Prefrontal Cortex: You Have Your Own Signature of How It Functions

My patients often arrive frustrated, sensing that their anxiety and inattention seem to feed off each other. When I explain the nuances of brain function, I start from a simple truth that applies whether or not someone is affected by a mental health condition: we all have the same brain regions responsible for the basic tasks of maintaining attention, solving problems, controlling impulses, tolerating frustration, regulating emotion, and reflecting on our inner thoughts. How effectively those regions perform, of course, depends on the state of one’s brain health.

It quickly becomes clear that because these regions are so deeply interconnected, a problem in one rarely stays contained and it bleeds into the others. It isn’t as simple as saying, “You have anxiety because your ventral or medial PFC is affected,” or “You have ADHD because your dorsolateral PFC is affected,” based on findings from individual research studies.

The brain doesn’t know its own diagnosis. Each person’s PFC regions function like divisions within a company, each acting as its own CEO, not only interconnected with one another, but also linked to many other cortical and subcortical (lower) regions of the brain. To complicate things further, the same brain regions and circuits can be implicated across multiple different disorders. People’s strengths and weaknesses emerge from how several of these regions function together, in relation to one another.

For reference, the four main regions within the PFC that support one another’s function are as follows (As shown in the picture):

Dorsolateral PFC (dorso = top; lateral = to the side, roughly where Mickey Mouse ears would sit): The CEO of higher-level thinking that include problem solving, organization, cognitive flexibility, memory, attention, and even emotional control.

Medial Prefrontal Cortex (mPFC) (the inner wall of the brain in the PFC, visible if you slice the brain in half from front to back): Involved in evaluating ourselves with self-reflection, and a key hub in the brain’s resting-state network as well as judging others. This region produces self-referential thinking and rumination, awareness and analytical thinking about ourselves and others, while integrating long-term memory and attention.

Orbitofrontal Cortex (OFC) (on the underside of the PFC, just above the bony eye sockets): Determines affective value and sends signals about what to expect and what to do in the context of reward or punishment. This region plays a key role in decisions tied to motivation, risk, and reward-seeking habits like eating choices, financial decisions, and similar behaviors.

Ventrolateral PFC (ventro = below; lateral = to the side): The CEO tasked with moderating emotional control, anger, frustration tolerance, impulse control, and inhibiting action.

An accurate description, like your own brain’s functional signature that is variable in real life.