Pseudobulbar Affect

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Overview

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.

Symptoms

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.

 

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