The Impact of Executive Dysfunction on Relationships

(The last part of Schizophrenia and PTSD is giving me trouble, so you’re getting next Sunday’s post a week early. Enjoy.)

Executive dysfunction is associated with major depressive disorder, bipolar disorder, generalized anxiety disorder, ADHD, ADD, schizophrenia, autism, and Parkinson’s disease. It is probably found in numerous other contexts as well, but that’s a long enough list to be going on with.

But before we get into executive dysfunction, we need to talk about executive function.

Definitions for executive function sound either vague or jargony. WebMD says “Executive function is a set of mental skills that help you get things done.” Well, that doesn’t tell us very much. Wikipedia goes for full on jargon “Executive functions (also known as cognitive control and supervisory attentional system) are a set of cognitive processes — including attentional control, inhibitory control, working memory, and cognitive flexibility, as well as reasoning, problem solving, and planning — that are necessary for the cognitive control of behavior: selecting and successfully monitoring behaviors that facilitate the attainment of chosen goals.”

Breaking down the jargon, executive functions are “a set of cognitive processes” aka “things the brain does.” These processes “are necessary for the cognitive control of behavior: selecting and successfully monitoring behaviors that facilitate the attainment of chosen goals” aka “being able to decide what to do and follow through on that decision so you can meet your goals.” And we are right back at WebMD’s definition: shit the brain does so we can get things done. Okay… it sounds vague, but being able to get shit done is pretty important. Still without knowing what these “processes” or “mental skills” are, these definitions don’t help much. So let’s take a look at the rest of the jargon.

What Are the Executive Functions?

Attentional control

Aka, being able to control your attention span. This includes both being able to pay attention to things when you need to and being able to break your attention away from things when appropriate.

Inhibitory control

You ever drop a 5 pound can of beans on your toes and bite your lip to keep from yelling “Oh my fucking god that hurts!” in the middle of the grocery store? That’s inhibitory control. Inhibitory control stops us from doing the things that we know we shouldn’t do.

Working memory

just what it says. Being able to remember things.

Cognitive flexibility

Aka being able to mentally cope with and adapt to change. One test for cognitive flexibility in children is giving them a stack of cards and telling them to sort by color. Half way through the stack tell them to switch to sorting by number. Cognitive flexibility lets us deal with changing plans, realign our actions to meet new goals, or just shift from casual shoot-the-shit mode to more formal interactions when your boss walks into the break room.

Reasoning

What is says, the ability to think, reason and understand shit. It is kind of scary to go from being able to think through and debate Focault to not being able to string two thoughts together well enough to figure out that 2+2=4, but that’s what many people with executive dysfunction live with. At least, those of us who are well to have times when are executive functions work and times when they don’t.

Problem solving.

Again, what it says. Being able to look at a problem and figure out how to solving it.

Planning

Yup, what it says. Being able to plan the steps to do something, reach a goal, or put together a damn schedule.

 

Read over that list and think about how hard daily life would be if you couldn’t do those things.

Several times Michael has needed to know how to do something and I’ve researched it for him. He couldn’t figure out how to get on google, search for what he wanted, and apply what he found to the problem. The more out of his comfort zone the “something” is, the more likely he is to need help. This is executive DYSfunction. When the executive functions, don’t.

I’ve dealt with my share of executive dysfunction as well. In my case it’s worst with decision making. On a bad day ask me what I want for dinner, and I’ll freak out. I can’t hold all the options in my head so I can compare them and decide “Pizza sounds good.” This became a major problem during my last child birth. I hit a point where I couldn’t think clearly enough to make decisions. I told the nurses “I can’t make decisions right now, any decisions that need to be made, go through Michael. He knows what is best for me.”

Well, when the baby was crowning they ignored me (which was somewhat understandable as I was completely out of my head—but damn they had better options than manhandling me), ignored Michael, and ignored my birth plan. And I couldn’t process what was going on well enough to realize that they were trying to help me, never mind communicate why they were making things worse. I’m still dealing with the trauma from that.

Executive Dysfunction and Polyamory

Executive dysfunction impacts relationships in a lot of ways. For instance, on a night when I can’t make decisions—I can’t decide to have sex. (Pro-tip: if someone is not capable of deciding to have sex, you don’t have sex.) Or maybe I’m horny and both my partners are there, and I can’t decide who I want sex with. (Pro-tip: if someone is not capable of deciding who they want sex with, you don’t have sex.) If I was thinking clearly, maybe we would have sex. But I wasn’t, so we didn’t.

