Pseudobulbar affect (PBA) is a condition characterized by seemingly inappropriate display of emotion (or affect) by a person without an accompanying reason for the emotion. For example, a person may begin crying or laughing for no apparent reason. The persona experiences a significant disparity between their expression of emotion and their actual emotional experience.
PBA is normally seen as a symptom of a neurological condition. Conditions where PBA can be diagnosed include amyotrophic lateral sclerosis (ALS), Parkinson’s disease, multiple system atrophy, progressive supranuclear palsy, and multiple sclerosis (MS). PBA may also be a component of traumatic brain injury, Alzheimer’s disease and other dementias, stroke, and brain tumors.
People who experience PBA will often complain about extreme episodes of either crying or laughing in response to an emotional situation where such emotions may be appropriate, but expressed inappropriately. But in PBA, the emotional response is taken to an extreme, with outright crying (instead of just feeling tearful) or uncontrolled laughter when a chuckle would be more appropriate.
Some people may confuse pseudobulbar affect as a sign of a type of mental disorder, like schizophrenia, depression, or bipolar disorder. However, PBA is typically not considered a mental disorder, but a neurological impairment.
Specific Symptoms of Pseudobulbar Affect
PBA is diagnosed as a significant and noteworthy change from the patient’s previous emotional responses, with the following symptoms (Simmons et al, 2006; Poeck, 1969):
- The emotional response is situationally inappropriate.
- The person’s feelings and the emotional response are not closely related.
- The duration and severity of the episodes cannot be controlled by the person.
- Expression of the emotion does not lead to a feeling of relief.
Necessary elements of a PBA emotional episode:
- A significant change from previous emotional responses.
- Inconsistent with or disproportionate to mood.
- Not dependent on a stimulus, or are excessive relative to that stimulus.
- Causes significant distress or social/work/school impairment.
- Not better accounted for by another psychiatric or neurologic disorder.
- Not due to a drug or medication.
Causes and Prevalence of PBA
It is not known what causes PBA. It appears to be a brain condition involving complex neurological abnormalities in brain pathways and neurochemicals, specifically disruptions involving serotonin and glutamate. The National Institutes of Health notes that scientific reviews of the literature in this area find that PBA is associated with widespread anatomical and neurophysiological abnormalities (Ahmed & Simmons, 2013).
Prevalence rates of PBA vary widely, anywhere from 9.4 percent to 37.5 percent, depending upon the underlying neurological disease. Such rates suggest anywhere from 2 to 7 million Americans experience symptoms of pseudobulbar affect (Ahmed & Simmons, 2013). Pseudobulbar affect is not seen outside of an underlying neurological condition.
Treatment of PBA
Pseudobulbar affect is typically treated by medications, which help manage and keep the inappropriate displays of emotion under control for the person.
Antidepressant medications — such as tricyclic antidepressants (TCAs) or selective serotonin reductase inhibitors (SSRIs) — have typically been some of the most commonly prescribed drugs for treatment of PBA. The cough suppressant dextromethorphan has also been used as a potentially effective treatment. When such types of medications are prescribed, they are done so “off-label,” because they have not been specifically approved for the treatment of this condition.
More recently, the U.S. Food and Drug Administration approved Nuedexta in 2010 for the treatment of PBA, making it the first FDA-approved drug. The medication is a combination of dextromethorphan 20 mg and quinidine 10 mg.
PBA can be successfully treated once properly diagnosed by a physician experienced with pseudobulbar affect. If you’re concerned about PBA in yourself or a loved one, please seek out further assistance from your doctor.
Ahmed, A & Simmons, Z. (2013). Pseudobulbar affect: prevalence and management. Ther Clin Risk Manag. 2013; 9: 483–489. doi: 10.2147/TCRM.S53906
Cummings JL, Arciniegas DB, Brooks BR, et al. (2006). Defining and diagnosing involuntary emotional expression disorder. CNS Spectr. 11, 1–7.
National Institutes of Health. Pseudobulbar affect.
Poeck K. (1969). Pathophysiology of emotional disorders associated with brain damage. In: Vinken PJ, Bruyn GW, editors. Handbook of Clinical Neurology. Vol. 3. Amsterdam: North Holland Publishing; 343–367.