Pseudobulbar affect (PBA)

Normally the brain signals whether crying or laughing is appropriate and if so, how long, how exuberant or not exuberant and short.
With Pseudobulbar Affect, (PBA), emotional lability, labile affect or emotional incontinence, a person has involuntary or uncontrollable episodes of crying, laughing, yawning or other emotional expressions due to brain damage.

The crying and laughing fits are usually too intense and do not match the emotion being felt. The person is not capable to stop these emotional outbursts. This makes the person with brain injury feel really embarrassed, ashamed.

PBA can occur after traumatic brain injury, after a stroke or CVA, after a brain tumor, in Alzheimer's, vascular dementia, ALS, MS, Parkinson's and PSP.
In rare cases, uncontrollable fits of laughter can constitute a form of epilepsy.
In a healthy person, the neurotransmitters that stimulate and inhibit are in balance, including emotions. They interact with a complex of nerve pathways that control emotion and with nerve pathways that display emotion. Damage may have occurred there due to brain injury. In some people, compulsive laughing and compulsive crying disappear over time.


Pseudobulbar palsy/pseudobulbar syndrome

When someone has failure of the facial and throat muscles on both sides, this is called a pseudobulbar syndrome/paresis. This syndrome occurs in several neurological disorders and often after brain injury. It causes difficulty with chewing, swallowing and speaking, among other things. The tongue cannot be moved properly. Compulsive crying and laughing also occur with this syndrome. Furthermore:
dysarthria, faltering or delayed speech, dysphagia, difficulty swallowing, resulting in slower eating and weight loss, dysphonia, changes in the voice, emotional lability or compulsive crying or laughing.


Risk of misdiagnosis

A person with PBA may be misdiagnosed as 'depressed' or as having a personality change due to dementia, Alzheimer's, or as the crying being an expression of a permanent feeling of sadness or hopelessness.

The difference is that PBA crying episodes are relatively short periods of time that are not accompanied by enormous sadness. Someone  may feel fine for one minute, and the next minute suddenly crying over the smallest things for seemingly no reason. Laughs at very inappropriate times. Has stress or frustration because of fits of crying and/or laughing. Avoids public, social or family life because of uncontrollable crying/or laughing periods. Is concerned that these episodes of crying and/or laughing could be mistaken for depression or another condition.


An video about PBA, forced crying/compulsive laughter:


Describe the symptoms accurately

Because PBA is sometimes mistaken for other conditions, you should describe your symptoms accurately. How often does it happen? How long does it take? How do you feel while it's happening?

It is important to tell your doctor or practitioner these details.

  • Do you cry when you are not sad or down?
  • Do you laugh at inappropriate moments, when there is nothing or little funny?
  • Is the crying and/or laughing sudden, frequent, and uncontrollable?
  • How often do these fits of crying and/or laughing occur?


Tips on how to deal with it for the person affected

  • Explain to the people around you something about PBA, show them this page of our website. 
  • Your crying and laughing fits can surprise people around you. The more you help them understand PBA, the better they will know how to respond.
  • If you can, try to distract yourself. If you feel a fit of crying or laughing coming on, try to think of something else. When a fit of crying is approaching, try to think of something cheerful and, conversely, when a fit of laughter is approaching, think of something sad. For some people, the fit of crying or laughing occurs before they can even try to think about anything else. Then try to change your posture, especially if the diaphragm has difficulty moving:
  • Change your body position: If you are standing, try sitting down. If you are sitting, try getting up and walking. Change the movement
  • Whenever you think you're going to laugh or cry, take a deep breath. Breathe in and out slowly until you think the shower is over. Open the window, let fresh air come in.
  • Try to relax. Try to massage or consciously release tension from your forehead, neck, shoulders, jaw and other muscle groups. Tension can accumulate during a PBA attack.


For bystanders

Many bystanders often feel a bit misled by the fit of crying or laughing or even confused and wonder where the crying or laughing came from, what triggered it.
Some feel guilty because they don't know how to help.
Some feel frustrated or sad that their loved one is struggling with PBA.

  • Try to distract the person. In case of laughing, don't join in laughing.
  • Try not to get caught up in the emotion of crying. After all, the person does not feel deep sadness.

Remember that PBA affects everyone, not just the one suffering this syndrome. 

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