Executive dysfunction as a transdiagnostic mechanism of psychopathology: a neurocognitive framework for diagnosis and intervention

Psychiatric disorders are typically classified using categorical diagnostic systems based on symptom clusters. However, these frameworks often fail to capture the cognitive and neurobiological mechanisms that transcend diagnostic boundaries and influence everyday functioning. Executive dysfunction, encompassing impairments in inhibitory control, working memory, cognitive flexibility, planning, and emotion regulation, was historically linked to focal damage in prefrontal brain regions. Converging evidence from neuropsychology, cognitive neuroscience, genetics, and clinical research indicates that executive dysfunction is prevalent across multiple psychiatric conditions and closely linked to functional impairment. This theory-driven article proposes that executive dysfunction represents a transdiagnostic dimension of psychopathology reflecting a shared neurocognitive vulnerability. Disruptions in both "cool" executive processes (e.g., cognitive control and working memory) and "hot" executive processes (e.g., emotion regulation and motivational control) may constitute a common pathway through which diverse psychiatric disorders impair adaptive functioning. Executive dysfunction is further conceptualized as an intermediate phenotype linking genetic liability, distributed neural circuit disruption, and everyday behavioral regulation. This perspective supports a shift toward transdiagnostic, mechanism-based mental health interventions that prioritize executive functioning as a central target for improving real-world functioning and long-term recovery.