Pseudobulbar Affect Causes Uncontrollable Laughing/Crying

Understanding Pseudobulbar Affect and Pathological Laughing/Crying

Uncontrolled expressions of emotion like sudden bouts of laughing or crying can be embarrassing and confusing for those experiencing them. These emotional outbursts appearing disconnected from mood are often misunderstood, but actually represent a medical condition known as pseudobulbar affect (PBA).

PBA, sometimes also called pathological laughing and crying, involves frequent episodes of exaggerated, involuntary emotional displays. These outbursts occur despite not feeling sad or happy congruent with the laughter or tears. PBA is caused by neurological problems disrupting normal regulation of emotions.

Recognizing PBA as the source of uncontrollable emotionalism is important, as it can often be mistaken for mental illness. But understanding this condition helps identify appropriate treatments to gain control over these confusing and disruptive symptoms.

What Causes Pseudobulbar Affect?

PBA arises from injury or dysfunction involving the neurological pathways that connect the frontal lobes with the brainstem. The frontal lobe areas involved in assessing emotional context become disconnected from the Pons and medulla oblongata which govern motor expression of emotion.

This neural disinhibition results in expressions of laughing or crying that are excessive, involuntary, or incongruent with mood state. Common underlying neurological conditions leading to PBA include:

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

PBA reflects impaired signaling between cognitive control centers and motor expression of emotion. The outbursts are involuntary physiological responses, rather than purposeful displays meant to reflect internal feelings.

Distinguishing PBA from Depression or Mood Disorder

Because uncontrollable bouts of crying are a hallmark of PBA, it is often mistaken as a sign of depression or other mood disorder. However, the root cause and most effective treatment approach differ between PBA and depressive disorders.

With PBA, laughing or crying outbursts are involuntary neurological reactions not intentionally meant to convey sadness or happiness. Patients report the emotional displays feel contradictory or disconnected from their actual mood state.

In contrast, crying in major depressive disorder represents an intentional expression of sadness congruent with low mood. The tears align with depressed thought patterns and negative emotions consciously felt at the time.

Recognizing PBA as the driver of frequent crying episodes rather than mood disorder is critical because different treatment approaches are warranted. While antidepressants help some PBA patients, many do not respond fully without therapies specifically targeting disinhibition.

Common Signs and Symptoms

Some key signs pointing to possible PBA as an explanation for uncontrolled emotional displays include:

• Frequent crying or laughing that feels excessive, involuntary or unconnected to mood
• Inability to control outbursts despite efforts to restrain
• Outbursts or expressions not logically fitting the situation
• Presence of underlying neurological illness like stroke, MS, or dementia
• Episodes lasting typically less than 2 minutes
• Confusion, embarrassment, or frustration related to episodes
• No apparent stimulus or thoughts triggering the outburst

PBA episodes can vary widely, occurring up to dozens of times per day or just sporadically. Laughing or crying may happen alone or switch between the two. Seeking treatment is often prompted after an outburst causes public embarrassment.

Impact on Quality of Life

Frequent PBA episodes can significantly impair social, occupational, and daily functioning. People may withdraw socially out of embarrassment over uncontrollable expressions. Stigma or relationship friction may develop if others interpret the outbursts as manipulative or indicative of mental illness.

Crying spells also reduce work productivity and engagement in hobbies or leisure. The disabling nature of PBA worsens overall quality of life, underscoring the value of accurate diagnosis and treatment.

Gaining Control Over PBA Through Targeted Treatment

While no cure exists for neurological causes of PBA like stroke or MS, symptom relief is often possible through a few main treatment approaches:

Medications Targeting Neurotransmitters

Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine are FDA approved specifically for PBA treatment. Other antidepressants may also be tried. These help raise serotonin levels involved in emotional inhibition.

Nuedexta, combining dextromethorphan and quinidine, modulates glutamate and serotonin activity. It was the first drug approved for PBA in 2010.

Off-label options like amitriptyline, fluvoxamine, nimodipine, or valproic acid may hold benefits too. Finding the optimal medication or combination takes some trial and error based on specific patient factors.

Avoiding Triggers Where Possible

While outbursts are involuntary, keeping a diary may help identify situations tending to provoke episodes. Avoiding known triggers where possible, like overstimulating environments or activities requiring emotional regulation, can then reduce frequency.

Letting close contacts know about the condition and typical outburst patterns also fosters understanding that episodes are temporary physiological reactions outside the persons control.

Psychotherapy for Coping Strategies

Counseling helps PBA patients develop behavioral techniques to attempt to feel outbursts arising and employ grounding or distraction skills. Soothing self-talk, focused breathing, and discreetly stepping away can aid short-term suppression.

Support groups also provide validation that PBA symptoms are manageable medical problems, not reflections of flawed character. Reducing embarrassment and isolation supports overall well-being.

Speech and Physical Therapy

For PBA resulting from stroke, speech therapy may help strengthen facial musculature resistence against involuntary movements. Physical therapy can also address posture and mobility factors influencing outbursts.

A multidisciplinary rehabilitation approach combining emotional regulation and motor control therapies shows promise for reducing PBA episode frequency, severity, and associated disability.

Importance of Accurate Diagnosis

Uncontrolled laughing or crying caused by PBA is fundamentally different from emotional expressions in mood disorders like depression. Unfortunately PBA is still under-recognized and undertreated.

Raising awareness of this condition as a potential explanation for unprompted emotional outbursts is vital. People affected deserve to understand the true reason behind their involuntary crying or laughter bouts.

Correctly identifying PBA provides reassurance the episodes are not due to personal weakness or imaginary problems. Appropriate medical therapies and coping strategies can then help individuals gain liberating control over these disruptive symptoms.

Seeking a Specialist for Evaluation

PBA often requires assessments by neurologists, psychiatrists, or neuropsychiatrists to definitively diagnose. Input from psychologists and primary doctors is also key.

Comprehensive medical history, neurological exam, imaging, and symptom journals help differentiate PBA from mood disorders. Specialized PBA screening tools like the CNS-LS may assist.

Dont hesitate to specifically ask providers about PBA if you experience uncontrollable emotionalism. Increased screening remains vital for prompt access to life-improving treatments.

Future Directions in PBA Research and Treatment

While PBA therapies have advanced greatly, further progress is needed to deepen understanding and expand treatment options. Areas of focus include:

• Brain imaging studies on neural circuitry changes underlying PBA
• Genetic factors influencing PBA vulnerability and severity
• New medication targets and delivery methods
• Alternate neuromodulation approaches like transcranial magnetic stimulation
• Enhanced psychotherapeutic and behavioral intervention techniques

Increased research funding and recruitment for clinical trials remains vital to drive innovation. PBA prevalence will likely rise with aging populations, highlighting urgency for those affected today and in the future.

Living Better

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.