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 is often associated with dramatic changes in opinions and behaviors. Mood lability is seen or reported in various conditions, including:

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What Is a Labile Mood?

A person with labile mood shows rapid changes in their emotions that don't seem to relate to any outside situations or seem to be inappropriate for the situation. A person with a labile mood often appears as though they do not have control over their emotions.

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. 

The variability of terms used to describe this condition 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
  • Emotional instability or dysregulation
  • Pseudobulbar affect (when referring to mood lability in neurological disorders or brain injury)

Symptoms

The main symptoms of mood lability are uncontrollable outbursts of emotions. These outbursts are usually an exaggerated or inappropriately intense emotional reaction.

Other symptoms of mood lability include:

  • Short emotional outbursts that don’t last for more than a few minutes.
  • Mixed emotional outbursts, 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 journal of your episodes, and your mood between episodes. This daily journal will give you an idea of how volatile and extreme your emotional outbursts are.

Causes

A common cause of mood lability is associated with conditions affecting the brain and neurological system. When mood lability is related to a neurological disorder, it is called pseudobulbar affect (PBA) and develops when the neural pathways that control emotion are disrupted, leading to the loss of control over emotional responses.

Conditions often associated with PBA include:

When characterizing and diagnosing mental health disorders, the intense, rapid, and frequent shifts in mood—sometimes referred to as mood lability—is often seen in conditions such as:

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

What Is Pseudobulbar Affect?

Also known as laughing disorder, pseudobulbar affect (PBA) is a condition that 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.

Ruling Out Medical Conditions

For a mental health condition, blood tests or imaging exams won't help but may sometimes be ordered to help rule out medical conditions that may be contributing to the symptoms.

A psychological evaluation is likely to be recommended, which allows for you to openly discuss with your doctor some of the events that have led to you experiencing these symptoms as well as the duration and level of intensity of those emotional outbursts.

This collective information can help medical providers and mental health professionals gain an understanding of your treatment needs and provide you with an appropriate level of care.

If you think you have PBA, talk to your doctor. If you have a neurological condition, you might already be treated by a doctor who can diagnose PBA. 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.

To accurately diagnose PBA, other causes must also be ruled out. PBA can be missed by doctors because they attribute the crying episodes to depression.

Treatment

If you have a mild case of mood lability and it doesn’t affect your daily life then you won’t need medication. But if your mood swings are extremely volatile, then you can try 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 mood lability. 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), can help reduce the frequency and severity of labile mood episodes. Antidepressants for the treatment of labile mood are typically prescribed at doses lower than are those used to treat clinical depression.

Therapy

Engaging in psychotherapy (talk therapy) will help you learn how to manage your emotions and urges in a healthy way. From learning new coping skills to better understanding your emotional triggers, you will be prepared to handle all 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—you have no control over 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 manage your moods and understand any contributing factors that may need to be addressed.

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Article Sources
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