The hallmark symptom of pseudobulbar affect (PBA) appears straightforward—a forced emotional response that is either exaggerated or doesn’t fit how you truly feel. The emotions that people with PBA most often express are involuntary laughing or crying. Despite the obvious symptoms, PBA is notoriously hard to diagnose. Working closely with your doctor is the best way to get the right diagnosis and long-term care for PBA, and this resource will share strategies for achieving both.

Hiding in Plain Sight: Why Is PBA Difficult to Diagnose?

How many people in the United States have pseudobulbar affect? That’s a hard question to answer. According to a study published in 2011, researchers estimated that anywhere between 1.8 million and 7.1 million Americans have PBA. The researchers also discovered that only 41% of patients who discussed their PBA symptoms with their doctor actually received the right diagnosis.1

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Why is PBA commonly under diagnosed and misdiagnosed? Because it mirrors other much more common disorders, namely depression, anxiety, bipolar disorder, and other forms of mental and emotional illness.

But PBA is not a psychological disorder, despite the appearance of its symptoms. PBA is a neurologic disorder. PBA occurs secondary to a neurologic condition (such as multiple sclerosis, Alzheimer’s disease, or stroke) or traumatic brain injury. Unlike most cases of depression, PBA episodes are involuntary, sudden, and they don’t reflect true feelings. Depression and PBA are two distinct conditions that require a different treatment approach to manage.

However, diagnosing PBA gets further complicated because depression and PBA can—and often do—coexist. Many people with PBA withdraw from public life out of fear an episode will occur. Social isolation can lead to depression and other psychological disorders. That’s why getting an accurate PBA diagnosis is so important: Once you know you have PBA, you can get the right treatment, and you can help educate others. 

How to Prevent A Misdiagnosis 

If you’re concerned you may have pseudobulbar affect, taking this PBA self-assessment is a good place to start. Though it’s not a substitute for a medical doctor’s diagnosis, you may consider bringing the results with you to help start a conversation during a doctor’s visit.

Sharing details of your disorder is the best way to prevent a misdiagnosis of depression, anxiety, or other psychological disorder. Be prepared to share key details of your medical history, as understanding previous or current neurologic disorders and brain injury is important to securing a PBA diagnosis.

Also, help your doctor understand the fine details of your emotional outbursts. Writing specifics of your episodes in a diary is a great way to capture the important distinctions that will help your doctor diagnose you correctly.

When you describe your PBA episodes in your diary and to your doctor, make sure to cover the following information:

  • What triggers your outbursts (crowds, stressful situations, etc.)
  • How long do they last?
  • How often do they occur?
  • How do you feel during and after the outbursts?
  • Do your expressions match your true emotions (ie, do you cry during a light-hearted moment at a birthday party)?
  • Do you feel that your emotions are exaggerated (ie, do you laugh for several minutes at a mildly funny joke)?
  • Can you control the outbursts?
  • How do these outbursts affect your life (ie, do you avoid going out in public)?

Though PBA is often misdiagnosed as depression, it’s important that you tell your doctor if you’re experiencing symptoms of depression in addition to PBA. Your doctor can create treatment plans to address both conditions. 

Strategies to Successfully Working with Your Doctor

Once you have been diagnosed with pseudobulbar affect, your doctor will work with you on how to limit the disorder’s effect on your daily life. One way to manage PBA is through medication.

Several medications can reduce the number and severity of PBA episodes. While antidepressants have long been used to help manage the condition, the US Food and Drug Administration (FDA) has approved 1 medication to treat PBA: dextromethorphan, hydrobromide and quinidine sulfate (Nuedexta). Your doctor will help you understand the benefits and drawbacks of each type of medication as it relates to you.

Before starting any new medication, tell your doctor about the medications you’re currently taking—even if they’re over-the-counter drugs, vitamins, or herbal supplements. Doing so may prevent serious drug interactions. You may consider bringing a list of your current medications to ensure nothing is missed.

In addition to medication, your doctor may work with you to explore other means to manage your condition. Meditation, therapeutic exercise (yoga, for example), and practicing PBA coping strategies can provide a well-rounded treatment approach. Your doctor may also refer you to other specialists, such as an occupational therapist, for additional strategies on how to keep PBA from interfering in your daily life.

As you try new treatments, it’s important that you monitor how well they’re working for you. Keeping a PBA episode diary isn’t just beneficial for securing a PBA diagnosis, it can also help you and your doctor gauge whether your treatment plan is reducing the frequency and severity of your outbursts. It can also help you determine if a treatment is having an adverse effect (eg, side effects from medication). 

Living Well with PseudoBulbar Affect

Your relationship with your doctor is paramount to living well with pseudobulbar affect (PBA). PBA often elicits feelings of embarrassment and anxiety in those who have it, but you shouldn’t avoid being open about the condition to your doctor. Being honest about how PBA affects your life and how treatments are working is important. Not all treatments work for everyone, but you can help your doctor find the right approach for you. By taking the time to track episodes of forced laughing or crying, you’ll paint a realistic picture of how you live with PBA. And with that information, your doctor can craft a treatment plan that restores your quality of life.

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Last Updated: Jan 8, 2019