Understanding the Pseudobulbar Affect: Causes, Diagnosis, and Coping Strategies

Understanding the Pseudobulbar Affect: Causes, Diagnosis, and Coping Strategies


The pseudobulbar effect is a neurological condition where a person experiences sudden, involuntary, and uncontrollable episodes of laughing or crying. Around the globe and in our country, there has been a significant prevalence of causes related to post strokes depression, and anxiety. Globally, the pseudobulbar affect (PBA) cases ranged from 11% to 34%. Few cases of this effect have been reported. Since the main cause of PBA is still unknown, therefore, many clinicians have misdiagnosed it. Hence, people can mistake PBA for depression, which results in the overlapping of symptoms. This confusion happens as people with PBA can have depressive disorders or other depressive episodes. According to research, 30% to 35% of people with PBA have depression. Of people who talk about PBA episodes, around 40% of patients receive a diagnosis of this effect and only half or less get proper treatment. In this article, we will learn more about the pseudobulbar affect.

Also Read: Psychology Behind Emotional Regulation and Dysregulation


It is important to know the symptoms of PBA as people can mix this effect with mood.
The symptoms include:

  • Difficulty in controlling your emotions
  • Agitation
  • Anxiety
  • Reduction in social interaction
  • Emotional flatness
  • Irritation

Other than these symptoms that are listed above, There are other symptoms of it. As we know laughter and crying are human emotions, but when these emotions start disconnecting you from social context, then it can raise a concern. Patients with this emotional incontinence are unable to handle their laughter and crying like showing these emotions at an inappropriate time or laughing while having a serious conversation.

These inconsistencies in emotions can reduce their social interactions and make them live in isolation. It happens due to their unpredictable nature and face difficulty while expressing their emotions to others.

Also Read: The Psychology Behind Crying: Understanding the Emotional Tears

As the episodes of PBA are sudden and uncontrollable, it can make patients embarrassed. The duration of these episodes could be a few seconds or hours. Moreover, these episodes can happen in response to other emotions, which include sadness, anger, happiness, joyfulness, etc.
Additionally, the patient with PBA also faces physical symptoms like headache and difficulty in breathing.

Causes And Risk Factors

The root cause of the Pseudobulbar affect is still not known and can be understood as the disorganization caused in the neurological pathways of the brain and hence not being able to regulate emotions effectively. The neurological conditions that can happen are stroke, dementia, brain injury, brain tumors, and Multiple sclerosis (MS). Etc.

Our brain is the primary reason behind all the emotions we express and feel, therefore it is important to understand what part of the brain affects PBD. The prefrontal cortex is known to be a part of the brain that regulates emotions and is associated with PBA through the prefrontal cortex and amygdala. Whenever the functional connectivity between them is changed or altered, they disturb the regulation of emotions.

This effect can be seen in people with Amyotrophic lateral sclerosis (ALS) and the one having bulbar onset form as it affects the muscles around the jaw and throat. When you look at the Brain MRI scans of individuals with ALS, there has been an alteration in the frontal area of the brain that includes fronto-tempo-parietal-cerebellar circuits, which causes disruption in expressing your emotions.

This affect become more common among people with dementia and Multiple sclerosis (MS) but it can affect anyone who has neurological conditions. It is important to note that pseudobulbar affect is not a mental health issue. Moreover, this condition can happen to anyone both men and women are equally at risk of developing this neurological condition.

Diagnosis and Testing

As for diagnosing any issues, symptoms play a crucial role in establishing the idea about the problem related to our physical and mental well-being. In the case of pseudobulbar effects, this diagnosis of symptoms becomes difficult as it is the same symptoms found in depression and anxiety. Whenever diagnosing the PBA it is important to look for the frequency and intensity of the laughing and crying episodes. Other symptoms may also be present like lack of emotion, and apathy. Apart from the frequency and intensity of these episodes, another important symptom to consider is how socially active the patient is. Patients with PBA may have difficulty in building social relationships with others.

Moreover, it is also important to consider the medical history of the person with pseudobulbar affect. If the patient has a history of stroke or traumatic brain injury, then he is likely to develop this neurological condition.

Also Read: Is Your Relationship Emotionally Rich?

Treatment Options


Medication is one of the ways to treat pseudobulbar affect. As there is, no solid cure for these affect medications can help in certain ways to manage these uncontrollable laughing or crying episodes. Antidepressants like Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are prescribed for patients of PBA. Other antidepressants like Tricyclic antidepressants work to block serotonin reuptake and monoamine oxidase inhibitors (MAOIs) help to inhibit the breakdown of serotonin. Nuedexta® (dextromethorphan hydrobromide and quinidine sulfate) is a medication approved by the FDI for the treatment of PBA.

Cognitive Behavioural Therapy:

Another treatment for pseudobulbar affect is cognitive behavioral therapy. These therapies help to change your thought process toward positivity and introduce behaviors to improve emotional well-being. Cognitive behavioral therapies are because our thoughts and feelings make our behavior toward others. Therefore, in the treatment of this effect, these therapies, identify the negative thoughts that may cause episodes of uncontrollable laughing or crying. Based on the analysis, they work more on adaptive thoughts, which helps to manage these emotions.

Coping strategies

Identifying Triggers:

By adopting coping strategies, one can manage the pseudobulbar effect in a manageable way. One of the ways to manage it is by identifying the triggers. In order to identify these triggers, you should keep track of the environment you are living in, and any thoughts or emotions contributing to the development of those episodes. Moreover, having a conversation with your loved ones and family can also help to better understand your triggers. When these triggers get identified, it would be easy for you to use coping strategies against them.

Also Read: Are You Emotionally Weak?

Relaxation, Deep Breathing:

Relaxation and deep breathing techniques play a significant role as coping strategies against pseudobulbar affect. By relaxation, patients can reduce the intensity of the uncontrollable episodes in an efficient manner and hence help them to manage their emotions effectively. Moreover, deep breathing slows down the heart rate and reduces the physical symptoms linked to PBA. Furthermore, these techniques can make your mind filled with positivity. This can be done by shifting your mind to activities like walking or listening to calming music. It also reduces the frustration and anger feeling in one’s mind.

  • https://my.clevelandclinic.org/health/diseases/17928-pseudobulbar-affect-pba
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849173/
  • https://mymsaa.org/ms-information/symptoms/pba/
  • https://www.researchgate.net/publication/372690668_Mental_health_disorders_post-stroke_a_scenario_in_India
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9312808/
  • https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect
  • https://alsnewstoday.com/pseudobulbar-affect-als/#:~:text=Pseudobulbar%20affect%20(PBA)%20is%20thought,control%20the%20expression%20of%20emotions.
  • https://pubmed.ncbi.nlm.nih.gov/26415311/

Leave feedback about this

  • Rating