What Is Pseudobulbar Affect?

Crying and laughter are a normal part of a healthy life. We shed tears when we're overcome with grief or overwhelmed with joy. We giggle at punchlines, chuckle at auto-text corrections, and laugh out loud (LOL) at trending videos on social media.

Yet, for at least 1 million Americans, laughter and crying occurs suddenly, uncontrollably, and often at the wrong time. This response isn't a sign of a happy or blue mood but rather a nervous system disorder called pseudobulbar affect (PBA).

PBA has also been called:

  • Emotional incontinence
  • Emotional lability
  • Involuntary crying
  • Pathological laughing and crying

 

Symptoms

If you or someone you love has PBA, you might notice:

  • Sudden, extra intense fits of crying or laughter that you can't control
  • Crying or laughter that doesn't seem right for the situation
  • Episodes that last longer than you expect
  • Outbursts of frustration and anger
  • Facial expressions that don't match emotions

The outbursts occur several times a day many times a month.

Symptoms aren't linked to mood. In other words, you may feel happy but start crying and not be able to stop. Or you could feel sad but start to laugh when you shouldn't. You might just cry or laugh a lot. Some people say the symptoms come on so quickly it's like a seizure. It's easy to mistake the symptoms for those of depression or bipolar disorder.

If you have PBA, you might become anxious or embarrassed in public. You might worry about a future episode and be tempted to cancel plans with friends or family. If you're caring for someone who has it, you might feel confused or frustrated. The emotional toll of the condition can greatly affect recovery and quality of life. It's important to seek care and treatment from a qualified doctor.

Causes

Scientists believe PBA may result from damage to the prefrontal cortex -- the area of the brain that helps control emotions. Changes in brain chemicals linked to depression and hyper moods (mania) could also play a role.

An injury or disease that affects your brain can lead to pseudobulbar affect. About half the people who've had a stroke get it. Other brain conditions commonly linked to PBA include:

 

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Diagnosis

If you or someone you love is crying or laughing a lot and you don't know why, talk to a doctor. PBA is hard to diagnose because it mimics other problems like depression or other mood disorders.

Tell the doctor about the symptoms, including when they occur and how long they last. It can help to keep a diary of your crying and laughing episodes.

Your doctor won't need to do tests to diagnose PBA. But to rule out a form of epilepsy that can cause similar symptoms, he might order an electroencephalog (EEG), a painless test that tracks your brain waves.

Two questionnaires help determine if the laughing and weeping are signs of PBA:

  • Pathological Laughing and Crying Scale (PLACS): The doctor asks you questions about the episodes, including how long they lasted, how they related to your mood and social situation, and how much distress you felt afterward.
  • Center for Neurologic Study-Lability Scale (CNS-LS): You answer questions about your symptoms. How often do they occur? How do they make you feel? For example, "I find myself crying very easily," or, "I'm easily overcome with laughter."

 

Treatment

Doctors used to prescribe antidepressants to control PBA symptoms, but they didn't always work well. In 2010, the FDA approved dextromethorphan/quinidine (Nuedexta), the first drug therapy for PBA. Studies show it helps control outbursts of crying and laughing in people with MS and ALS.

Living With Pseudobulbar Affect

Take steps to feel more in control of your health. To help you and your loved ones ease anxiety during a PBA episode, the National Stroke Association has these recommendations:

  • Talk to people about PBA and how it affects you and your family. This will help prevent those around you from being surprised or confused when an episode occurs.
  • Shift position. If you feel a laughing or crying attack coming on, change how you're sitting or standing.
  • Breathe slowly and deeply. Keep doing this during an episode until you feel in control.
  • Relax. A flare-up is emotional and can make your muscles tense. Relax your shoulders and forehead after one happens.

 

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on June 6, 2018

Sources

SOURCES:

Ahmed, A. Therapeutics and Clinical Risk Management, November 29, 2013.

Brain Injury Association of America: "What is pseudobulbar affect (PBA)?

Cruz, M. Pharmacy and Therapeutics, June 2013.

Johns Hopkins Health Library: "Electroencephalogram (EEG)."

Merriam-Webster Dictionary: "Prefrontal Cortex."

National Center for Advancing Translational Sciences: "Pseudobulbar affect."

National Multiple Sclerosis Society: "Pseudobulbar Affect."

National Stroke Association: "Pseudobulbar Affect. -- PBA."

News Release, Avanir Pharmaceuticals.

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