Imagine not being able to control when you laughed or when you cried. While it’s not a well-known condition, this is reality for those who suffer from pseudobulbar affect (PBA), which is thought to affect nearly two million Americans. PBA occurs in people with an underlying neurologic condition like Alzheimer’s disease or other dementias, stroke, traumatic brain injury (TBI), multiple sclerosis (MS), Parkinson’s disease, or Lou Gehrig’s disease (ALS).
PBA causes involuntary and unpredictable episodes of crying or laughing often when there is nothing sad or funny triggering those emotional responses. This type of emotional distress can leave those who have it and their families feeling embarrassed and can cause them to avoid social situations.
When Staten Island, New York resident Richard Anderson returned home after recovering from a brain injury he experienced after being hit by a car while crossing the street during a family vacation in 2004, he and his family both noticed that he was not the same person as he was before.
He was an active family man who now found himself unable to participate in important family events like a father-daughter dance with his daughter Angelica due to outbursts of spontaneous and unprovoked episodes of crying. “It was very upsetting to me to have tears just rolling down my face,” said Mr. Anderson.
Mr. Anderson’s experience with PBA is not unique. PBA occurs when disease or injury damages the part of the brain that controls how we express our emotions. In his case, this part of his brain was damaged in the accident. This damage can disrupt brain signaling, causing a ‘short circuit’, and triggering episodes of involuntary crying or laughing. While PBA is caused by these conditions, it’s a separate and treatable condition.
PBA can sometimes be mistaken for other conditions, as its symptoms might be attributed to the patient’s underlying neurologic condition or depression. But unlike depression, PBA is actually a neurologic condition, and PBA episodes are sudden, unpredictable, and may not truly reflect the way you feel inside. Mr. Anderson experienced some frustration as his doctors were able to treat his injuries, but did not initially recognize and manage his uncontrollable crying and laughing.
If you or someone you know is dealing with a disease that is commonly associated with PBA, or experienced a brain injury, you will want to look out for these symptoms. Ask your doctor about PBA if:
- The person begins to laugh or cry for no reason.
- The person laughs or cries at inappropriate times – for example if the patient greets sad news about a family member with laughter.
- The person has an exaggerated emotional reaction to something sad or funny that doesn’t match the gravity or context of the situation.
- The person expresses to you that they can’t control their tears or laughter.
As in Mr. Anderson’s case, these types of episodes can cause embarrassment and be so disruptive that they can interfere with normal activities or cause avoidance of social situations. It’s important to talk to your doctor if you are experiencing symptoms of PBA. A doctor can help you learn more about the condition and provide educational resources.
People who suffer from PBA may find it challenging, but here are a few ideas that might make it a little easier to cope:
- Keep an episode diary. This will help you and your doctor better understand your PBA episodes.
- Be open about it. Let people know that you cannot always control your emotions because PBA outbursts are the result of neurologic damage.
- Talk to other patients. They can help you feel like you are not alone and may be able to provide helpful tips.
- Distract yourself. If you feel an emotional episode coming on, try to focus on something unrelated.
- Change your body position. Note the posture you take when having an episode. When you think you are about to cry or laugh, change your position.
- Breathe. Take slow deep breaths until you are in control.
- Relax. Release the tension in your forehead, shoulders, and other muscle groups that tense up during an emotional episode.
These tips are general coping techniques and are not substitutes for medical advice from your doctor. If you’re experiencing symptoms of PBA, be sure to talk to your doctor and ask what options are available to help you cope with PBA outbursts.