Overview

Pseudobulbar affect (PBA) is a condition that’s characterized by episodes of sudden uncontrollable and inappropriate laughing or crying. Pseudobulbar affect typically occurs in people with certain neurological conditions or injuries, which might affect the way the brain controls emotion.

If you have pseudobulbar affect you'll experience emotions normally, but you'll sometimes express them in an exaggerated or inappropriate way. As a result, the condition can be embarrassing and disruptive to your daily life.

Pseudobulbar affect often goes undiagnosed or is mistaken for mood disorders. Once diagnosed, however, pseudobulbar affect can be managed with medication.

Symptoms

The primary sign of pseudobulbar affect (PBA) is frequent, involuntary and uncontrollable outbursts of crying or laughing that are exaggerated or not connected to your emotional state. Laughter often turns to tears. Your mood will appear normal between episodes, which can occur at any time. Crying appears to be a more common sign of PBA than laughing.

The degree of the emotional response caused by PBA is often striking, with crying or laughing lasting up to several minutes. For example, you might laugh uncontrollably in response to a mildly amusing comment. Or you might laugh or cry in situations that others don't see as funny or sad. These emotional responses typically represent a change from how you would have previously responded.

Because pseudobulbar affect often involves crying, the condition is frequently mistaken for depression. However, PBA episodes tend to be short in duration, while depression causes a persistent feeling of sadness. Also, people with PBA often lack certain features of depression, such as sleep disturbances or a loss of appetite. But depression is common among those who have pseudobulbar affect.

When to see a doctor

If you think you have PBA, talk to your doctor. If you have a neurological condition, you might already be treated by a doctor who can diagnose PBA. Helpful specialists include neuropsychologists, neurologists and psychiatrists.

It's suspected that many cases of pseudobulbar affect go unreported and undiagnosed due to a lack of awareness about the condition.

Causes

Pseudobulbar affect (PBA) typically occurs in people with neurological conditions or injuries, including:

  • Stroke
  • Amyotrophic lateral sclerosis (ALS)
  • Multiple sclerosis (MS)
  • Traumatic brain injury
  • Alzheimer's disease
  • Parkinson's disease

While further research is needed, the cause of PBA is believed to involve injury to the neurological pathways that regulate the external expression of emotion (affect).

Complications

Severe symptoms of pseudobulbar affect (PBA) can cause embarrassment, social isolation, anxiety and depression. The condition might interfere with your ability to work and do daily tasks, especially when you’re already coping with a neurological condition.

April 01, 2016
References
  1. Mack E, et al. Information/education page: Pseudobulbar affect. Archives of Physical Medicine and Rehabilitation. 2014;95:1599.
  2. Brooks BR, et al. PRISM: A novel research tool to assess the prevalence of pseudobulbar affect symptoms across neurological conditions. PLOS One. 2013;8:e72232.
  3. Ahmed A, et al. Pseudobulbar affect: Prevalence and management. Therapeutics and Clinical Risk Management. 2013;9:483.
  4. Engleman W, et al. Diagnosing pseudobulbar affect in traumatic brain injury. Neuropsychiatric Disease and Treatment. 2014;10:1903.
  5. Galvez-Jimenez N. Symptom-based management of amyotrophic lateral sclerosis. http://www.uptodate.com/home. Accessed Feb. 29, 2016.
  6. National Stroke Association. Pseudobulbar affect — PBA. http://www.stroke.org/we-can-help/survivors/stroke-recovery/post-stroke-conditions/emotional/pba. Accessed March 1, 2016.