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Explaining Unpredictable Emotional Episodes

Pseudobulbar affect (PBA) is a medical condition characterized by sudden and uncontrollable episodes of crying or laughing. It is sometimes referred to as emotional lability, pathological crying and laughing or emotional incontinence. An episode of PBA can occur at any time, even in inappropriate social situations.

PBA can occur in stroke survivors or people with other neurologic conditions such as dementia, multiple sclerosis, Lou Gehrig’s disease (ALS) or traumatic brain injury. It is thought to affect more than 1 million people in the U.S. PBA is often mistaken for depression, causing it to be underdiagnosed, undertreated and sometimes inappropriately treated.

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Pseudobulbar Affect: An Emotional Mismatch 

Watch this video to learn more about PBA.


PBA ScaleOnly a doctor can diagnose PBA. However, the Center for Neurologic Study-Lability Scale (CNS-LS), developed by healthcare professionals, can help you assess whether you have symptoms of PBA. Your answers to this simple seven-question scale will help you determine whether to talk to your healthcare provider about PBA. A CNS-LS score of 13 or higher may suggest PBA.

When you are finished completing the scale, you will receive recommendations for how you can talk to your doctor based on your score.

This scale is not intended as a substitute for professional medical assessment and/or advice. Please consult your healthcare provider.

» Take the CNS-LS assessment.


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The first step to treating PBA is to get an accurate diagnosis. Because people with PBA may cry a lot, their symptoms may be confused with depression. However, PBA is not depression. PBA can be treated. Ask your healthcare professional about PBA treatment options.

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  • Be open about the problem so people are not surprised or confused when you have an episode.
  • When you feel an episode coming on, try to distract yourself by counting the number of objects on a shelf or by thinking about something unrelated.
  • Take slow deep breaths until you're in control.
  • Relax your forehead, shoulders and other muscle groups that tense up during an emotional episode.


Results of a 2010 National Stroke Association survey about PBA after stroke showed that:

  • 53 percent of stroke survivor respondents reported symptoms of PBA based on their answers to the Center for Neurologic Study-Lability Scale (CNS–LS). This percentage is higher than the 6 to 34 percent cited in medical literature.
  • Fewer than one in five stroke survivor respondents were familiar with PBA.
  • About four in 10 respondents indicated that PBA episodes interfered with their social activities, including spending time with friends and family.
  • More than one-quarter of respondents suffering from PBA symptoms indicated that they experienced PBA outbursts frequently or often.
  • Only about one-third (38 percent) of respondents with PBA symptoms were treated for their episodes.

For other research information, see:


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Content Updated: May 2013

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