What if you knew someone who laughed at every joke you told, or just laughed all the time? Would you think of the person as good-natured, enjoys your company or is just a wonderful person to be around?
Well, the person may indeed be all of the above but for some two million people in the U.S. alone it’s not a laughing matter at all. For these people laughing or crying – often uncontrollably – is a symptom of a serious condition known as Pseudobulbar affect or PBA. It’s a little known condition, but for those who have it – as well as those who live or work with such people – it can be serious.
Charles Darwin Noted The Problem
In their study, published in the Journal of Neuropsychiatry , researchers Randolph Schiffer and Laura Pope, describe PBA as a socially and occupationally disabling disorder that involves involuntary and inappropriate outbursts of not just laughing, but fits of crying as well. The condition, they say, was described as early as 1872 when Charles Darwin noted the disorder in his own research. Later research found that the condition was neurologically based, essentially an area in the brain that involved the loss of cerebral control. The condition has also been referred to as “emotional liability” and “emotional incontinence.”
While the condition is rare, researchers have found that it more prevalent in people who have multiple sclerosis and those suffering from Lou Gehrig’s Disease (ALS). One study found that as many as half of ALS patients might have symptoms of PBA. There is also some research that suggests those with Alzheimer’s Disease might also have symptoms of PBA. Stroke, traumatic brain injury (TBI), Parkinson’s disease, brain tumors, and several other conditions have also been suggested as having lead to episodes of PBA.
In addition to the medical conditions associated with PBA, the condition can lead to emotional and psychological issues as well, such as problems with relationships, social activities and more.
Condition Often Misdiagnosed
The nature of PBA suggests that the condition can happen to almost anyone. One incident described in the research is of a New York man who was in a traffic accident that caused brain injury, after which he suffered from PBA for years afterward. The damage he suffered, and that others have suffered with as well, is the disruption of the brain’s signaling function, essentially causing a 'short circuit', and triggering episodes of involuntary crying or laughing.
One of the problems with PBA is that it often is misdiagnosed, as depression for example. PBA symptoms can be experienced even though there is no reason for it as opposed to depression where there might be an underlying issue, feelings, or other causes (see chart).
Researchers continue to hone in on PBA. There is now a scale that doctors can use to measure the severity of symptoms on a zero to three-point scale. Scores on a series of tests or questions provide an overall score to identify patients with PBA. Other measuring tools have also been developed.
Unfortunately, there are as yet no drugs to treat the problem of PBA although testing with antidepressants has been conducted. For now, scientists suggest those who suffer from PBA or those who live with them to turn to their physician if their loved one laughs or cries for no apparent reason or at times that are at odds with the situation (such as laughing when they hear bad news), their reaction to something is vastly exaggerated, or when the person themselves tells you they can’t seem to control their laughing or crying.
In these cases, researchers suggest keeping a diary of when and why the episodes the symptoms occur. Was it at a happy birthday party that the person began to cry? Was there some particular type of conversation or situation that seems to typically set off an emotional outburst?
Dealing With The Problem
One of the important ways medical professionals suggest dealing with PBA is to not keep the problem hidden. While someone with PBA might present some embarrassment to those around him or her, understanding of the problem is key. If you suffer from the condition yourself you might want to let others know of your situation so they can be forewarned about how you may act. It’s also suggested that you seek out other patients (your physician might be able to find others they are treating) you can talk to and share experiences with or perhaps form a support group with.
Some other ideas that researchers have offered for dealing with PBA are trying to distract yourself when you feel an emotional episode beginning – try to focus your attention elsewhere. Something as simple as changing your body position might help. If you notice that that your emotions are about to take a leap in a certain direction, move around and see if you can’t control or diminish the severity of the emotional outburst. You might also try to relax a little more. It’s often the case that feeling a PBA event coming on might make you tense up. Fight that feeling by doing just the opposite – relax your shoulder and neck muscles, go as limp as possible as see if that lessens or eliminates the PBA event.
1. The Journal of Neuropsychiatry and Clinical Neurosciences 2005;17:447-454. 10.1176/appi.neuropsych.17.4.447