovered. And I used to have an unbelievable memory for all kinds of things. Ironically, people still say things to me like, “Wow, you have a great memory for stuff!” but I KNOW the decline I have experienced. It’s a bit disconcerting. But if I understand these articles correctly, maybe my experience is normal for OCD? If that is true, then it’s a great relief. I’ve also always had a difficult time with time management. I’m late for almost everything. Anyway, sorry to have written a book here, but this is new info for me and I find it fascinating. ( And I really hope nobody thinks I was bragging about the grades. I promise that is not my intent. It’s just what happened and I wanted to properly explain my history. You know us OCDers! No detail can be left out in any proper re-telling of a story!)

    • Sunny, I happen to be looking at this post and realize I never responded to your wonderful comment six months ago! Sometimes they just slip by me! Anyway, I hate not responding so better late than never! I always appreciate your insight and sharing.

  7. willitbeok says:

    Very interesting find. I know just off-hand that I definitely have issues with time management and decision-making. People with OCD also often feel a sense of something like hyper-responsibility, and by that I mean they feel like they are responsible more than others if something were to go wrong. I sometimes wonder if that is the reason for my issues with time management and making decisions — but perhaps not; maybe it just goes along with OCD for some other reason.

    I wonder if people with OCD who get used to being tortured by their obsessive thoughts also get so used to thinking that way, that it is hard for their brain to manage time or make decisions any other way? People with OCD are essentially slaves to negative thoughts until they receive successful treatment, and I often think it’s just so hard to break the mental habits I’ve fallen into as a result of that.

    • You bring up some interesting points, and I agree that it can be difficult to figure out where the issues with time management and decision making actually stem from. And I also agree that it’s incredibly difficult to break the mental habits you mention. I did write a post a while back about hyper-responsibility: https://ocdtalk.wordpress.com/2012/06/18/ocd-and-hyper-responsibility/, which, as you say, is so common in those with OCD. Thanks for your great comment!

      • willitbeok says:

        I didn’t mean to imply, by the way, that you didn’t know about hyper-responsibility — for all I can remember, I even read your post already. 😛 But I find it to be an interesting facet of OCD.

      • Oh, I didn’t take your comment that way, and I hope I didn’t imply that I thought that you thought I didn’t know about hyper-responsibliity 🙂 No worries!

  8. rmh13 says:

    Hi Janet,
    This is a really interesting post. I have OCD and can relate very much to Tina’s post above. When it comes to work and university I couldn’t be more organised (although having recently graduated I am out of work at the minute whilst I concentrate on CBT); I am always on time and have never missed a deadline. However, in my personal life I am rarely on time for anything…!
    Very interesting and thought-provoking post!

    • Thanks for sharing! Maybe what you and Tina both describe isn’t that uncommon? So interesting. Congratulations on your graduation and good luck with your therapy. Good for you for tackling your OCD!

  9. C says:

    My friends and I joke about my “spiritual gift” of being able to remember birthdays…I’m 25 and still remember many of my friends birthdays from elementary school…and sometimes even their phone numbers…or if someone just mentions their birthday in conversation (like the birthday of my best friends brother-in-law…why do I remember this?? haha) I think having a good memory is a pretty common characteristic in people with OCD. I also feel like I have to be super organized with my ocd so that I don’t make a mistake, which makes it easier to be more relaxed in other areas where mistakes aren’t so detrimental. I can also identify with the decision-making: I struggle with it all the time, having too many options sometimes. Thanks for the post–interesting information!

    • Boy, I could sure use some of that great memory you have :)! My son always complains about his bad memory, so who knows? The brain is certainly a complicated organ, and there is still so much to learn……Thanks for sharing!

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