What to Know About Laughing and Crying Disorder

Table of ContentsView AllTable of ContentsSymptomsPrevalenceDiagnosisCausesTreatment

Table of ContentsView All

View All

Table of Contents

Symptoms

Prevalence

Diagnosis

Causes

Treatment

Close

Laughing disorders, aka pseudobulbar affect, involve episodes of uncontrollable laughter orcryingduring situations that do not warrant that reaction. These episodes are commonly intense and may beinappropriateor exaggerated given the social setting.Other terms to describe laughing disorders include involuntary emotional expression disorder,emotional lability, pathological laughter, crying, or emotional incontinence.

For anyone who experiences frequent and severe cases of uncontrollable laughter or crying, these events can be incredibly disruptive to daily functioning.

At a GlancePseudobulbar affect, aka laughing and crying disorder, can lead to inappropriate outbursts of laughing and crying that don’t match the context. These moments can happen regardless of the person’s mood and often lead to considerable distress. Why this happens isn’t entirely clear, but it is linked to neurological conditions and brain injuries, including MS, Parkinson’s, TBI, and stroke. Treatments typically involve medications that can help lower the frequency and severity of these laughing and crying outbursts. If you or someone you love experiences these bursts of sudden, intense, and uncontrollable crying or laughing, be sure to talk to a doctor.

At a Glance

Pseudobulbar affect, aka laughing and crying disorder, can lead to inappropriate outbursts of laughing and crying that don’t match the context. These moments can happen regardless of the person’s mood and often lead to considerable distress. Why this happens isn’t entirely clear, but it is linked to neurological conditions and brain injuries, including MS, Parkinson’s, TBI, and stroke. Treatments typically involve medications that can help lower the frequency and severity of these laughing and crying outbursts. If you or someone you love experiences these bursts of sudden, intense, and uncontrollable crying or laughing, be sure to talk to a doctor.

Symptoms of Laughing Disorders

When a person lives with pseudobulbar affect, it isn’t uncommon for them to burst into unexpected fits of laughter or crying.

These incidents typically occur without any relation to their currentmood. These tears or laughter may go on for a considerable period of time with the affected person unable to suppress their reaction. The event is usually distressing to the person affected.

In other cases, a person may have reason to laugh or cry at a comment or occurrence. However, this expression of humor or sadness is usually extreme and does not reflect their true experience of the event.

Pathological laughter or crying may also lead to more frequent and extreme emotional outbursts. These may, in turn, increase fits of anger or frustration.

While emotional incontinence can involve laughter and/or crying—crying is more commonly seen in people living with this condition.

How Common Is Pseudobulbar Affect?

Laughing and crying disorder typically occurs in people living with existingneurological disorders. Prevalence estimates are highly variable.

One study found that 9% of nursing home residents had symptoms of the condition.Other research suggests that it affects between 3.6% and 42.5% of people with Parkinson’s disease.

Diagnosis of Laughing Disorder

Pseudobulbar affect is very commonly undiagnosed, underdiagnosed, or misdiagnosed as a mood disorder such as depression.This is particularly observed where crying is the dominant expression of the condition.

For a correct evaluation, clinicians will evaluate thebehaviorof the individual suspected of living with laughing disorder.

This assessment may be determined using the following criteria:

Pseudobulbar affect may also be measured using scales or questionnaires. The Center for Neurologic Study—Lability Scale (CNS-LS) and the Pathological Laughter and Crying Scale are administered to patients to determine the reason behind theemotional outbursts.

Causes of Pseudobulbar Affect

A definite cause of laughing disorder is yet to be established. However, this disorder is commonly observed in people with neurological conditions.Depending on diagnostic frameworks and other factors, an estimated 10% to 50% of people withneurological illnesseslive with pseudobulbar affect.

These include disorders such as:

A lack of voluntary control over emotions is likely responsible for laughing disorders.Playing a key role in this is the cerebellum. This part of the brain regulates emotional responses to correspond with social situations and mood.

Where there is a disruption to the cerebellum circuitry, this may affect voluntary control over emotions.

Likewise,neurotransmitterssuch asserotoninandglutamatecan impact the development of emotional incontinence. This is because of the vital role they play in cerebellar pathways in the brain.

Laughing Disorder Treatment

The treatment of laughing disorder is focused on reducing the severity and frequency of uncontrollable outbursts. To achieve this, oral medications are commonly recommended.

Antidepressants

The main objective of these medications is to improveserotoninlevels in the brain. This is achieved usingselective serotonin reuptake inhibitors(SSRIs) such ascitalopram,fluoxetine, andsertraline.

