Pseudobulbar affect (PBA)

Overview

Pseudobulbar affect (PBA) is a condition characterized by uncontrollable, sudden episodes of laughter or crying, often at inappropriate times. It usually affects individuals with certain neurological diseases or injuries, altering the brain’s capability to regulate emotions. Although emotions are felt normally, their expression can be disproportionate or misplaced, causing embarrassment and disruption in everyday activities. Frequently misidentified as a mood disorder, PBA, when accurately diagnosed, is manageable through medication. The condition is also known by several other terms, including:

• Emotional lability
• Emotional incontinence
• Involuntary emotional expression disorder
• Pathological laughing and crying
• Compulsive laughing or weeping

Symptoms

Pseudobulbar affect (PBA) is primarily characterized by sudden, involuntary, and uncontrollable episodes of crying or laughing that are disproportionate or unrelated to the individual’s actual emotional state. Often, laughter can unexpectedly turn into tears. Outside of these episodes, a person’s mood typically appears normal, and these episodes can happen unexpectedly. Crying is a more frequent manifestation of PBA than laughter.

The intensity of the emotional reaction in PBA cases is notably severe, with episodes of crying or laughing that can last several minutes. For instance, an individual might find themselves laughing excessively over a comment that is only slightly humorous, or they may laugh or cry in contexts that others might not find particularly humorous or sad. This behavior usually deviates significantly from their previous emotional responses.

PBA is often confused with depression due to its frequent crying episodes; however, while PBA episodes are brief, depression is characterized by a continuous state of sadness. Furthermore, PBA patients typically do not exhibit other symptoms common in depression, like sleep problems or a decrease in appetite, although it is not uncommon for individuals with PBA to also experience depression.

When to consult a healthcare provider

If you suspect you may be experiencing PBA, it’s important to discuss your symptoms with a healthcare provider. Those with neurological conditions might already be under the care of a doctor capable of diagnosing PBA. Specialists who can offer support include neuropsychologists, neurologists, and psychiatrists.

It is believed that many instances of pseudobulbar affect remain unnoticed and undiagnosed, partly due to a general lack of knowledge about the condition.

Causes

The exact cause of pseudobulbar affect is unknown. Pseudobulbar affect (PBA) is frequently seen in individuals with neurological disorders or injuries, such as:

• Alzheimer’s disease
• Amyotrophic lateral sclerosis (ALS)
• Brain tumors
• Epilepsy
• Multiple sclerosis (MS)
• Parkinson’s disease
• Stroke
• Traumatic brain injury
• Wilson’s disease

Although more investigation is required, damage to the neural pathways that control how emotions are expressed on the outside (affect) is thought to be the root cause of PBA.

Risk factors

Pseudobulbar affect (PBA) is a neurological disease that affects both adults and children. According to studies, PBA influences:

• It affects about 50% of people with amyotrophic lateral sclerosis (ALS).
• About 48% of people with traumatic brain injury and,
• About 46% of people with multiple sclerosis (MS).