Pseudobulbar Affect (PBA)

Collage of multiple emotions
Pseudobulbar affect is the latest name for a neurological condition also known as emotional lability, reflex crying and involuntary emotional expression disorder, among others.

PBA occurs as a result of neurological diseases such as:

  • Stroke
  • Amyotrophic lateral sclerosis (ALS)
  • Parkinson’s
  • Traumatic brain injury
  • Multiple sclerosis
  • Dementia
  • Wilson’s disease
  • Brain tumors

In PBA, there’s a disconnect between the frontal lobe (which controls emotions) and the cerebellum and brain stem (where reflexes are mediated). The effects are uncontrollable and can occur without an emotional trigger. Those with PBA have involuntary bouts of crying, laughter or anger. The outburst may be out of proportion, e.g., something slightly sad yields exaggerated weeping. On the flip side, sad or somber occasions might spur uproarious laughter. Or there could be rapid switching between laughing and crying.

  • PBA has three common features:
  • Involuntary Brief (lasting seconds to minutes)
  • Stereotyped, meaning they have a similar appearance across disorders and within patients

But there’s good news: PBA can be treated. The first step is to get an accurate diagnosis. Ask your health care professional about PBA treatment options. Educating caregivers and other family members is also important.

These coping techniques may help:

  • Be open about the problem so people aren’t surprised or confused when you have an episode.
  • Distract yourself by counting the number of objects on a shelf or by thinking about something unrelated when you think you’re about to have an episode.
  • Take slow deep breaths until you’re in control.
  • Relax your forehead, shoulders and other muscle groups that tense up during an episode.
  • Change your body position. Note your posture when you’re having an episode.
  • When you think you’re about to cry or laugh, change your position.

These tips aren’t substitutes for medical advice. Talk with your doctor about additional ways to cope with your PBA episodes. Because people with PBA may cry a lot, their symptoms are often confused with depression. But PBA is not depression. In the past, PBA has been treated with anti-depressants, although they may only be moderately successful. Ongoing research into stroke, traumatic brain injury, multiple sclerosis, Alzheimer's disease and ALS continues to increase our knowledge about PBA. If you’d like to participate in a clinical trial, go to to find a study near you. In the meantime, it’s always important to communicate all of your symptoms to your doctor as you work towards a treatment plan.

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