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Treating Involuntary Crying and Laughing

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This content is created or selected by the Healthgrades editorial team and is funded by an advertising sponsor. The content is subject to the Healthgrades medical review process for accuracy, balance and objectivity. The content is not edited or otherwise influenced by the advertisers appearing on this page except with the possible suggestion of the broad topic area. For more information, read the Healthgrades advertising policy.

When Crying or Laughing Doesn’t Match Your Emotional State

Medically Reviewed By Heidi Moawad, M.D.

Strong emotional expressions that don’t fit your feelings or the situation could be affecting your relationships, social life, and career.

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Crying during a sad movie or laughing when your friend tells a joke are typical reactions. However, if you’re laughing or crying unexpectedly, you might be wondering what is causing these responses. 

It may be pseudobulbar affect (PBA), which makes you lose control over your emotional expressions. PBA is caused by neurological disorders or brain damage. It’s important to know that PBA is not the same as depression or bipolar disorder. If you are an expressive person, or if you tend to feel strong emotions, that is not the same as PBA.

PBA affects up to half Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  of people with strokemultiple sclerosis (MS), and Parkinson’s disease. Being unable to control your emotional reactions can be upsetting and disrupt your day-to-day life. 

Talk with a doctor if you have symptoms of PBA. They can provide a diagnosis and treatment.

What is pseudobulbar affect?

Damage to connections between the cerebellum (the area that controls balance) and the cerebral cortex (the area that understands emotions and controls emotional expressions) can cause PBA.

The following brain disorders can cause PBA:

How these conditions damage the pathways controlling emotions is unclear.

How can PBA affect your life?

People with PBA can suddenly laugh, cry, or express fear, with or without a trigger. Sometimes, there is a trigger, and people with PBA may cry excessively about something that is only a little sad or might laugh about something that is only mildly funny.

Sometimes, unusual emotional expressions can occur in response to triggers — like laughing when angry or crying when scared. Other people who don’t know that you or your loved one has PBA could misunderstand, or feelings can be hurt.

Some people living with PBA are aware of what’s happening but can’t control their emotional expressions and might feel embarrassed. Other people who have PBA have advanced dementia. They might not be fully aware of the symptoms and might not attempt to control them.

PBA episodes can happen at any time. They can last a few seconds to a few minutes.

Expressing misplaced emotions can negatively affect your relationships, work, and social lives. People may not understand why you’re laughing or crying. You may be embarrassed, making you withdraw from friends, family, and social situations.

These effects happen on top of symptoms you already have from the condition that caused PBA. 

What can you do?

PBA episodes are brief, and a few coping techniques can help you manage them. Sometimes, distraction works. Try to think about something unrelated to the situation.

Relaxation is another effective technique. When you start to laugh or cry, take slow, deep breaths to regain control. Relax your face, shoulders, and any other parts of your body that have tensed up.

If these techniques don’t work, talk with a doctor. Medications can treat PBA. Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta) is the only drug approved specifically for PBA. 

Selective serotonin reuptake inhibitor (SSRI) antidepressants such as citalopram (Celexa) and sertraline (Zoloft) also help some people with PBA. SSRIs won’t cure the condition but may improve the symptoms. 

Summary

PBA involves episodes of intense emotional expressions — laughter or crying — that don’t fit the situation and are out of your control. This condition affects people with brain disorders like stroke and traumatic brain injury, and it can have adverse effects on your relationships, work, and social life.

Relaxation and distraction can help you manage PBA symptoms. If those techniques don’t help, medications may help you control your emotions.

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  1. Nwabueze, C. (2023). Emotional incontinence: A case report of pseudobulbar affect in the setting of alcohol use disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10259877/
  2. Pseudobulbar affect (PSA). (n.d.) https://www.biausa.org/brain-injury/about-brain-injury/pba
  3. Pseudobulbar affect (PSA). (2023). https://mymsaa.org/ms-information/symptoms/pba/
  4. Pseudobulbar affect (PSA). (2018). https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke/pseudobulbar-affect
  5. Pseudobulbar affect (pathological laughing and crying). (2022). https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

Medical Reviewer: Heidi Moawad, M.D.
Last Review Date: 2023 Nov 16
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