Likewise,tricyclic antidepressants (TCAs)like amitriptyline and nortriptyline, or norepinephrine/serotonin reuptake inhibitors such as venlafaxine or duloxetine can reduce the intensity of these episodes.

SSRIs and TCAs may be effective in managing pseudobulbar affect due to the serotonin boost they provide.

Dextromethorphan

The combination ofdextromethorphan(brand name: Nuedexta) andquinidineare the only FDA-approved medications for managing pseudobulbar affect.While dextromethorphan belongs to a class of medications calledcentral nervous systemagents, quinidine is grouped under antiarrhythmics.

The combination of these medications increases the amount of ​​dextromethorphan in the body. This pairing helps to manage laughing disorders.

Takeaways

Laughter as a Coping Mechanism

15 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Goldin DS.Pseudobulbar affect: An overview.J Psychosoc Nurs Ment Health Serv. 2020;58(9):19-24. doi:10.3928/02793695-20200624-08Nwabueze C, Azam M, Kekere V, Odenigbo N, Banu F, Fouron P.Emotional incontinence: A case report of pseudobulbar affect in the setting of alcohol use disorder.Cureus. 2023;15(5):e38976. doi:10.7759/cureus.38976Kazi SE, Anwar A.Pseudobulbar affect presenting as aggressive behavior.Cureus. 2022;14(2):e21978. doi:10.7759/cureus.21978Foley K, Konetzka RT, Bunin A, Yonan C.Prevalence of pseudobulbar affect symptoms and clinical correlates in nursing home residents.Int J Geriatr Psychiatry. 2016;31(7):694-701. doi:10.1002/gps.4374Hakimi M, Maurer CW.Pseudobulbar affect in Parkinsonian disorders: A review.J Mov Disord. 2019;12(1):14-21. doi:10.14802/jmd.18051Kekere V, Qureshi D, Thanju A, Fouron P, Olupona T.Pseudobulbar affect mimicking depression: A case report.Cureus. 2022;14(6):e26235. doi:10.7759/cureus.26235Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA.Pseudobulbar affect: Prevalence and association with symptoms in multiple sclerosis.Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523Nabizadeh F, Nikfarjam M, Azami M, Sharifkazemi H, Sodeifian F.Pseudobulbar affect in neurodegenerative diseases: A systematic review and meta-analysis.J Clin Neurosci. 2022;100:100-107. doi:10.1016/j.jocn.2022.04.009Gerontological Society of American.Pseudobulbar affect: An often-overlooked condition.Demler TL.Introduction to pseudobulbar affect: setting the stage for recognition and familiarity with this challenging disorder.Am J Manag Care. 2017;23(18 Suppl):S339-S344.Turell W, Roc A, Pioro E, Howson A.Living with the burden of pseudobulbar affect: A qualitative analysis of the effects of education on patient experience.J Patient Exp. 2020;7(6):1324-1330. doi:10.1177/2374373519899597Frazier MR, Hoffman LJ, Popal H, Sullivan-Toole H, Olino TM, Olson IR. A missing link in affect regulation: the cerebellum.Soc Cogn Affect Neurosci. 2022;17(12):1068-1081. doi:10.1093/scan/nsac042Young FG, Nguyen D.Treatment of pseudobulbar affect (PBA) in a patient with a history of traumatic brain injury, partial brain resection, and brainstem stroke: A case report.J Med Case Rep. 2020;14(1):235. doi:10.1186/s13256-020-02525-3Chen JJ.Pharmacotherapeutic management of pseudobulbar affect.Am J Manag Care. 2017;23(18 Suppl):S345-S350.Villeneuve Y, Cruz-Santiago D, Masson H, Clerc D.Treatment of pseudobulbar affect in a mixed neurodegenerative disorder with compounded quinidine capsules and dextromethorphan cough syrup.SAGE Open Med Case Rep. 2020;8:2050313X20921076. doi:10.1177/2050313X20921076

