How do you know if your executive function issues are genetic or trauma?
February 23, 2025 8:47 AM Subscribe
I've read that executive dysfunction is highly hereditary. Therefore what is the likelihood that ED is purely a result of CPTSD or is it more likely that it is already present and only worsened by CPTSD?
Basically what does the science say on this?
Basically what does the science say on this?
There isn't a good answer to this question as it's framed. "Executive function issues" covers an extremely broad set of symptoms which are often poorly defined, and which often do not have a single identified cause. You won't find reliable statistics that tell you X percentage of people have executive function issues because of Y, W percentage of people have executive function issues because of Z, and so on - the science just doesn't (and can't) work that way.
And even if those statistics existed, they wouldn't be useful for diagnosing an individual; at most they would point to things to consider. But you couldn't look at an individual and say, "because the population-level statistics say X percentage of executive function issues are caused by Y, there's X percent chance that this individual's executive function are caused by Y." An individual is an individual.
This really is something that you need to work through on an individual basis with a professional.
posted by Kutsuwamushi at 9:38 AM on February 23 [7 favorites]
And even if those statistics existed, they wouldn't be useful for diagnosing an individual; at most they would point to things to consider. But you couldn't look at an individual and say, "because the population-level statistics say X percentage of executive function issues are caused by Y, there's X percent chance that this individual's executive function are caused by Y." An individual is an individual.
This really is something that you need to work through on an individual basis with a professional.
posted by Kutsuwamushi at 9:38 AM on February 23 [7 favorites]
I've read that executive dysfunction is highly hereditary.
With the preface that this is still a live debate and not settled science...
Initial claims that ADHD was closely tied to genetics was based on some twin studies. But these twin studies had a very deep flaw - basically, the question researchers posed was, "If one twin gets a diagnosis, how frequent is it that the other twin gets a diagnosis?" Not surprisingly, they found that usually one diagnosis followed the other. That's it. This obviously misses the fact that parents, teachers, etc. tend to view twins less as individuals and more as a pair.
Since then, studies comparing actual DNA of people with an ADHD diagnosis find roughly a 1/3 genetic overlap between individuals, and broad consensus is that it's a mix of genetic and environmental factors.
You may find the book Stolen Focus interesting - he covers the scientific debate I've laid out (among other related topics), and cites his sources. He also interviews a social worker/therapist who noticed patterns between "attention problems" and childhood poverty/trauma.
But yes, best to work out your own individual case with a professional or two.
posted by coffeecat at 10:03 AM on February 23 [2 favorites]
With the preface that this is still a live debate and not settled science...
Initial claims that ADHD was closely tied to genetics was based on some twin studies. But these twin studies had a very deep flaw - basically, the question researchers posed was, "If one twin gets a diagnosis, how frequent is it that the other twin gets a diagnosis?" Not surprisingly, they found that usually one diagnosis followed the other. That's it. This obviously misses the fact that parents, teachers, etc. tend to view twins less as individuals and more as a pair.
Since then, studies comparing actual DNA of people with an ADHD diagnosis find roughly a 1/3 genetic overlap between individuals, and broad consensus is that it's a mix of genetic and environmental factors.
You may find the book Stolen Focus interesting - he covers the scientific debate I've laid out (among other related topics), and cites his sources. He also interviews a social worker/therapist who noticed patterns between "attention problems" and childhood poverty/trauma.
But yes, best to work out your own individual case with a professional or two.
posted by coffeecat at 10:03 AM on February 23 [2 favorites]
you couldn't look at an individual and say, "because the population-level statistics say X percentage of executive function issues are caused by Y, there's X percent chance that this individual's executive function are caused by Y."
You could do that. I've seen Department of Human Services professionals who should have known better do pretty much exactly that, abusing population-level statistics on co-sleeping and SIDS to construct an excuse for threatening a vulnerable Aboriginal single mother with removal of her infant son, over whom they had no pre-existing protection order and no other justification for obtaining one.
But you shouldn't, and neither should any member of your care team. How you operate is a sound basis on which to design the support you need; where you fit into the multiple cross-cutting spectra that characterize the general population is not.
posted by flabdablet at 10:08 AM on February 23 [2 favorites]
You could do that. I've seen Department of Human Services professionals who should have known better do pretty much exactly that, abusing population-level statistics on co-sleeping and SIDS to construct an excuse for threatening a vulnerable Aboriginal single mother with removal of her infant son, over whom they had no pre-existing protection order and no other justification for obtaining one.
