What Is Mood Lability?

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Mood lability is an intense or rapidly changing emotional response that is out of proportion to the situation at hand. It may be associated with dramatic changes in thoughts and behaviors. Mood lability is associated with various conditions, including borderline personality disorder, and pseudobulbar affect (PBA), which can occur due to neurological issues, such as after a stroke.

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What Is a Labile Mood?

While shifts in mood can be completely normal—triggered by stress, and/or part of dealing with a physical health condition—mood lability also can be a symptom of mental illness. 

Labile moods appear as rapid changes in emotions that don't seem to relate to external factors or seem to be inappropriate for the situation. A person who has labile moods often appears as though they do not have control over their emotions.

The variability of terms used to describe these symptoms and related conditions has created some confusion among people who suffer from it, as well as within the medical field. Some other terms used to describe mood lability include:

  • Involuntary emotional expression disorder
  • Affective instability
  • Emotional instability or dysregulation
  • Pseudobulbar affect (when referring to mood lability due to certain neurological disorders or brain injury)

Symptoms

The main symptoms of mood lability are sudden, exaggerated, unpredictable, or uncontrollable changes in moods and emotions. These are usually exaggerated or inappropriately intense emotional reactions.

Other symptoms of mood lability include:

  • Short emotional outbursts that don’t last for more than a few minutes
  • Mixed emotional states, such as laughing that turns into crying
  • Laughing or crying in situations that other people don’t find funny or sad
  • Emotional responses that are over-the-top for the situation
  • Emotional outbursts that are out of character

If you are unsure if you are suffering from labile mood, it’s a great idea to keep a daily journal to track your episodes and your mood in-between the episodes. This daily journal will give you an idea of how frequent, volatile, and extreme your emotional outbursts are.

Causes


Intense, rapid, and frequent shifts in mood are often seen in conditions such as:

  • Borderline personality disorder (BPD)
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • PBA

Mood lability in PBA is often associated with conditions affecting the brain and neurological system.

Conditions often associated with PBA include:

PBA is believed to develop when the neural pathways that control emotion are disrupted, leading to the loss of control over emotional responses.

What Is Pseudobulbar Affect?

Also known as pathological laughing, PBA causes random outbursts of laughing or crying. Many people who experience this condition start to avoid social situations and isolate themselves from others.

Diagnosis

While there’s no specific test for diagnosing mood lability, your doctor will ask you a series of questions about your medical history and moods to confirm the diagnosis. Your doctor will ask you about events associated with your symptoms, other accompanying symptoms, and the duration and level of intensity of your emotional outbursts.

Ruling Out Medical Conditions

Blood tests or imaging exams may sometimes be ordered to help rule out medical conditions that may be contributing to the symptoms.

You may also have a mental health evaluation, which will help your doctor identify a mental health disorder.

If you think you have PBA, talk to your doctor. PBA is often misdiagnosed as depression because some of the symptoms, such as crying episodes, are similar.

There are also two types of questionnaires that help physicians diagnose pseudobulbar affect:

  • The Pathological Laughing and Crying Scale (PLACS), in which the clinician interviews the patient.
  • The Center for Neurologic Study–lability scale (CNS–LS), which is a self-reporting questionnaire.

Treatment

If you have mild symptoms of mood lability and it doesn’t affect your daily life then you may not need medication. But if your mood swings are extremely volatile or if they reflect an underlying psychiatric condition, then you may benefit from medication, therapy, or a combination of both.  

Medications

Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta) is currently the only medication approved by the Food and Drug Administration (FDA) to specifically treat PBA. Clinical studies in people with neurological conditions found that it reduced the frequency of emotional outbursts by about half.

Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and atypical antipsychotics can help reduce the frequency and severity of labile mood episodes, and your doctor might prescribe one of these medical treatments for you.

Therapy

Engaging in psychotherapy (talk therapy) will help you learn how to manage your emotions and expressive urges in a healthy way. From learning new coping skills to better understanding your emotional triggers, you will be better prepared to handle aspects of your mood lability.

Coping

There are some coping mechanisms you can use to help ease your symptoms, and also help loved ones understand what you are going through:

  • Be open about your symptoms and your condition with loved ones and friends, so they aren’t surprised when you have an episode.
  • Take slow deep breaths when you feel you are about to have an episode.
  • If you feel like you are about to have an emotional outburst, try to distract yourself by counting nearby objects to focus your mind elsewhere.
  • Do a quick body relaxation exercise from head to toes when you are about to have an episode. 
  • Figure out what triggers your episodes, be it stress, fatigue, or frustration.
  • If you do have an episode, do not dwell on it or berate yourself for it. 

A Word From Verywell

If you or someone close to you is experiencing intense or rapidly changing emotional responses that are out of proportion to the situation at hand, speak with a healthcare provider. If you end up receiving a diagnosis of mood lability, you can work with a team of mental health professionals to help understand what is causing it and find ways to manage your moods.

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