Pseudobulbar Affect

Pseudobulbar affect (PBA) describes a disorder that causes a person to experience uncontrollable episodes of crying, laughing, or other emotional displays that are out of context in their social interactions. Typically, pseudobulbar affect occurs secondary to other neurological conditions.

The impact of pseudobulbar affect is substantial. It can result in embarrassment for people suffering from the disorder, their family, and their caregivers. Pseudobulbar affect may also restrict social interactions causing a lower quality of life.

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Pseudobulbar Affect Symptoms

The primary sign of pseudobulbar affect is having uncontrollable outbursts of laughing or crying in situations other people do not find funny or sad. You may also switch from crying to laughing for no apparent reason. Episodes can occur at any time.

Symptoms of pseudobulbar affect can cause anxiety, embarrassment, and social isolation.

Pseudobulbar Affect Treatments

Medications may help if you suffer from pseudobulbar affect. They may include:

Antidepressants – tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may help reduce the frequency and severity of PBA episodes
Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta) – a medication that is designed to specifically treat PBA and is approved by the Food and Drug Administration (FDA)

You may find it helpful to see a neurologist, neuropsychologist, or physical medicine and rehab specialist.

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Additional Information

How common is pseudobulbar affect?

Currently, it is estimated that between two million and seven million people in the U.S. have experienced symptoms consistent with pseudobulbar affect. But again, pseudobulbar usually does not develop unless a pre-existing neurological disorder or injury is present.

Who gets pseudobulbar affect?

Pseudobulbar affect typically occurs secondary to a neurological injury or disease, such as:

Pseudobulbar affect may also occur in people who suffer a physiological disorder such as Graves disease, hyperthyroidism, or hypothyroidism.

How is pseudobulbar affect diagnosed?

Pseudobulbar affect (PBA) is often misdiagnosed as depression or bipolar disorder. Periods of crying or laughing tend to be shorter in duration in people with PBA than in those with depression. However, depression is common among people who have PBA.

The following criteria may be used to diagnose pseudobulbar affect:

Your emotional response is inconsistent or inappropriate to the situation, unrelated to medication, and not accounted for by any other psychiatric or neurological disorder
Your feelings and your response to those feelings are not related
You cannot control the duration or the severity of episodes of crying or laughing
Expression of emotion does not lead to a feeling of relief

Information and Resources

Archives of Physical Medicine and Rehab
National Institutes of Health

Currently, it is estimated that between two million and seven million people in the U.S. have experienced symptoms consistent with pseudobulbar affect.