Pseudobulbar affect (PBA) is a condition that many people don’t understand. It produces uncontrollable emotional expressions—usually laughing or crying—that are exaggerated and/or don’t reflect how the person truly feels. People often incorrectly link PBA to depression, but PBA is a neurological disorder—not an emotional one. Moreover, people with PBA may struggle with explaining their condition to loved ones, causing them to avoid social situations out of fear that an episode may occur.

However, talking about PBA (which also called labile affect, emotional incontinence, forced crying and laughing, or emotional lability) is an essential part of managing the disorder. You can help those around you understand what PBA is (and what it isn’t). In turn, your family and friends will be better sources of support for you.

Here, you’ll get tips on how to talk with others about forced laughing and crying—and learn from 2 people who have walked in your shoes.

“A Little Information Goes a Long Way:” Nancy’s Journey with PBA

When Nancy Higginbottom had her first stroke in 2009, she had no emotional complications. When she suffered her second stroke in 2015, things were different.

“The first time I noticed I was behaving oddly was when I was in the bathroom with an aide who was helping me brush my teeth,” Higginbottom said. “Suddenly, I was wailing. The aide kept saying, “It’s OK, let it out.’ All I could think was, ‘Let what out?’ I wasn’t feeling sad, but I couldn’t stop crying. I couldn’t control myself or my emotions, and that is a very scary feeling.”

Higginbottom also recalled uncontrollably laughing during occupational therapy. She’d be following directions from her therapist when giggles would overtake her.

Eventually, Higginbottom began managing her condition with anti-depressant medication and sought support on social media to help her learn and talk about PBA. That’s when she started to regain control.

“I talk about PBA a lot,” she said. “I’m a YouTuber, and I’ve been known to talk in my videos about stroke and PBA. Two years ago, I started a stroke survivor’s Facebook group and post information to open discussions about PBA.”

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Higginbottom said that when she had her second stroke, the lack of education she had around PBA would have made it difficult for her to explain her condition to others. She hopes the information she provides on social media puts others in a better position to talk about it.

“I was so scared and confused when I had my stroke, and I feel if I had more education prior to going through it myself maybe it wouldn’t have been so bad,” she said. “A little information goes a long way.”

Why Talking About PBA Is Important: Clarifying Misconceptions About PBA

Several misconceptions exist about PBA. Are these emotions really out of your control? Are you sure you’re not depressed? Is PBA even a true condition or just a symptom of your original neurological condition?

By talking about PBA to family and friends, you can put these myths to rest. And as Higginbottom put it: Talking about PBA not only helps others learn about the condition but also learn about you.

“I think the biggest misconception about PBA is that you are faking and just looking for attention,” she said. “People have a hard time understanding that you have no control over your emotions because it’s never happened to them. It’s such an embarrassing condition and to not be understood is so difficult.”

Delanie Stephenson, who developed PBA in 2012 after suffering a stroke, met Higginbottom via Higgingbottom’s stroke survivor’s Facebook group. She said people often minimize the effect PBA has on her life.

“It’s more than a little bit of extra laughing and crying over spilled milk—it’s feeling as if your brain is in the driver’s seat, and you have no control,” Stephenson says. “That’s not a good feeling.”

Stephenson said PBA can weave its way into every relationship, even in the most everyday events. When disciplining her kids, she may start hysterically laughing. When having a conversation with her husband about his day at work, she may erupt in tears.

In addition to thinking PBA is just a “little extra laughing and crying,” Stephenson said people make light of the disorder in other ways.

“When I tell people I have PBA, a lot of people say, ‘Oh yeah, I do that, too,’ and that’s frustrating because they don’t,” she said. “They don’t get it. You don’t get it unless you’re going through it yourself. And then some people think PBA isn’t real. Which is crazy in my book.”

Helping others understand PBA includes dispelling 2 other major misconceptions:

  • The difference between PBA and the underlying neurological condition

PBA is a separate condition that may be related to an underlying brain injury or neurological condition, but they are distinct. If you suffer from a neurological condition, like a stroke or multiple sclerosis, that does not mean you’ll develop PBA.

  • That PBA is not depression

Depression is an emotional condition, so it’s related to your mental and emotional health. PBA is a neurological condition, and it’s related to the brain. When a person with depression cries, it reflects their emotional state. On the other hand, a person with PBA may be crying but not feel sad—the emotion is out of their control. Also, depressive episodes may extend for months whereas PBA episodes typically dissipate within a few minutes.

Stephenson said her family has been open and understanding about being educated on PBA, which has eased a burden on her.

“I have been honest about everything—it’s so important to share as much as you can about PBA,” Stephenson said. “The more your family knows, the more they’ll understand you. In the beginning, it was so frustrating for my husband because he didn’t know what was going on. He now knows and understands PBA.”

Need a Place to Start? PBA Conversation Starters

Talking about pseudobulbar affect can be challenging. You must explain a condition that is riddled with misconceptions, but you can help others empathize with you by shedding light on your condition. These conversation starters can help you kick off the discussion:

“My emotions may confuse you sometimes. I may laugh or cry when it’s not appropriate, or my emotions may seem to go on for longer than they should. Here’s why that happens…”

“If I have an episode while I’m with you, a helpful way for you to react is…”

“While I can’t completely prevent these emotional episodes from happening, I am managing my condition by…”

Higginbottom also shared some helpful advice when explaining the onset of a PBA episode.

“When I’m talking to someone new and feel myself well up with tears, I just say, ‘My stroke makes me cry sometimes. I’m not sad, please just try to ignore it,’” she said. “This almost always leads to a PBA discussion and hopefully some understanding.”

If you experience forced laughing and crying in your daily life, you may find it easy to withdraw from public situations. But social isolation can cause a host of other problems, and help is out there in the form of PBA support groups. Connecting with other people who understand you and pseudobulbar affect may give you the confidence to talk about your condition and help you retake control of your life.

“I refuse to let PBA stop me. I am determined to live my life,” Higginbottom said. “Eventually, you learn that it doesn’t matter what people think about you. What matters most what you think of yourself.”

Last Updated: Jan 14, 2019