How to Treat and Manage a Laughing Disorder

Laughing disorder, also known as pseudobulbar affect (PBA), is a condition that causes random outbursts of laughing or crying. This can be disrupting and embarrassing for both the individuals with it and their families. Many people who experience this condition start to avoid social situations and isolate themselves from others.

Finding ways to cope and manage PBA symptoms could help to relieve the strain on mental health caused by this condition.

What Is Pseudobulbar Affect (PBA)?

PBA is uncontrolled crying or laughing that is above the expected response to the emotion felt or situation. The feeling experienced internally is significantly less than the level expressed outwardly and is difficult to control. The expressed emotion of laughter or crying could also be the opposite of the feeling, such as laughter during a sad situation. The symptoms are out of the individual’s control and are difficult or impossible to consciously stop.

PBA is underdiagnosed because the symptoms are typically under-reported. When symptoms are reported it can often be misdiagnosed for other mood disorders, like bipolar disorder or depression. 

It can be confusing because there are many names given to uncontrollable emotions such as involuntary emotional expression disorder, emotional lability, pathological laughter and crying, and emotional dysregulation.

Who Is at Risk?

The exact cause of PBA is still unknown; it has been associated with conditions affecting the brain and neurological system. It 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:

• Dementia and Alzheimer's disease
• Lou Gehrig's disease or Amyotrophic Lateral Sclerosis (ALS)
• Multiple sclerosis (MS)
• Epilepsy or seizure disorders 
• Parkinson’s Disease
• Traumatic brain injuries
• Stroke

Diagnosis

PBA is diagnosed by neurological evaluations by your healthcare provider or with the use of standardized questionnaires.

During the evaluation by your healthcare provider, they will ask questions about your symptoms to assess the emotional response to your emotions felt and appropriateness for the situation the symptoms happened in. They will also review any medications you are taking and your medical history for possible causes of the symptoms.

Two of the standardized questionnaires used to diagnose PBA are:

• The Pathological Laughter and Crying Scale
• The Center for Neurological Study-Lability Scale

Treatment

PBA is managed primarily with the use of medications, like antidepressants or combined medications. The goal of treatment is to reduce the frequency and severity of emotional outbursts.

Treatment of PBA typically includes drugs used for other mood disorders like depression. Trycyclic antidepressants and selective-serotonin reuptake inhibitors are commonly used in smaller doses than what is used for treating depression.

In 2010, the Food and Drug Administration (FDA) approved medication specifically designed to treat PBA called Neudexta, which is a combination of dextromethorphan and quinidine. Since then, Neudexta has become the primary treatment for PBA. 

Emotional and Psychological Impact

PBA increases stress and anxiety for people, family members, and caregivers because of concerns about an emotional outburst and how people would react to it. It affects mental, social, and emotional health.

It can be very difficult for other people to understand PBA and there can be a fear of other people’s reactions to inappropriate expressions. Many people who have PBA feel the need to avoid social situations and the activities that they used to enjoy because they don't want to feel the embarrassment if they suddenly have an emotional outburst.

Related Issues

While mental health conditions—like anxiety and depression—have not been associated with the development of PBA, people who have it may develop these conditions because of increased stressors. People with PBA and their family members can experience increased anxiety and stress about the condition.

There can be a concern that an involuntary emotional expression will happen during an inappropriate moment causing embarrassment and discomfort. This added stress causes some people to avoid social contact and going out to do their favorite activities, contributing to the development of an anxiety disorder or depression. 

Coping

With treatment, the number of emotional outbursts can be reduced. This helps people to feel more comfortable going out for social events. Because PBA often occurs in individuals with other conditions that disrupt the neurological system, the treatment of PBA is different for everyone.

There are no cures for PBA and medications don’t guarantee emotional outbursts will be completely stopped. The condition is manageable and coping strategies can be used to help reduce anxiety and stress about laughing disorder. Coping strategies include:

• Discuss your condition with family, friends, co-workers, people you see often, or people you are by at a social event. This can help them understand your condition and help you feel less embarrassed if you do experience symptoms.
• If you found that a specific location or event is a common trigger, you could avoid that situation or find a different way to participate in that event.
• Try to distract yourself by changing to a different conversation topic, changing locations, or focusing on something in your environment to distract your mind from your symptoms.
• Try taking slow, deep breaths to help relax your body and mind.
• If possible, try changing the position of your body.

A Word From Verywell

PBA is an underdiagnosed condition that can cause great discomfort for people diagnosed with it and to their family members. Open communication about the condition can help to reduce some of the anxiety and stress about having these outbursts because it helps to empower patients and other people to understand the symptoms.

PBA can take a toll on an individual’s mental health. Taking medications prescribed by a healthcare provider and knowing strategies to help cope with an outbreak can help to reduce the frequency and severity of symptoms. This helps people feel more comfortable participating in the hobbies and social activities that they enjoy with less anxiety and stress.

If you ever are experiencing an unexplained emotional response that seems disproportionate to the actual event or the emotion that you experienced be sure to discuss this with your healthcare provider to help you better manage your symptoms.