Executive Dysfunction & Eating Disorders: When Simple Tasks Feel Impossible

Written by: Angela Derrick, Ph.D. & Susan McClanahan, Ph.D.

Date Posted: March 24, 2025 7:14 pm

Executive Dysfunction & Eating Disorders: When Simple Tasks Feel Impossible

How Executive Dysfunction Complicates Eating Disorder Recovery

For many individuals living with an eating disorder (ED), the basic act of nourishing themselves can be mentally exhausting. Seemingly simple tasks like deciding what to eat, preparing a meal, or even remembering to have breakfast can feel next to impossible. It’s easy to assume that laziness or a lack of willpower is to blame, particularly since we have usually been conditioned to be extraordinarily hard on ourselves. In reality, the difficulty often stems from executive dysfunction — a disruption in the brain’s ability to plan, organize, and follow through on tasks.

According to a study in PubMed, “Neuropsychological studies have consistently found impaired executive function (EF) among ED patients. EF is particularly involved in fundamental skills of daily living and in behavioral and emotional regulation.”  

According to Dr. Angela Derrick of SpringSource Psychological Center,  “many of my patients can become overwhelmed by the multiple steps involved in completing daily tasks.  This can lead to a “shut down” in which they retreat from the task to manage the experience of being flooded.  Therapy helps patients slow down, regulate themselves, and approach tasks from a more step-wise and compassionate perspective.”

When executive dysfunction intersects with an eating disorder, recovery becomes more challenging. Self-awareness around this issue, however, can make all the difference when healing from cycles of avoidance and self-blame. There is hope and help available to implement specific strategies and skills that can assist in overcoming the most challenging of circumstances. With help, deconstructing critical thought patterns that damage our ability to recover can be learned, practiced, and become second nature.

Why Can’t I Just Get Started?  Understanding Executive Dysfunction

Planning, organizing, initiating tasks, and regulating emotions are just a few of the brain’s mental processes that make up the system of executive functioning. Controlled by the prefrontal cortex, these cognitive functions form the brain’s command center. When executive function is compromised, these everyday tasks can become significantly more difficult.

People with executive dysfunction may have trouble starting tasks, maintaining focus, or following through on plans. Decision-making can feel paralyzing, and successful time management may seem unattainable. Other common experiences include forgetting appointments, misplacing items, or feeling mentally foggy. Executive dysfunction results from the brain’s struggle to coordinate actions effectively.

Conditions like ADHD, eating disorders, depression, anxiety, and trauma often go hand in hand, and anyone under chronic stress or mental strain can experience these same challenges. For those living with an eating disorder, trouble with executive functioning can significantly impact their ability to nourish themselves consistently.

How Executive Dysfunction Manifests in Eating Disorders

When someone with an eating disorder also faces executive dysfunction, the challenges surrounding food can become even more complex. Tasks such as grocery shopping, meal planning, and cooking — which require organization, decision-making, and time management — may feel impossible.

For some, executive dysfunction includes forgetting to eat. Hunger cues may be too subtle and easy to overlook. Skipping meals can become a frequent, albeit unintentional, occurrence that reinforces restrictive behaviors and makes it harder to meet nutritional needs.

Individuals with binge eating tendencies might find their ability to recognize fullness cues hindered. They may also struggle to resist impulsive eating or establish a structure around preparing balanced meals. This can result in chaotic eating patterns, often accompanied by feelings of guilt, shame, and frustration.

Difficulties with emotional regulation — another hallmark of executive dysfunction — can further complicate one’s relationship with food. Stress, anxiety, or shame may make it more challenging to break free from avoidance cycles, while the mental overwhelm of planning meals can lead to procrastination, decision paralysis, or reliance on convenient (and often less nourishing) options.

For those navigating both executive dysfunction and an eating disorder, developing sustainable strategies — such as keeping easy snacks visible, pre-planning simple meal options, or using reminders to eat — can be key steps in fostering more consistent and compassionate self-care. A qualified eating disorder therapist can help you navigate these challenges and implement proven strategies to overcome executive dysfunction issues.

The Seven Core Executive Functions & Their Relationship to Eating Disorders

Executive functions comprise a set of cognitive skills that allow us to manage our thoughts, emotions, and actions effectively to achieve our goals. These functions are vital for daily tasks, decision-making, and overall mental well-being.

When someone with an eating disorder also struggles with executive dysfunction, everyday tasks related to food, meal planning, and self-care can become overwhelming. Each executive function plays a crucial role in managing behaviors, emotions, and routines — and when these functions are impaired, they can reinforce disordered eating patterns.