15 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Goldin DS.Pseudobulbar affect: An overview.J Psychosoc Nurs Ment Health Serv. 2020;58(9):19-24. doi:10.3928/02793695-20200624-08Nwabueze C, Azam M, Kekere V, Odenigbo N, Banu F, Fouron P.Emotional incontinence: A case report of pseudobulbar affect in the setting of alcohol use disorder.Cureus. 2023;15(5):e38976. doi:10.7759/cureus.38976Kazi SE, Anwar A.Pseudobulbar affect presenting as aggressive behavior.Cureus. 2022;14(2):e21978. doi:10.7759/cureus.21978Foley K, Konetzka RT, Bunin A, Yonan C.Prevalence of pseudobulbar affect symptoms and clinical correlates in nursing home residents.Int J Geriatr Psychiatry. 2016;31(7):694-701. doi:10.1002/gps.4374Hakimi M, Maurer CW.Pseudobulbar affect in Parkinsonian disorders: A review.J Mov Disord. 2019;12(1):14-21. doi:10.14802/jmd.18051Kekere V, Qureshi D, Thanju A, Fouron P, Olupona T.Pseudobulbar affect mimicking depression: A case report.Cureus. 2022;14(6):e26235. doi:10.7759/cureus.26235Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA.Pseudobulbar affect: Prevalence and association with symptoms in multiple sclerosis.Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523Nabizadeh F, Nikfarjam M, Azami M, Sharifkazemi H, Sodeifian F.Pseudobulbar affect in neurodegenerative diseases: A systematic review and meta-analysis.J Clin Neurosci. 2022;100:100-107. doi:10.1016/j.jocn.2022.04.009Gerontological Society of American.Pseudobulbar affect: An often-overlooked condition.Demler TL.Introduction to pseudobulbar affect: setting the stage for recognition and familiarity with this challenging disorder.Am J Manag Care. 2017;23(18 Suppl):S339-S344.Turell W, Roc A, Pioro E, Howson A.Living with the burden of pseudobulbar affect: A qualitative analysis of the effects of education on patient experience.J Patient Exp. 2020;7(6):1324-1330. doi:10.1177/2374373519899597Frazier MR, Hoffman LJ, Popal H, Sullivan-Toole H, Olino TM, Olson IR. A missing link in affect regulation: the cerebellum.Soc Cogn Affect Neurosci. 2022;17(12):1068-1081. doi:10.1093/scan/nsac042Young FG, Nguyen D.Treatment of pseudobulbar affect (PBA) in a patient with a history of traumatic brain injury, partial brain resection, and brainstem stroke: A case report.J Med Case Rep. 2020;14(1):235. doi:10.1186/s13256-020-02525-3Chen JJ.Pharmacotherapeutic management of pseudobulbar affect.Am J Manag Care. 2017;23(18 Suppl):S345-S350.Villeneuve Y, Cruz-Santiago D, Masson H, Clerc D.Treatment of pseudobulbar affect in a mixed neurodegenerative disorder with compounded quinidine capsules and dextromethorphan cough syrup.SAGE Open Med Case Rep. 2020;8:2050313X20921076. doi:10.1177/2050313X20921076

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Goldin DS.Pseudobulbar affect: An overview.J Psychosoc Nurs Ment Health Serv. 2020;58(9):19-24. doi:10.3928/02793695-20200624-08Nwabueze C, Azam M, Kekere V, Odenigbo N, Banu F, Fouron P.Emotional incontinence: A case report of pseudobulbar affect in the setting of alcohol use disorder.Cureus. 2023;15(5):e38976. doi:10.7759/cureus.38976Kazi SE, Anwar A.Pseudobulbar affect presenting as aggressive behavior.Cureus. 2022;14(2):e21978. doi:10.7759/cureus.21978Foley K, Konetzka RT, Bunin A, Yonan C.Prevalence of pseudobulbar affect symptoms and clinical correlates in nursing home residents.Int J Geriatr Psychiatry. 2016;31(7):694-701. doi:10.1002/gps.4374Hakimi M, Maurer CW.Pseudobulbar affect in Parkinsonian disorders: A review.J Mov Disord. 2019;12(1):14-21. doi:10.14802/jmd.18051Kekere V, Qureshi D, Thanju A, Fouron P, Olupona T.Pseudobulbar affect mimicking depression: A case report.Cureus. 2022;14(6):e26235. doi:10.7759/cureus.26235Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA.Pseudobulbar affect: Prevalence and association with symptoms in multiple sclerosis.Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523Nabizadeh F, Nikfarjam M, Azami M, Sharifkazemi H, Sodeifian F.Pseudobulbar affect in neurodegenerative diseases: A systematic review and meta-analysis.J Clin Neurosci. 2022;100:100-107. doi:10.1016/j.jocn.2022.04.009Gerontological Society of American.Pseudobulbar affect: An often-overlooked condition.Demler TL.Introduction to pseudobulbar affect: setting the stage for recognition and familiarity with this challenging disorder.Am J Manag Care. 2017;23(18 Suppl):S339-S344.Turell W, Roc A, Pioro E, Howson A.Living with the burden of pseudobulbar affect: A qualitative analysis of the effects of education on patient experience.J Patient Exp. 2020;7(6):1324-1330. doi:10.1177/2374373519899597Frazier MR, Hoffman LJ, Popal H, Sullivan-Toole H, Olino TM, Olson IR. A missing link in affect regulation: the cerebellum.Soc Cogn Affect Neurosci. 2022;17(12):1068-1081. doi:10.1093/scan/nsac042Young FG, Nguyen D.Treatment of pseudobulbar affect (PBA) in a patient with a history of traumatic brain injury, partial brain resection, and brainstem stroke: A case report.J Med Case Rep. 2020;14(1):235. doi:10.1186/s13256-020-02525-3Chen JJ.Pharmacotherapeutic management of pseudobulbar affect.Am J Manag Care. 2017;23(18 Suppl):S345-S350.Villeneuve Y, Cruz-Santiago D, Masson H, Clerc D.Treatment of pseudobulbar affect in a mixed neurodegenerative disorder with compounded quinidine capsules and dextromethorphan cough syrup.SAGE Open Med Case Rep. 2020;8:2050313X20921076. doi:10.1177/2050313X20921076

