Pseudobulbar Affect: An Emotional Mismatch
How Talking About Pseudobulbar Affect Can Help
Opening up to others about your condition can help ease your concerns about uncontrollable laughing or crying — and help those around you know how to react when these symptoms strike.
By Brian P. Dunleavy
Medically Reviewed by Sanjai Sinha, MD
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Pseudobulbar affect (PBA) is a condition in which uncontrollable or inappropriate laughing or crying can strike for no reason, often in those with certain neurological conditions or injuries. It is believed that PBA occurs when areas of the brain that control how you express your emotions become injured. As a result, people with PBA may dread social situations because of the potential for episodes of laughter and crying to occur at inappropriate times. While these symptoms can’t always be controlled, being open with others about your condition can help ease your concerns — and can help those around you know how to react if an episode occurs.
“Given the ability of PBA to markedly impair social and other relationships, in order to preempt a misunderstanding, it may be advisable to inform certain people of the condition, especially those who might misunderstand a PBA display and those who are highly likely to see it,” says Edward Lauterbach, MD, a neuropsychiatrist and professor emeritus of psychiatry and neurology at Mercer University School of Medicine in Macon, Georgia, who has specialized in treating people with the condition.
While talking to friends, family, and coworkers about your PBA can help, what exactly should you tell them? Here are a few things to say:
“PBA is common.”“It can be very liberating to simply be open with the people in your life about your PBA, by first explaining that it’s normal and common in people with certain health conditions, like Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and Parkinson’s disease, or in people who have experienced a stroke or traumatic brain injury,” explains Richard D. Zorowitz, MD, a rehabilitation medicine specialist at MedStar National Rehabilitation Network in Washington, D.C., and a professor of clinical rehabilitation medicine at Georgetown University School of Medicine, who has treated people with the condition.
In fact, research suggests that as many as 2 million Americans have PBA — and that may be an underestimate, given that the condition too often goes undiagnosed. The Brain Injury Association of America estimates that more than 9 million people are actually living with the condition.
“I can’t control my symptoms all the time.”Laughing or crying at inappropriate times can make you feel self-conscious — especially if the people around you are caught off guard by the reaction. If they know PBA is the cause of your emotional response, they’re less likely to be offended if you laugh in a serious situation or cry during an enjoyable one. Also, if they know these symptoms often arise without warning, they’re likely to be more patient and tolerant.
“I had one patient whose best friend slipped on her kitchen floor and broke her leg, whereupon my patient broke into uncontrollable laughter, even though she did not at all feel like laughing and was instead grievously concerned for her friend,” recalls Dr. Lauterbach. “This was very embarrassing and distressing to my patient, and created difficulty for her relationship.” Discussing your condition with those around you may help alleviate the emotional strain of these types of situations.
“My symptoms are…”Being specific about your exact symptoms helps those around you know what to expect. If you know that you tend to laugh or cry in particular situations, share that information with others.
“When people have these episodes and they’re out in the community or in the middle of a conversation, laughing or crying without reason, people may mistake it as an inappropriate reaction to what they’re saying,” Dr. Zorowitz says. Sharing the details of your exact symptoms can help alleviate social discomfort.
“I’m taking steps to control my PBA.”“I always tell people,” says Zorowitz, “that you have to explain, ‘This is what I have, and I am getting treatment for it.’”
While prescription medications for PBA may not stop symptoms altogether, they can reduce the frequency and severity of episodes. If you’re not already taking medication to control your PBA, be sure to talk to your doctor about treatment options.
You can also explain to people how simply talking about your condition and helping others understand what you’re going through can, in turn, help you manage.
Don’t Be Afraid to “Overshare”
Above all, Zorowitz believes, there’s no such thing as “oversharing” when it comes to PBA. “It’s important,” he says, “to tell not only people like your friends, family, and coworkers but also people you meet at social gatherings or even waiters at restaurants and store clerks.”
In fact, being open with everyone in your life about your PBA can ultimately result in support, helping you manage the condition.
“Given the social embarrassment that PBA can cause, it’s worth notifying friends, family [and others] about your condition,” says Lauterbach.
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