Have you ever witnessed someone exhibiting mood-incongruent behavior? Laughing uncontrollably when mad? Crying uncontrollably over something minor? What you might have witnessed is something called Pseudobulbar Affect (PBA)—also known as emotional incontinence, labile affect, forced crying, pathological emotionality, and emotional lability. PBA is resultant of a neurological disorder or a brain injury. Most commonly, individuals living with Multiple Sclerosis (MS), brain tumors, ADHD, Parkinson’s disease, Alzheimer’s disease, Grave’s disease, and the after effects of a stroke are most likely to exhibit pseudobulbar affect. Persons suffering from this condition have no control over their incongruent moods. This condition got the name pseudobulbar affect because its symptoms are similar to those caused by a lesion on the medulla oblongata (i.e., a bulbar lesion).


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Symptoms of PBA

The most common symptom of pseudobulbar affect is mood-incongruent behavior. Laughing hysterically at a funeral. Uncontrollable crying when someone tells a joke. These are the classic signs of this condition. In some cases, the symptoms are less incongruent and just exaggerated. Individuals living with PBA are generally aware of the inappropriateness of the response but have no voluntary control over the behavior. Symptoms may be intermittent or can be severe and debilitating, negatively impacting the quality of life. Characteristics of PBA symptoms include:

  • Outbursts occurring several times a day
  • Outbursts lasting between a few seconds to a few minutes
  • Sudden and unpredictable onsets – some individuals liken it to a seizure

Because of the inability to control the inappropriate emotional outbursts linked to pseudobulbar affect, if you are living with this condition, you may socially withdraw from your relationships and find yourself unable to engage in everyday activities—related to work, daily life, and social pursuits.

Some attribute the symptoms of this disorder, incorrectly, to clinical depression. The distinction between the two is congruency of mood. If you are living with depression, your uncontrollable crying is most likely due to sadness. With pseudobulbar affect, as discussed, your uncontrollable crying may be due to a funny story. The duration of the symptoms is another key differentiator. PBA symptoms are brief with an unpredictable onset. Depression symptoms are longer in duration and are congruent to the mood. That is, crying because feeling down/depressed. Though, it’s not uncommon that depression and PBA co-exist.

What Are The Causes of PBA?

The causes of pseudobulbar affect are secondary in nature. If you are experiencing symptoms of this disorder, there is a biological cause of the condition—either a brain injury or some type of neurological condition. As mentioned previously, PBA is the result of damage to the medulla oblongata, strokes, multiple sclerosis, Parkinson’s disease, and other similar neurological disorders. Oftentimes, it is described as a “wiring” problem—the wires connecting the brain and emotions are disrupted, resulting in inappropriate mood responses.

With stroke victims, PBA is one of the most prevalent behavioral syndromes—affecting up to 52% of the population. Those with a prior history of stroke are more likely to exhibit symptoms of PBA. Although at a lower occurrence, several individuals living with multiple sclerosis also exhibit PBA symptoms—up to 10% of the patient population. While lower in prevalence than stroke victims, PBA tends to cause more severe MS symptoms—including accelerated intellectual deterioration and neurological and physical disabilities. The Brain Injury Association of America (BIAA) reports that 80% of the population suffering from brain injuries indicate symptoms of PBA, with statistical investigations estimating the occurrence of PBA in traumatic brain injury patients to be at 55% or greater.

Treatment Options

If you are living with pseudobulbar affect, the condition is not curable but it is treatable. Both pharmacologic and nonpharmacologic interventions exist. If medications are considered the best course of treatment by your doctor, you might be prescribed some type of antidepressant, antipsychotic, or anticonvulsant. The only FDA-approved drug for the treatment of PBA is dextromethorphan hydrobromide/quinidine sulfate (DM/Q – Nuedexta brand). This drug combo acts as a mechanism to block DM hepatic metabolism and as a serotonin and norepinephrine reuptake inhibitor.

Patient education is one of the most cited beneficial treatment options for individuals living with this condition and for their close friends and family. Teaching the transient nature of the disorder and learning how to separate the behavior from the underlying neurological cause are key treatment options. It’s important that friends and family members understand that their loved one suffering from this condition has no control over the behavior—it’s the result of an underlying neurological illness or brain injury.

In addition to education, basic relaxation techniques can ease symptoms of PBA—and in some cases eliminate the symptoms from flaring. If you are living with this condition, try meditation, yoga, deep breathing, and art and music therapy to alleviate symptoms or the severity of symptoms.

Cognitive behavioral therapy is also an option to change your thought processes and resultant behaviors and feelings. Though scientific research has not yet uncovered strong treatment options for this condition, the above options can take the edge off—especially with an educated mindset of the causes and symptoms of pseudobulbar affect.

Living with Pseudobulbar Affect

There is no cure, but there are options. Communicate with others about your condition—this will not only help them understand, but it will help you when you suffer an episode in front of them. Keep an eye out for other comorbid disorders that occur with this condition—including clinical depression. When feeling an episode start, straighten your posture—it has been found to halt full-blown PBA reactions. Lastly, focus your mind on the opposite mood that you are experiencing. While you have no control over your behaviors, you might nip it in the bud before it starts. And just remember, if you are having an episode—it will be over in a matter of seconds or minutes. You can live a good life with pseudobulbar affect—just be open, honest, and aware of your condition—the first step in treatment alone.

Last Updated: Jun 10, 2020