You are here

Pseudobulbar Affect

Pseudobulbar affect (PBA) is a frequently reported post-stroke condition, with up to half of all stroke survivors experiencing it at some time. Despite it's prevalence, PBA is often misdiagnosed. PBA can be difficult to recognize or diagnose for a number of reasons, including similarity to depression, embarassment on the part of the patient, or difficulty in discussing the symptoms with a helathcare professional.

PBA can have a very negative impact a survivor’s social life and relationships and can even enhance a stroke survivor's experience of disability.

Expand All

What is Pseudobulbar Affect?

Have you experienced sudden outbursts of uncontrollable crying or laughing? If so, you may have PBA. It is sometimes referred to as mis-matched emotions, pathological crying and laughing or emotional incontinence. An episode of PBA can occur at any time, even in inappropriate social situations.

PBA is often mistaken for depression, causing it to be underdiagnosed, undertreated and sometimes inappropriately treated.

Only a healthcare provider 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.

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

Can Pseudobulbar Affect be treated?

PBA can be treated. 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. Ask your healthcare professional about PBA treatment options. Education of patients, families, and caregivers is an important component of the appropriate treatment of PBA.

Tips to live with PBA

  • 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.
  • Change your body position. Note the posture you take when having an episode. When you think you are about to cry or laugh, change your position.

These tips are general coping techniques and are not substitutes for medical advice. Talk with your doctor about additional ways to cope with your PBA episodes and whether a treatment plan may be appropriate.

Research about PBA

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.

Find a Support Group


Get Involved

For over 30 years we have been the trusted source for free resources and education to the stroke community. Together, we empower survivors and their circle of care to thrive after stroke. Make your tax-deductible donation today to support the growing needs of the stroke community.