Understanding Pseudobulbar Affect

Pseudobulbar affect (PBA) is a neurological condition involving involuntary, sudden, and frequent episodes of laughing or crying that does not match how a person feels. Often misdiagnosed as a mood disorder, PBA is actually a neurological condition that occurs because of an existing neurological disorder or disease, such as:

• Traumatic Brain Injury (TBI)
• Stroke
• Amyotrophic Lateral Sclerosis (ALS)
• Multiple Sclerosis (MS)
• Alzheimer’s Disease
• Parkinson’s Disease

How Does Pseudobulbar Affect Happen?

Research indicates that PBA involves an injury to the neurological pathways that regulate the external expression of emotion. When neural pathways are disrupted, a person may involuntarily express emotions that are not appropriate to the situation.

Normally, the cerebral cortex, which is at the front of the brain, communicates with the cerebellum, at the back of the brain, to control our emotional responses to situations. But sometimes, the cerebellum becomes damaged, disrupting the communication between these two areas. PBA is thought to be a result from that miscommunication.

Individuals who have PBA may laugh uncontrollably in response to something that is not funny, or cry for no apparent reason.

Recognizing the Signs and Symptoms

Many cases of PBA go undiagnosed because many people don’t know the condition exists. Knowing the signs, causes, and symptoms can help people notice PBA and get treatment to manage the condition.

PBA can be frustrating for individuals who experience it and for those around them. People with PBA may laugh uncontrollably in response to something that isn’t that funny or they may cry in situations that others don’t see as sad.

Just as no two brain injuries are alike, no two individuals will show PBA in the same way. You or your loved one may have triggering events that cause a laughing or crying response that is disproportionate to the situation in duration or expression. You or your loved one may feel embarrassed or confused. There may be a noticeable display of frustration during an episode. For example, facial expressions or body movements may appear to be spasms.

Feeling overwhelmed, stressed, or anxious is a normal response to the challenges of life, especially when living with a brain injury or other neurological disorder. As PBA can mimic other conditions, it can be difficult to diagnose. That is why it is frequently mistaken for depression. If you suspect you or your loved one has PBA, you can take action.

The Center for Neurologic Study-Lability Scale (CNS-LS) is a short questionnaire that can help individuals with neurologic illness or injury identify the presence of PBA symptoms and their frequency. A CNS-LS score of 13 or higher may suggest PBA, but low and high scores can occur in persons with and without PBA. After a week of tracking, patients can share the questionnaire with their physician. Take the quiz to determine your CNS-LS score.

Similarly, keeping a detailed journal is helpful when talking with health care providers about PBA symptoms. Keeping track of episodes is important to assist in communicating with your healthcare provider. The PBA Episode Journal (available in our free PBA Self-Advocacy Toolkit) is a great resource to make sure you capture specific information.

Is it Depression or is it Pseudobulbar Affect?

PBA can look like a lot of other conditions, so it can be difficult to diagnose. In fact, it is often disguised, misinterpreted, and mistaken for depression.

According to the Mayo Clinic, PBA differs from depression in that “PBA episodes tend to be short in duration, while depression causes a persistent feeling of sadness. Also, people with PBA often lack certain features of depression, such as sleep disturbances or a loss of appetite.”

Here are a few ways to tell the difference between depression or PBA:

• How long do the individual’s crying episodes last? With PBA, symptoms will last from seconds to minutes; with depression, feelings of sadness can last for weeks or months.
• How is the individual behaving? With PBA, behavior does not change; with depression, a person can seem fatigued, agitated, or apathetic.
• Is the person seeing things clearly? With PBA, there is no misperception; depression can cause one to have a distorted or negative view of him or herself, others, and the future.

Five Facts about Pseudobulbar Affect

1. PBA is a condition that occurs secondary to a brain injury or neurological disorder.
2. Because crying is a common symptom of PBA, people often confuse PBA with depression. But PBA is caused by damage to the nervous system, while depression is psychological, related to a person’s emotional or mental state.
3. PBA episodes are unpredictable. They can occur at any time and last for several seconds or minutes.
4. People who experience PBA – as well as their caregivers and others around them – may feel frustrated, embarrassed, worried, or confused by PBA’s symptoms. If left untreated, PBA may negatively impact relationships, social situations, work, and quality of life.
5. Symptoms can range from mildly disturbing to seizure-like episodes.