Let’s take a detailed look at the seven core executive functions:

1. Activation (Task Initiation)

What it is: The ability to start tasks through organizing thoughts and getting into action. For instance, when you are ready to start your workday, you go to your desk, wake up your computer, and start responding to your emails without delay. However, when affected by executive dysfunction, you know you need to respond to your emails, but instead, you spend 45 minutes scrolling through social media, convincing yourself you’ll “start in five minutes.” The longer you put it off, the more difficult it feels to begin. 

If you are dealing with an eating disorder, the healthy example includes recognizing that you’re hungry, deciding what to eat, and starting to prepare a meal. With executive impairment, despite feeling hungry, you might find yourself frozen on the couch, mentally overwhelmed by the steps needed to prepare food. Even simple choices—like selecting a snack—can feel paralyzing. Hours might pass before you eat, or you could skip the meal altogether. For someone with an eating disorder, this delay can reinforce restrictive behaviors and intensify binge urges later on.

2. Focus (Sustained Attention)

What it is: The ability to maintain concentration on a task despite distractions. For example, while working on a report, you remain focused even when an alert comes across your phone or you can hear a conversation happening in an adjacent office. With executive dysfunction, you may start the report but keep shifting to other tasks. Despite your intention to finish, your attention keeps drifting.

In the context of an eating disorder, healthy functioning might be when you cook dinner, stay fully engaged, and follow the recipe without losing focus. This process could break down if you begin cooking but get distracted halfway through. You might forget that you’ve left food on the stove and burn the meal. This is both frustrating and defeating, especially when it happens regularly. When executive dysfunction is present, this is an all too easy pattern to repeat.

3. Effort (Sustaining Effort and Energy Regulation)

What It Is: The ability to stay motivated, energized, and engaged over time—especially with longer or more demanding tasks. For instance, you start studying for an exam and maintain a steady pace for two hours. When impaired, you sit down to study but feel mentally drained within 10 minutes. Despite knowing you need to continue, your brain feels foggy, and you keep zoning out.

Another healthy example for someone struggling with an eating disorder is they plan to go grocery shopping, choose quality ingredients, and prepare balanced meals—even if they don’t feel particularly motivated. However, when someone is impaired, the thought of grocery shopping or even just making a list is tough to accomplish.

4. Emotion Regulation

What It Is: The ability to manage emotional responses, especially in stressful or frustrating situations. For instance, after spilling coffee on your shirt before a meeting, you calmly clean it up and change clothes. When executive functioning is impaired, after spilling coffee, you may feel overwhelmed, angry, or ashamed. Instead of moving forward, you spiral into frustration and struggle to regain focus for the rest of the day.

When you have an eating disorder, healthy emotional regulation might look like this: after feeling anxious about an unexpected social dinner, you remind yourself it’s okay to feel uncomfortable and decide to attend anyway. When impaired, intense anxiety about a meal spirals into avoidance. You skip the gathering, isolate yourself, and feel even worse afterward. Difficulty regulating emotions can exacerbate disordered eating behaviors as individuals turn to food (or the avoidance of food) to cope with distress.

5. Memory (Working Memory)

What It Is: The ability to hold and manipulate information in your mind to complete a task. For instance, while following a recipe, you can remember the next three steps without needing to reread them. With executive dysfunction, you often forget what step you’re on in the recipe, which forces you to go back over the instructions. You might also lose track of what ingredients you’ve already used, possibly ruining the dish and causing feelings of failure. As a result, you may not want to attempt cooking again.

6. Action (Self-Monitoring and Impulse Control)

What It Is: The ability to control impulses, monitor behavior, and make intentional choices. For example, you might be about to interrupt someone during a meeting, but you catch yourself and decide to wait your turn. When impaired, you impulsively blurt out a thought during the meeting, only to realize later that it was rude behavior and off-topic or poorly timed. Afterward, you regret not pausing to think before speaking.

An example if you have an eating disorder includes recognizing that you’re eating quickly due to stress and intentionally slowing down to check in with your hunger cues. With executive impairment, you might impulsively eat large amounts of food in response to emotional overwhelm, unable to pause and recognize what’s happening until afterward.

Conversely, if you struggle with food restriction, you may impulsively avoid meals as a way to exert control, which reinforces disordered patterns. Without self-monitoring skills, disordered behaviors — such as binging, purging, or avoiding food — can become more difficult to interrupt.

7. Planning and Organization

What It Is: The ability to set goals, create steps to achieve them, and keep track of information and priorities. For example, when preparing for a trip, you create a checklist, pack effectively, and leave on time. When impaired, you begin packing but soon feel overwhelmed or distracted. You forget essential items, leave tasks undone, and end up rushing out the door late.