But you shouldn't, and neither should any member of your care team. How you operate is a sound basis on which to design the support you need; where you fit into the multiple cross-cutting spectra that characterize the general population is not.
posted by flabdablet at 10:08 AM on February 23 [2 favorites]
Yeah, "executive function issues" or "executive disfunction" is a common symptom that can result from many different causes. In the same way that knowing you have a fever doesn't tell you whether you have a virus, bacterial or fungal infection, or some other issue, executive functioning problems doesn't in and of themselves indicate a specific problem. This is why the proper method is to do a differential diagnosis, ie compare the suite of problematic symptoms against the possible diagnoses to see which one (or ones) fit your situation best. This is done between the patient and a subject-matter expert and will be considered at multiple points during the diagnostic process.
Some neurodivergencies, like ADHD and Autism, have strong genetic components. This is one of the reasons why the diagnostic criteria for these conditions require evidence of their presence in childhood.
Patterns of abuse can become part of family culture and passed on between generations in what is often called the cycle of abuse. Science is also still learning about the ways in which trauma alters genetic expression (the way cells enact their genetic code), the term for that is epigenetics.
One place to start, along with finding a trustworthy doctor to help you, is to look at the patient assessment measures that have been added to the most recent revision of the DSM 5*. These measures do not tell you if you definitely have a specific issue; they are intended as a starting point for the diagnostic process, but they can help narrow the field or to provide evidence for pursuing a specific diagnosis. Think of it like taking your temperature and checking your blood pressure--it's not going to tell you definitely what's wrong, but it might point you in the general right direction. As a personal example, despite believing for many years I had anxiety, when I took the screener for anxiety, I got a very low (not severe) score--whereas on the ADHD measure I got a very high score, also against my expectation. It was an essential starting step in the process that ended eventually in an official diagnosis.
*The DSM (Diagnostic and Statistical Manual) is the primary diagnostic tool used for mental health conditions in the US; other parts of the world may use the ICD or another rubric.
posted by radiogreentea at 10:29 AM on February 23 [1 favorite]
Some neurodivergencies, like ADHD and Autism, have strong genetic components. This is one of the reasons why the diagnostic criteria for these conditions require evidence of their presence in childhood.
Patterns of abuse can become part of family culture and passed on between generations in what is often called the cycle of abuse. Science is also still learning about the ways in which trauma alters genetic expression (the way cells enact their genetic code), the term for that is epigenetics.
One place to start, along with finding a trustworthy doctor to help you, is to look at the patient assessment measures that have been added to the most recent revision of the DSM 5*. These measures do not tell you if you definitely have a specific issue; they are intended as a starting point for the diagnostic process, but they can help narrow the field or to provide evidence for pursuing a specific diagnosis. Think of it like taking your temperature and checking your blood pressure--it's not going to tell you definitely what's wrong, but it might point you in the general right direction. As a personal example, despite believing for many years I had anxiety, when I took the screener for anxiety, I got a very low (not severe) score--whereas on the ADHD measure I got a very high score, also against my expectation. It was an essential starting step in the process that ended eventually in an official diagnosis.
*The DSM (Diagnostic and Statistical Manual) is the primary diagnostic tool used for mental health conditions in the US; other parts of the world may use the ICD or another rubric.
posted by radiogreentea at 10:29 AM on February 23 [1 favorite]
When I read your question, I thought "Wow there was a related question the other day that might have some insight for you" and then I realized you asked that question as well.
It seems like you see or seek something like a bright line or definable difference between something that is (at least theorized to be) genetic or developmental versus something that results from one's experiences in life. I don't think you will get that answer.
There's too much we still don't know. We haven't nailed down the genetics (or the epigenetics). One of the things that it seems like genetics can do, is create a vulnerability to a given disease. It may then take another trigger, be it an experience or a viral infection or a gestational or environmental exposure or whatever, to manifest. And even then, the existence and success, or not, of any immediate treatment, plays a role. These factors vary so much from individual to individual. Two people could have the same genetic mutation (I'm not talking the same genes, but the same mutation) and both experience a trauma. How would scientists 'control' for their differences in their parenting, the difference in the rest of their genetic makeup, the way they internally processed their thoughts around the trauma, the quality of treatment they received.
You might be able to control for some of these things generally, but not all of them, not enough to provide a reliable framework to determine something like "__% of people's executive function is caused by ADHD, __% by ASD, __% by traumatic brain injury, __% by pure genetics, __% by traumatic experiences, __% by hormone fluctuations related to perimenopause" (just to list a handful of things I know that can have executive function challenges as a cause; there are more I am sure).
Like I said in your other question, I empathize with your desire to get an answer to this question. I experience the same feelings. It is hard not to know. I am terribly sorry, sincerely, that my entire answer and most of the ones you received, are not answering your question. I don't think it is answerable, so at least my motivation is to help you understand why.
posted by fennario at 10:56 AM on February 23 [11 favorites]
It seems like you see or seek something like a bright line or definable difference between something that is (at least theorized to be) genetic or developmental versus something that results from one's experiences in life. I don't think you will get that answer.
