PseudoBulbar Affect (PBA) is a neurological condition which affects a surprising number of people. It can sometimes occur as a result of a brain injury or can be a side effect of another disease. PseudoBulbar Affect causes uncontrollable laughing and crying, which can come on suddenly, and can occur frequently.
A person suffering from PBA may laugh or cry even if they are not amused or sad. Sometimes, they do feel the emotion that they are displaying but not to the extent which they are showing it. This suffering is something that many caretakers or loved ones struggle with when it comes to people with PBA.
There are almost two million people in the United States alone that have been diagnosed as suffering from PBA and more than seven million people who have symptoms which are suggestive of the condition. PBA sufferers are often people who have had a traumatic brain injury, but they can also be people with Alzheimer’s disease, multiple sclerosis, ALS, Parkinson’s disease, or stroke victims.
The condition is characterized by exaggerated emotional expression. It means that people have complicated and hard to understand responses to things they see or experience. They struggle with excessive expression of emotions. They may appear incredibly happy even if they are not, and may seem depressed, yet they are glad. It is essential to understand this difference. PBA is a condition which is classed as being ‘neurologic.’ That is because it is caused by some damage to the central nervous system. In contrast, depression is a psychological condition which means that the cause is not damage, but an imbalance that alters the sufferer’s mental or emotional state.
Some people who have PBA are also depressed. The two are not linked, although the difficulties in coping with PBA can compound the impact of the depression. The two conditions should be managed as separate ones.
Coping with PBA
The impact of PBA is something that can be far-reaching. Usually, someone who has PBA will also be struggling with another neurologic condition, and this means that it can be even harder to cope with the difficulty of the situation at hand. It can be frustrating to have an episode of PBA in public. This frustration is caused because while the condition is a common one, it is not something that a lot of people are well educated about so having someone comfort you while you are crying may be frustrating if you are not actually sad. Having an episode of PBA which includes laughing may be embarrassing if it occurs at an inconvenient or inappropriate time.
Managing PBA starts with getting an accurate diagnosis. Not all episodes of laughing or crying are associated with PBA. Some people experience those symptoms for other reasons such as depression or PTSD, or even bipolar disorder. However, sometimes episodes that are associated with PBA go undiagnosed for a long time because it is assumed that they are related to something else.
If you, or someone that you take care of, is suffering from stress because they are crying or laughing unexplainably, or they are suffering from sudden outbursts of crying that are hard to explain, then talk to a doctor. Even if there is already a diagnosis of depression, raising the idea that they could be PBA is a useful starting point for a discussion.
It is hard to treat PBA, but educating the people that you spend the most time with will help to take some of the stress and frustration away. There are some other options, too. If you find that you are about to have an episode, then you might be able to stop it by forcing yourself to focus on something else. Some people find that sitting down (if they are standing) or walking around (if they are sitting) can help to control their frame of mind. Massaging any tense muscles and taking long, slow deep breaths can also help with managing an episode. You won’t be able to stop every attack, but even controlling the situation until you can make it to a private place could help to make the attacks feel less stressful, and keep things more manageable for you in the short term.