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Uncontrollable crying or laughing: A common but frequently misunderstood problem

People with pseudobulbar have sudden outbursts of involuntary emotional displays they cannot control. They may start to cry or laugh, often when there is nothing sad or funny to trigger those emotional responses.

HAVE you ever heard of pseudobulbar affect or PBA? If you answered no, you’re not alone. Charles Darwin first described this health condition now known as PBA more than 130 years ago, but many patients and members of the medical community don’t realize that this debilitating disorder may affect approximately 2 million people in the U.S.

What is PBA?

People with PBA have sudden outbursts of involuntary emotional displays they cannot control. They may start to cry or laugh, often when there is nothing sad or funny to trigger those emotional responses. Even though PBA episodes are often confused with other conditions like the signs of depression, PBA is a separate and treatable neurological condition.

When does PBA occur?

PBA happens because of an existing, primary neurological condition, like Alzheimer’s disease, Parkinson’s disease, multiple sclerosis (MS), Lou Gehrig’s disease (ALS), stroke or traumatic brain injury. The episodes of uncontrollable laughing and/or crying occur unpredictably, and can be frequent and severe.

PBA can happen when disease or injury damages the part of the brain that controls normal expression of emotion. This damage can disrupt brain signaling, causing a “short circuit” and triggering episodes of involuntary crying or laughing. Unlike depression, PBA episodes are often sudden, unpredictable and may be greatly exaggerated to how one is feeling or even contrary to the person’s actual mood.

How does PBA affect patients and their families?

PBA’s unpredictable, involuntary emotional displays can cause anxiety and embarrassment, particularly in public settings. These episodes can be so disruptive for some people that they avoid social situations and grow to feel more and more isolated over time. For those suffering and for their loved ones and caregivers already dealing with the struggles of the primary neurologic condition, PBA’s impact can be severe and disabling.

Patients suffering from PBA often find their outward expressions – laughing or crying – in conflict with what they’re really feeling inside or as an exaggerated response. For example, an animal rescue commercial may tip their emotion toward slight feelings of sadness, but previously, they would not generally burst into an exaggerated fit of crying as a result. In some cases, the outbursts have nothing to do with the emotion. In fact the patient could be extremely sad – when attending a loved one’s funeral, for example – and suffer an outburst of loud, boisterous laughing without being able to stop. These types of inappropriate emotional episodes can have a significant negative impact not only on the patients but their families and/or caregivers as well.

So how can patients and caregivers recognize the symptoms of PBA? Here are five clues:

1. The patient has a neurologic condition such as Alzheimer’s disease, Parkinson’s disease, MS or Lou Gehrig’s disease, or has suffered a stroke or traumatic brain injury.

2. The patient bursts out crying or laughing for no apparent reason.

3. The patient laughs or cries at inappropriate times.

4. The patient experiences outbursts of emotion that are exaggerated or inappropriate for the situation.

5. Patients can’t control their laughter or tears, even when they try to.

Although there are many ways to cope with PBA symptoms, there is medication for the treatment of PBA. Ask your healthcare professional what PBA treatment options are available.

In addition to treatment, PBA patients and their loved ones can take steps to reduce PBA’s impact on their lives. Patients may benefit from:

Keeping an episode diary to help them better understand their episodes and what triggers them.

Implementing coping techniques such as distracting themselves when they feel an episode coming on.

Changing their body position.

Practicing deep breathing and muscle relaxation.

Encouraging patients to talk about PBA. It may also help to reassure them that you understand their episodes are not under their control.

 

If you or a loved one is suffering from symptoms of PBA, talk to your physician. To learn more about PBA, visit www.pbainfo.org. (ARAContent) â– 

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