There's too much we still don't know. We haven't nailed down the genetics (or the epigenetics). One of the things that it seems like genetics can do, is create a vulnerability to a given disease. It may then take another trigger, be it an experience or a viral infection or a gestational or environmental exposure or whatever, to manifest. And even then, the existence and success, or not, of any immediate treatment, plays a role. These factors vary so much from individual to individual. Two people could have the same genetic mutation (I'm not talking the same genes, but the same mutation) and both experience a trauma. How would scientists 'control' for their differences in their parenting, the difference in the rest of their genetic makeup, the way they internally processed their thoughts around the trauma, the quality of treatment they received.
You might be able to control for some of these things generally, but not all of them, not enough to provide a reliable framework to determine something like "__% of people's executive function is caused by ADHD, __% by ASD, __% by traumatic brain injury, __% by pure genetics, __% by traumatic experiences, __% by hormone fluctuations related to perimenopause" (just to list a handful of things I know that can have executive function challenges as a cause; there are more I am sure).
Like I said in your other question, I empathize with your desire to get an answer to this question. I experience the same feelings. It is hard not to know. I am terribly sorry, sincerely, that my entire answer and most of the ones you received, are not answering your question. I don't think it is answerable, so at least my motivation is to help you understand why.
posted by fennario at 10:56 AM on February 23 [11 favorites]
There is no answer from science on the overall likelihood of causative factors that would be meaningful for any one person with ED, and likely never will be. It's too individual.
Some things you could think about and explore in therapy to help you get closer to an answer for yourself are 1) how many members of your family have ED or other signs of ADHD, or are likely to be neurodivergent in other ways? (many of these have a genetic link with ADHD) 2) how much trauma did you experience in your life? This can include things that are much, much "smaller" than many people think and 3) did you have ED or other ADHD symptoms as far back as you can remember or it only started after a certain time/event?
There are some factors that make it very complicated, though:
1) Both causes can be true independently.
2) Both causes can be true due to their interaction. Many (some people even think all) people who are neurodivergent have experienced some level of trauma directly due to their neurodivergence. Genetic susceptibility or neurodivergence can also make some people more sensitive to certain kind of traumatic events that might be less damaging for others.
3) Both causes can be true due to trauma caused by the ED/other issues caused by neurodivergence of the parents (and/or generational trauma from their own ND parents), especially if it was unrecognized/untreated, as the vast majority used to be.
1,2, and 3 can even all be true for the same person. They are for me.
In many cases, the "true" cause doesn't really matter, unless it changes the diagnosis and therefore access to meds. If meds or other strategies help you, it's equally valid to use them regardless of the "true" cause, which you're likely to never really know for sure.
posted by randomnity at 8:22 AM on February 24 [2 favorites]
Some things you could think about and explore in therapy to help you get closer to an answer for yourself are 1) how many members of your family have ED or other signs of ADHD, or are likely to be neurodivergent in other ways? (many of these have a genetic link with ADHD) 2) how much trauma did you experience in your life? This can include things that are much, much "smaller" than many people think and 3) did you have ED or other ADHD symptoms as far back as you can remember or it only started after a certain time/event?
There are some factors that make it very complicated, though:
1) Both causes can be true independently.
2) Both causes can be true due to their interaction. Many (some people even think all) people who are neurodivergent have experienced some level of trauma directly due to their neurodivergence. Genetic susceptibility or neurodivergence can also make some people more sensitive to certain kind of traumatic events that might be less damaging for others.
3) Both causes can be true due to trauma caused by the ED/other issues caused by neurodivergence of the parents (and/or generational trauma from their own ND parents), especially if it was unrecognized/untreated, as the vast majority used to be.
1,2, and 3 can even all be true for the same person. They are for me.
In many cases, the "true" cause doesn't really matter, unless it changes the diagnosis and therefore access to meds. If meds or other strategies help you, it's equally valid to use them regardless of the "true" cause, which you're likely to never really know for sure.
posted by randomnity at 8:22 AM on February 24 [2 favorites]
I'm wondering if lurking behind this is a fear that you are "doomed" by a genetic inheritance. In case that is a thought you have: the answer is no. No matter what, you can change environmental factors (therapy and medication) and get meaningful improvements in your symptoms.
posted by i_am_joe's_spleen at 11:32 AM on February 24 [2 favorites]
posted by i_am_joe's_spleen at 11:32 AM on February 24 [2 favorites]
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posted by greta simone at 9:20 AM on February 23 [14 favorites]