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Pseudobulbar Affect Infographic frontPseudobulbar Affect Infographic Back

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Pseudobulbar Affect (PBA)
(su•do•bul•bar)

Causes

PBA is a result of neurological diseases such as stroke, dementia, traumatic brain injury and Parkinson’s, and may result in losing control of emotions.

Disrupted signals in the brain lead to involuntary and sometimes inappropriate episodes of laughing, crying or angry outburst.

Symptoms

Sudden and uncontrollable episodes of anger, laughing, crying or all, with no clear cause.

“I know I shouldn’t be laughing, but I just can’t stop myself.” “I just lose control... I try to put it out of my mind, but I just can’t.”
INAPPROPRIATE: EXAGGERATED:
PBA outbursts often don’t match the situation in which they occur and generally don’t reflect the way a person feels. PBA outbursts of crying or laughing are more intense or last longer than appropriate for the situation.

PBA is sometimes referred to by other terms, such as emotional incontinence or pathological laughing and crying.

PBA is not Depression 

  • They’re similar but different
  • When someone with PBA starts crying, it doesn’t necessarily mean they’re sad
  • Someone who has depression feels sad on the inside when they cry.
  • A stroke survivor may have PBA and depression.
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    PBA DEPRESSION
    Crying, laughing, or both EXTERNAL EXPRESSION Crying
    Neurologic disease or brain injury always present UNDERLYING NEUROLOGIC CONDITIONS May or may not have underlying neurologic disorder
    Seconds to minutes; brief DURATION OF EPISODE Weeks to months; ongoing
    Uncontrollable CONTROL OF EPISODES Maybe moderated or controlled
    Exaggerated or doesn’t match feelings inside EMOTIONAL EXPERIENCE Emotions match mood of sadness inside
    Outbursts have no specific link to underlying thoughts ACCOMPANYING THOUGHTS Feelings of worthlessness, hopelessness

    How to manage PBA BE OPEN Let people know that you can’t always control your crying or laughing because you have a neurologic condition. DISTRACT YOURSELF If you feel an episode coming, try to focus on something unrelated, or do something. CHANGE BODY POSITIONS Note the posture you take when you have an episode. When you think you’re about to cry or laugh, change your position. BREATHE/RELAX Take slow, deep breaths until you’re in control. Release the tension in your muscles that tense up during a PBA episode.

    American Stroke Association A division of the American Heart Association

    Learn more at Stroke.org

    © Copyright 2021 American Heart Association, Inc., a 501(c)(3) not-for-profit. All rights reserved. American Stroke Association is a registered trademark of the AHA. Unauthorized use prohibited. DS17032 3/21