Pseudobulbar Affect (PBA)

Medically Reviewed by Jabeen Begum, MD on April 05, 2024
4 min read

Pseudobulbar affect (PBA) is a nervous system disorder that can make you laugh, cry, or become angry without being able to control when it happens.

PBA has also been called:

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

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

  • Sudden, intense fits of uncontrollable crying or laughter
  • Crying or laughter that doesn't seem right for the situation
  • Outbursts of frustration and anger
  • Facial expressions that don't match emotions

The outbursts can happen several times a day or many times a month.

Symptoms aren't linked to mood. In other words, you may feel happy but start crying and cannot 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 that it looks like a seizure. It's easy to mistake the symptoms for those of depression or bipolar disorder.

If you have PBA, you might get anxious or embarrassed in public. You might worry about a future episode and be tempted to cancel plans with friends or family. It can also lead to depression or anxiety.

Caring for someone who has it might make you 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.

PBA vs. depression

Doctors may misdiagnose PBA for depression, as they share some of the symptoms. But in most cases with depression, you can control a symptom such as crying, and it stops once your mood changes. Also, crying typically matches your mood, meaning you do it when you feel sad or upset. And, unlike with PBA, laughter is not usually a symptom of depression.

Scientists believe that PBA may result from damage to the prefrontal cortex, the area of your brain that helps control emotions. Damage to other parts of the brain, as well as 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 PBA. Other brain conditions commonly linked to PBA include:

PBA after stroke

PBA can happen if you've had a brain injury or live with a neurological condition such as a stroke. Research shows that more than one-third of people who've had a stroke have symptoms that suggest PBA.

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 such as depression or other mood disorders.

Tell the doctor about any symptoms, including when they happen and how long they last. It can help to keep a diary of 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, they might order an electroencephalogram (EEG), a painless test that tracks your brain waves.

Pseudobulbar affect test

Two questionnaires help to tell 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 were tied to your mood and social situation, and how upset you felt afterward.

Center for Neurologic Study-Lability Scale (CNS-LS). You answer questions about your symptoms, including how often you have them and how they make you feel. For example, "I find myself crying very easily" or "I'm easily overcome with laughter."

Doctors might prescribe antidepressants to control PBA symptoms. In 2010, the FDA approved dextromethorphan/quinidine (Nuedexta), the first PBA medication. Studies show it helps control outbursts of crying and laughing in people with MS and ALS. Internists, neuropsychologists, neurologists, and psychiatrists can help diagnose and treat PBA.

To help you and your loved ones ease anxiety during a PBA episode, and to feel more in control of your health, try these steps:

  • Talk to people around you about PBA and how it affects you and your family. This will help keep them from being surprised or confused when an episode happens.
  • Track your episodes in a diary, including what set them off and how long they lasted. This will help when you talk to your doctor about possible treatments.
  • Talk with other people who have PBA. They understand what it’s like and might have other tips that might help you.
  • Change your 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.

Pseudobulbar affect (PBA) causes episodes of uncontrollable laughing, crying, or anger that are unrelated to mood. Symptoms include sudden emotional outbursts multiple times a day, often without appropriate context. It's linked to brain damage from conditions such as Alzheimer's, ALS, or traumatic brain injury. The treatment may include antidepressants or other medications.