People living with pseudobulbar affect (PBA), also called emotional incontinence or emotional lability, experience uncontrollable and exaggerated emotions. This condition is characterized by sudden, unexpected laughing or crying. Outbursts may occur frequently and be stressful in social interactions.
PBA results from damage to the nervous system, either due to disease or injury. There is no cure for PBA, but medication can offer relief from symptoms. A doctor can help you manage the frequency and severity of outbursts.
The connection to neurological conditions
PBA is commonly associated with various neurological disorders, such as traumatic brain injury (TBI), multiple sclerosis (MS), Alzheimer’s disease, and Parkinson’s disease. When symptoms occur, they may not match the actual emotional state of the person. For example, a person with PBA may cry uncontrollably, even when they aren’t sad.
Outbursts usually occur unexpectedly, and people may not know how to manage their emotions.
The exact way PBA affects the brain is unclear, but doctors believe exaggerated emotions stem from disruptions in neural pathways responsible for regulating emotional expression.
Neurological damage or degeneration interrupts connections among neurons in several areas of the brain. This disconnection results in a loss of management over emotional responses, leading to the symptoms of PBA.
For example, in cases of TBI, damage to the brain disrupts neural pathways, leading to PBA symptoms. Similarly, diseases such as Alzheimer’s or Parkinson’s result in structural changes in the brain, contributing to emotional incontinence.
Symptoms and misdiagnosis
Recognizing PBA can be challenging. Its symptoms often overlap with symptoms of other mood disorders, such as depression or anxiety. People living with PBA may be misdiagnosed and offered treatment inappropriate to their situation.
The key differentiator between PBA and other mood disorders lies in the involuntary nature of emotional outbursts in PBA, which occur independently of the person’s underlying mood.
Your doctor may perform a comprehensive evaluation to reach an accurate diagnosis. Tools such as the Center for Neurologic Study-Lability Scale (CNS-LS) or the Pathological Laughter and Crying Scale (PLACS) can help your doctor assess the frequency and severity of PBA episodes. This helps your doctor differentiate PBA from other mood disorders.
Potential treatments for PBA
Managing PBA usually involves pharmacological and non-pharmacological treatments. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) have been effective in reducing PBA episodes by balancing levels of neurotransmitters inside the brain.
Also, the drug dextromethorphan combined with quinidine has been approved by the Food and Drug Administration specifically for PBA treatment. The combination of these medications helps balance neurotransmitter levels.
In addition to medications, non-pharmacological treatments can help manage symptoms. Your doctor may suggest behavioral therapy and counseling to cope with emotional fluctuations. Other therapies, such as mindfulness, relaxation, and cognitive behavioral strategies, can help lessen the psychological impact of PBA episodes.
Proactive care and seeking support
Understanding PBA can help you manage the condition.
If you experience unexpected emotional outbursts and have a neurological condition or brain injury, a doctor who specializes in neurology or psychiatry and who is familiar with PBA can reach a diagnosis and develop a treatment plan.
Living with PBA is a unique experience. However, knowing about its distinct features and association with underlying neurological conditions can help you receive an accurate diagnosis and treatment plan.