Michael and C have been talking about him taking a trip down to see her in September for nearly 6 months. I (foolishly, because I know Michael better than this) assumed they’d handle the planning and tell me what they decided. C doesn’t know Michael well enough to help him through the planning process. He hasn’t traveled by plane, never mind traveled alone, since he got sick. This is very far out of his comfort zone. C kept asking him open ended questions without any information, like “how long to you want to visit?” She was approaching it from “once I know how long he wants to visit, I’ll be able to set up accomodations for him and find flights and such.” But he couldn’t process his options well enough to pick how long he wanted to stay. So nothing got planned. I ended up in a three way phone call with both of them helping Michael with his end of the planning and (hopefully) showing C what kind of help he needs for next time. Most importantly: break things down into small, easy steps and yes/no question.

Communication

Executive dysfunction can make it difficult to put words to your thoughts and feelings, can make it hard to follow a conversation, and if multiple conversations are happening at once (like at a restaurant, con, or munch), it can be very difficult to follow the conversation you are trying to take part in.

Meeting people’s needs

Difficulty with problem solving can make it hard to figure out how to meet people’s needs. Often needs don’t mesh perfectly or are in conflict. You need alone time to regain your mental balance but your partner needs attention and reassurance that they are loved. Or one partner needs help making dinner while another partner needs someone to listen to their concerns. Or even just addressing concerns. “I don’t feel like you care about me,” can be hard to address when your brain won’t process “ways to show I care.”

Dealing with conflicts

Multiple relationships often require navigating conflicts. Difficulty focusing, problem solving, and other aspects of executive dysfunction can all cause problems here.

Issues of consent and consideration

You ever meet someone who doesn’t seem to have a mental filter on their mouth? Whatever they think they say, and often end up putting their foot in their mouth as a result. Well, some people with executive dysfuction have a broken mental filter on their actions. They curse when it is inappropriate, they scratch themselves in public. And yes, they may touch you when you haven’t given permission. This is something Michael and I struggled with a lot, and sometimes still do struggle with. My PTSD means there are times when I can’t deal with being touched, much less having my boobs grabbed. And there are times when he will come up from behind, reach around, grab my boobs, and when I freak out he ends up curled in a ball, trembling, “i’mm sorry, I’m sorry, I’m sorry, I’m sorry.” He knows he shouldn’t have grabbed. He knows I have reason to be angry, but somewhere in his brain between “idea” and “action” the red flag that was supposed to say “No, don’t do that.” didn’t pop up.

Personal opinion, but I believe problems with inhibitory control are closely related to difficulty with cognitive flexibility. Michael doesn’t go around grabbing random women’s boobs. He knows that grabbing a random woman’s boobs is never appropriate. But we have been in a relationship for 7 years. He has often been allowed to grab, play with, tease, bite, and otherwise touch my boobs. This means when his brain needs to take a couple extra steps. Instead of “Want to touch,” “DON’T” his brain needs to think “Want to touch.” “touching might be okay.” “Assess situation” “public? Private? Sexy times? Not sexy times? Has she said she is having a bad day?” etc, etc. And somewhere in that process, his executive dysfunction kicks in and before his brain can work through all the steps to “It’s not clear if it’s okay to touch or not, I need to ask,” his hands are on me.

Possible solution: set the rule that he needs to ask before every time he touches me. That avoids the issue of needing to process different situations. Problem with this solution: If we are having sex, I don’t want to need to give approval to every single touch. I want to be able to say “yes, please play with my breasts,” and relax and enjoy myself. So I live with the random grabbiness at other times.
Maybe you’d make a different decision.

Okay, I’m already past 1500 words, and I’ve barely touched on all the ways executive dysfunction can impact a relationship. But at least this gives you a start on understanding what executive dysfunction is and how it can cause problems. Every situation with executive dysfunction is different, and executive dysfunction varies in how bad it is.

The one useful tip I can give you: come up with a “safe word” for when executive dysfunction is a problem. I tend to say “my brain is broken” and “that breaks my brain” for “my executive dysfunction is bad right now and I can’t to what you are asking me” and “this specific thing is usually a problem because of executive dysfunction, even on a good day I might not be able to do it,” respectively. This way, people who care about me know that either this thing needs to be dealt with later or I will need help with whatever they are asking of me.

 

Disclaimer

This post is part of the Polyamory and Mental Illness blog series.

Help Support Polyamory on Purpose.

2 responses to “The Impact of Executive Dysfunction on Relationships

  1. Oh, THANK you for this.

    I acquired a cognitive-dysfunction issue suddenly and for unknown reasons (my neuropsych suspected that it was either my brain needing to constantly process and deal with the pain from my trigeminal neuralgia, *or* one/some of the many drugs that my neurologist gave me, trying ineffectively to treat the pain, may have caused it — many of the anticonvulsant meds were known for causing cognitive issues.)