Goldin DS.Pseudobulbar affect: An overview.J Psychosoc Nurs Ment Health Serv. 2020;58(9):19-24. doi:10.3928/02793695-20200624-08

Nwabueze C, Azam M, Kekere V, Odenigbo N, Banu F, Fouron P.Emotional incontinence: A case report of pseudobulbar affect in the setting of alcohol use disorder.Cureus. 2023;15(5):e38976. doi:10.7759/cureus.38976

Kazi SE, Anwar A.Pseudobulbar affect presenting as aggressive behavior.Cureus. 2022;14(2):e21978. doi:10.7759/cureus.21978

Foley K, Konetzka RT, Bunin A, Yonan C.Prevalence of pseudobulbar affect symptoms and clinical correlates in nursing home residents.Int J Geriatr Psychiatry. 2016;31(7):694-701. doi:10.1002/gps.4374

Hakimi M, Maurer CW.Pseudobulbar affect in Parkinsonian disorders: A review.J Mov Disord. 2019;12(1):14-21. doi:10.14802/jmd.18051

Kekere V, Qureshi D, Thanju A, Fouron P, Olupona T.Pseudobulbar affect mimicking depression: A case report.Cureus. 2022;14(6):e26235. doi:10.7759/cureus.26235

Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA.Pseudobulbar affect: Prevalence and association with symptoms in multiple sclerosis.Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523

Nabizadeh F, Nikfarjam M, Azami M, Sharifkazemi H, Sodeifian F.Pseudobulbar affect in neurodegenerative diseases: A systematic review and meta-analysis.J Clin Neurosci. 2022;100:100-107. doi:10.1016/j.jocn.2022.04.009

Gerontological Society of American.Pseudobulbar affect: An often-overlooked condition.

Demler TL.Introduction to pseudobulbar affect: setting the stage for recognition and familiarity with this challenging disorder.Am J Manag Care. 2017;23(18 Suppl):S339-S344.

Turell W, Roc A, Pioro E, Howson A.Living with the burden of pseudobulbar affect: A qualitative analysis of the effects of education on patient experience.J Patient Exp. 2020;7(6):1324-1330. doi:10.1177/2374373519899597

Frazier MR, Hoffman LJ, Popal H, Sullivan-Toole H, Olino TM, Olson IR. A missing link in affect regulation: the cerebellum.Soc Cogn Affect Neurosci. 2022;17(12):1068-1081. doi:10.1093/scan/nsac042

Young FG, Nguyen D.Treatment of pseudobulbar affect (PBA) in a patient with a history of traumatic brain injury, partial brain resection, and brainstem stroke: A case report.J Med Case Rep. 2020;14(1):235. doi:10.1186/s13256-020-02525-3

Chen JJ.Pharmacotherapeutic management of pseudobulbar affect.Am J Manag Care. 2017;23(18 Suppl):S345-S350.

Villeneuve Y, Cruz-Santiago D, Masson H, Clerc D.Treatment of pseudobulbar affect in a mixed neurodegenerative disorder with compounded quinidine capsules and dextromethorphan cough syrup.SAGE Open Med Case Rep. 2020;8:2050313X20921076. doi:10.1177/2050313X20921076

Meet Our Review Board

Share Feedback

Was this page helpful?Thanks for your feedback!What is your feedback?HelpfulReport an ErrorOtherSubmit

Was this page helpful?

Thanks for your feedback!

What is your feedback?HelpfulReport an ErrorOtherSubmit

What is your feedback?