National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Pseudobulbar affect

Not a rare disease Not a rare disease
Other Names:
Involuntary emotional expression disorder ; Emotional lability; Pathological crying and laughing; Involuntary emotional expression disorder ; Emotional lability; Pathological crying and laughing; Emotional incontinence; PBA See More
Pseudobulbar affect (PBA) is a condition characterized by episodes of sudden, uncontrollable and inappropriate episodes of crying or laughing.[1][2] The condition can be embarrassing and disruptive to daily life.[2] It typically occurs in people with certain neurological conditions or injuries that affect the way the brain controls emotion.[2] It is common in stroke survivors and people with conditions such as dementia, multiple sclerosis, Lou Gehrig’s disease (ALS) and traumatic brain injury.[1] PBA is thought to affect more than one million people in the United States.[1] The goal of treatment is to reduce the severity and frequency of emotional outbursts. Treatment may include the use of antidepressants and/or a combination of dextromethorphan and quinidine.[3][2]
Last updated: 11/9/2016
The long-term outlook (prognosis) for people with pseudobulbar affect (PBA) may depend on the underlying cause of the condition and any associated condition(s) the affected person has. However, it can have various negative impacts on functioning.[4]

Depending on severity, the condition can be highly disruptive to everyday life, causing distress, embarrassment, social isolation and, in some cases, an inability to work.[5][6] Some individuals may become housebound or may be moved to supervised living.[4] Unfortunately, the burden of illness associated with PBA is not well characterized. Studies in populations with stroke, Parkinson disease, and other movement disorders have shown that patients with PBA or similarly described symptoms of inappropriate laughing and/or crying have a greater incidence of depression and decreased executive function, sexual function, and ability to perform activities of daily living compared with patients with the same underlying neurological disorder but without PBA symptoms.[7]

Treatment for PBA can reduce the severity and frequency of symptoms.[4][2] One study involving people with multiple sclerosis and ALS showed that people on medication for PBA had about half as many laughing and crying episodes as did those taking the placebo.[2]

We are not aware of information about whether symptoms of PBA progress, resolve, or remain consistent over time.
Last updated: 11/9/2016

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

  • ClinicalTrials.gov lists trials that are related to Pseudobulbar affect. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

    Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

Organizations Providing General Support

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

In-Depth Information

  • The National Multiple Sclerosis Society provides information about Pseudobulbar affect for health professionals.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Pseudobulbar affect. Click on the link to view a sample search on this topic.

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know.

  1. Pseudobulbar Affect. National Stroke Association. May 2013; http://www.stroke.org/site/PageServer?pagename=PBA.
  2. Pseudobulbar affect. Mayo Clinic. April 1, 2016; http://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/home/ovc-20198592.
  3. Multiple Sclerosis: Hope Through Research - Inappropriate laughing or crying. National Institute of Neurological Disorders and Stroke (NINDS). December 30, 2013; http://www.ninds.nih.gov/disorders/multiple_sclerosis/detail_multiple_sclerosis.htm#240313215.
  4. Perotti LP, Cummings LD, Mercado J. Behavioral Treatment of Pseudobulbar Affect: A Case Report. Perspect Psychiatr Care. April, 2016; 52(2):82-87.
  5. Hammond FM et al. PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury. BMC Neurol. June 9, 2016;
  6. Li Z, Luo S, Ou J, Huang R, Wang Y. Persistent pseudobulbar affect secondary to acute disseminated encephalomyelitis. Socioaffect Neurosci Psychol. March 18, 2015; eCollection 2015:
  7. Colamonico J, Formella A, Bradley W. Pseudobulbar affect: burden of illness in the USA. Adv Ther. September, 2012; 29(9):775-798.