    This caused a lot of communication problems within my family (my at-the-time live-in partner and my adult daughter, with whom I normally have an extremely good relationship), because as far as they could tell, I just “changed,” and not for the better.

    Decision paralysis, meltdowns under extreme stress, difficulty talking/communicating/expressing thoughts, interrupting or struggling to follow the flow in conversations, not being able to remember who had said what, even minutes ago — and memory + impulse-control issues.

    The cherry on top is that according to my test results, I came down with a case of severe ADHD — which had very much not been an issue before, since I’d held various responsible jobs where self-motivation, focus, memory, and attention to detail were crucial.

    We wound up ALL going to therapy, with a therapist who specialized in brain-injury cases. That helped a great deal, both in helping me come up with coping and communication mechanisms, and it also helped my family understand me better.

    Still, it put a lot of strain on those two relationships (we’re all people who like to talk and are passionate about many topics of conversation, so interrupting and struggling to follow the flow meant that I was constantly getting “corrected” and snapped-at for not following the usual conversational “rules”), and while the therapy coping techniques helped a great deal, it was still an ongoing source of stress.

    (I’m surprised I can type coherently right now, because I had a bad episode earlier in the day, when I was struggling to speak *at all*, after my body had a nasty allergic reaction + pain flare, and the physical distress pretty much shut my brain off. Since then, I’ve taken meds and had a nap, and my mental functions are much improved . . . but I was still struggling to verbally get thoughts out until an hour or so ago.)

    But, yeah. Even had I been monogamous (since my other partners live far away and haven’t had to deal with this on a day-to-day basis, the way my live-in partner and daughter did, since we were all under the same roof), this would have caused a lot of family strife and difficulty. My mother, my only surviving parent, has no patience with my health issues and basically thinks I made the whole thing up.

    My therapist said that brain injuries/cognitive dysfunctions that are *intermittent* are often hardest for family members and loved ones to tolerate and understand — if I could do _X_ yesterday without a problem, why am I floundering today? Why do I have to ask for help, or can’t remember not to interrupt/blurt in conversations *some* of the time, but not others? It leads people to believe, consciously or unconsciously, that I choose to “just not try” some of the time — when that is very much not the case.

    I’m sorry that both you and Michael struggle with executive-function issues (it’s bad enough when it’s only one member of a household!), because I can imagine that your issues sometimes “don’t play nicely with each other.” When two people are burned-out and struggling, something as simple as picking dinner, or making necessary travel plans, can turn into an argument because you’re both frustrated and upset that the other person can’t handle it during your period of brain fog/cognitive dysfunction.

    Wishing you both well, and hoping that you’re both able to handle these issues with patience and kindness. I know that it meant the world to me during the times when I felt *understood*, and the people around me were considerate of the fact that I was *trying*, but that my brain was not being helpful some of the time.

    • *hugs* If you accept them.

      You are very welcome, and I’m sorry you have had to go through this. I think it is harder for people who have never had executive dysfunction. For Michael and I it has gotten worse over the years (for Michael especially) but we’ve always dealt with it to varying extents. And strnagely being in a relationship with someone else who has these problems actually makes it easier. It’s what you said about being “understood.” Sometimes our problems have a nasty synergy where they combine to make everything worse than it would be. But being with someone who understands what it is like makes everything else so much easier that the synergy is worth putting up with.

      FYI–you may know this already, but you seem surprised that you can type when you couldn’t speak. Verbal and written speech are controlled by different parts of the brain. Many people with executive dysfunction find that when they can’t speak, they can still write. Or vis versa. Michael and I have made use of this a number of times–pulling up a laptop or tablet and typing out what is wrong when we are broken to the point we can’t talk. Or if we are both having bad-verbal days, typing back and forth in chat.

      Very much agree about the difficulty of adjusting to intermittent problems. In our case, because we both live with intermittent executive dysfunction we “grok” that and manage okay. But Michael’s physical problems can vary severely from day to day or even hour to hour. And oh my god! Some days I want to strangle him because “If you can do this, why couldn’t you do THAT that you just made me do!” and some days I over compensate, assuming he can’t do anything, and interfering with his attempts to function on his own and take care of himself. We’ve managed, by hook or by crook, but it’s been quite a ride!

      I wish you the best in your relationships, and if you or your partners need someone to talk with about relationships with executive dysfunction, you are welcome to contact me.

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