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Uncontrolled Laughing Or Crying Is Linked To 5 Dangerous Conditions
Image Credit: Canva
SummaryPseudobulbar affect causes uncontrollable laughing or crying due to neurological conditions. While not dangerous, it can disrupt daily life.
Emotions are an organic and essential component of human life. They help individuals convey messages to others, reduce stress, and connect to the surroundings. However, in the case of some people, emotional responses are no longer in their control. Sometimes, the reactions can be excessive, inappropriate, or entirely out of place. This is known as pseudobulbar affect, which refers to an uncontrolled and sometimes exaggerated laughing or crying condition.
Although PBA itself is not a disease, it is closely related to neurological disorders and brain injuries. The effects of PBA can be distressing, but understanding its causes and treatment options can help manage its impact on daily life.
What Is Pseudobulbar Affect (PBA)?
PBA is a neurological condition that causes sudden, involuntary emotional outbursts. These episodes can manifest themselves through excessive laughing or crying that is inappropriate considering the context of the situation. These individuals experience extreme reactions with PBA, such as laughter during serious moments or tears in the absence of sadness, apparently without any emotional precipitate. These outbursts also occur for longer periods than may be expected in normal circumstances and are not easily controlled to see when or how long they occur.
Although PBA is not life-threatening, it can significantly affect a person's social and emotional well-being. People who experience PBA may find themselves embarrassed, frustrated, or isolated, as their emotional responses seem out of sync with their true feelings.
Studies estimate that up to 7 million Americans exhibit symptoms of PBA, and approximately 2 million individuals are diagnosed with the condition. PBA is most often seen in patients who have experienced a brain injury or suffer from neurological diseases. In some cases, PBA symptoms may be mistaken for mood disorders such as depression or anxiety, but the underlying causes are related to brain dysfunction rather than emotional instability.
What Causes PBA?
The root cause of pseudobulbar affect lies in the dysfunction of the central nervous system (CNS). More specifically, PBA results from damage to the brain's emotional regulation pathways, particularly the areas that control laughter and crying. Damage to these areas leads to involuntary emotional outbursts that are disconnected from the person’s actual feelings. Several neurological conditions can disrupt these pathways and increase the likelihood of developing PBA.
Here are five major conditions associated with PBA:
1. Stroke
A stroke occurs when blood flow to the brain is interrupted, depriving brain cells of oxygen and leading to their damage or death. This can result in physical disabilities, cognitive impairments, and emotional disturbances. Between 28% and 52% of stroke survivors experience PBA, with those assigned female at birth being at a higher risk. The symptoms of PBA are sometimes hard to differentiate from other effects that a stroke can bring.
Accurate diagnosis is very important. If you or someone you care about has had a stroke and cannot stop laughing or crying, you need to talk to a doctor, because these symptoms could mean PBA rather than a mood disorder.
2. Traumatic Brain Injury (TBI)
Traumatic brain injury often occurs due to external forces such as falls, car accidents, or sports injuries. TBIs can be a concussion or severe damage to the brain, and PBA is a common result of major head trauma. Studies have found that 5-48% of people with TBI develop symptoms of PBA, though this range varies due to underreporting and misdiagnosis.
Symptoms may be confused with another condition like depression or post-traumatic stress disorder, which can make them discuss emotional changes with a doctor who may have the patient referred for further neurology evaluation.
3. Multiple Sclerosis (MS)
Multiple sclerosis is an autoimmune disease in which the body's immune system fights against the protective covering of nerve fibers in the CNS, bringing about the disintegration of the communication process between the brain and the body. People with MS are more susceptible to developing PBA and have shown a prevalence rate of 10% from studies among patients with symptoms of involuntary laughter or crying.
MS-related brain lesions and the utilization of certain drugs can contribute to developing PBA. The lack of predictability of PBA can be especially problematic for an MS patient because it can create problems with social interactions as well as quality of life.
4. Amyotrophic Lateral Sclerosis (ALS)
Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative disease that affects cells in the nerve responsible for controlling voluntary movements of the muscles. As the motor neurons degenerate, patients begin experiencing muscle weakness, loss of mobility, and eventually, a failure to breathe. About 10% of patients with ALS develop PBA, in which crying is more common than laughing.
While ALS itself inflicts much physical and emotional stress, PBA can make an already difficult emotional experience even worse for patients and their families to bear.
5. Parkinson's Disease and Dementia
Parkinson's disease is a progressive neurological disorder affecting movement. PBA often occurs in advanced Parkinson's disease. The prevalence of PBA symptoms among Parkinson's patients has been reported to be 3.6% to 42.5%. In addition, the cognitive decline in Alzheimer's disease can also lead to PBA, and the prevalence among these patients has been estimated to be as high as 40%.
These conditions often have fluctuations in mood, which could be mistaken for mood disorders, complicating the diagnosis. Therefore, identification of symptoms of PBA in patients with Parkinson's and dementia is essential to ensure that these patients get proper care and support.
Symptoms of PBA
The symptoms of PBA are varied but usually involve:
- Increased emotional reactions: Laughter or crying for longer durations or of more intensity than the situation requires.
- Inappropriate crying and laughing: Laughing without a reason, e.g., at a solemn ceremony, or crying without having the feeling of sadness.
- Abrupt start: Episodes of crying and laughing can start without an identifiable emotional trigger.
- Inability to stop the episode: Unlike typical emotional outbursts, individuals with PBA are not able to control or end the episode once started.
- Emotional changes: Crying can change quickly into laughing, or vice versa, without any recognizable trigger.
Treatment for PBA
Although PBA is not a life-threatening condition, it can be very disruptive. There are treatments available to help manage the symptoms. Dextromethorphan/quinidine (Nuedexta) is the only FDA-approved medication specifically for PBA. This drug works by changing the way certain neurotransmitters function in the brain, helping to control emotional outbursts. In addition, antidepressants may be prescribed off-label to help alleviate symptoms in some cases.
Beyond medication, therapy and support groups can be very helpful in managing the social and emotional challenges of living with PBA. Cognitive-behavioral therapy (CBT) may help individuals understand their emotional responses and develop coping strategies to reduce the impact of PBA on their lives.
Pseudobulbar affect is a condition that can result from several serious neurological disorders. While the involuntary laughing and crying symptoms themselves are disturbing, it's the connection of PBA to brain dysfunction that will eventually lead to proper treatment and support for the patient.
If your loved one or you have sudden uncontrollable outbursts emotionally, it's essential to seek a comprehensive evaluation from the healthcare professional. With the right diagnosis and management plan, individuals with PBA can improve their emotional regulation and continue to live fulfilling lives despite the challenges of their condition.
Pseudobulbar affect (PBA).Multiple Sclerosis Association of America. 2010.
Pseudobulbar aPseudobulbar affect (PBA)ffect (PBA). American Stroke Association.
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