A healthy approach if you have an eating disorder involves planning meals for the week, making a grocery list, and following through. When impaired, you might find it difficult to plan meals ahead of time, forget some of the groceries you need, or feel overwhelmed by the thought of preparing balanced dishes. You may skip meals, lack structure, rely on highly processed snacks, or eat inconsistently.

The Overlapping Impact on Eating Disorders

When executive dysfunction intersects with an eating disorder, it can create self-reinforcing cycles, including:

• Task avoidance and skipped meals.
• Emotional overwhelm and bingeing or purging as a coping mechanism.
• Forgetfulness and unintentionally missing hunger cues.
• Poor planning and inconsistent food choices that worsen disordered behaviors.

The key to managing this intersection is introducing small, structured steps that reduce overwhelm—such as keeping snacks visible, using reminders for meals, or breaking food preparation into manageable stages.

Executive dysfunction often doesn’t affect all seven functions equally; some may feel more challenging to manage than others. Recognizing which areas present the most difficulty can help develop targeted strategies to enhance focus and increase self-compassion throughout the process.

What Causes Executive Dysfunction?

Executive dysfunction is typically linked to differences or disruptions in the brain’s prefrontal cortex, the area responsible for managing planning, focus, and self-regulation. While executive dysfunction isn’t a condition on its own, it’s a common symptom of various mental health conditions, neurological differences, and environmental factors. Key causes include:

1. Neurodevelopmental Conditions

• ADHD: Executive dysfunction is a core feature of ADHD, often making it difficult to initiate tasks, maintain focus, or regulate emotions.
• Autism Spectrum Disorder (ASD): Individuals with ASD may experience difficulty with flexible thinking, transitioning between tasks, or organizing daily routines.
• Learning Disabilities: Challenges with processing speed, memory, or focus can directly impact executive functioning skills.

2. Mental Health Conditions

• Depression: Low energy, impaired concentration, and feelings of overwhelm can make planning and decision-making especially difficult.
• Anxiety: Racing thoughts and excessive worry can overload the brain, making it harder to focus or take action.
• PTSD and Trauma: Trauma can impair the brain’s ability to regulate emotions and manage day-to-day responsibilities.

3. Neurological Injuries or Conditions

• Traumatic Brain Injury (TBI): Damage to the prefrontal cortex can disrupt cognitive control and impulse regulation.
• Stroke: Depending on the area of the brain affected, stroke survivors may struggle with memory, focus, and task management.
• Neurodegenerative Diseases: Conditions like Alzheimer’s or Parkinson’s can gradually weaken executive functions.

4. Chronic Stress and Burnout

• Prolonged stress floods the brain with cortisol, impairing cognitive flexibility, memory, and focus. Over time, this can severely impact executive functioning.

5. Sleep Deprivation

• Poor or insufficient sleep directly weakens the prefrontal cortex’s ability to manage attention, impulse control, and problem-solving.

6. Substance Use

• Alcohol, stimulants, and other substances can impair executive functions both in the short term (e.g., brain fog) and long-term with chronic use.

7. Hormonal and Biological Factors

• Hormonal shifts, such as those linked to pregnancy, menopause, or thyroid imbalances, can impact memory, focus, and emotional regulation.

8. Nutritional Deficiencies

• Lack of essential nutrients like B vitamins, iron, or omega-3 fatty acids can contribute to cognitive fog and difficulty managing tasks.

The Big Picture

Executive dysfunction isn’t caused by a lack of willpower — it’s rooted in how the brain processes information, regulates emotions, and manages energy. Understanding the underlying cause can be a crucial step toward finding effective strategies for support and improvement.

Effective therapies for executive dysfunction often focus on improving cognitive skills, building structure, and developing emotional regulation. Because executive dysfunction can stem from various causes (e.g., ADHD, anxiety, trauma), the best approach often combines strategies that target both the brain’s cognitive processes and the emotional struggles that accompany them. Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Cognitive Remediation Therapy (CRT), and Acceptance and Commitment Therapy (ACT) are a few of the evidence-based therapies that can help.

About SpringSource

At SpringSource Psychological Center, we understand that eating disorders are severe and complex mental health conditions that executive functioning issues can complicate. We are experts at providing the most effective and compassionate care for individuals struggling with eating disorders, and our therapists are skilled in CBT, DBT, ACT, and many other evidence-based therapies. We understand that the path to healing is varied, and we focus on compassionately addressing each individual’s unique needs.

With offices in downtown Chicago and Northbrook, Illinois, we offer in-person and virtual support. Call SpringSource today at 224-202-6260 or email info@springsourcecenter.com  | We offer free 15-minute initial consultations—schedule here.