Understanding Pseudobulbar Affect

Pseudobulbar affect, also known as PBA, is a condition that causes outbursts of sudden, uncontrolled laughter or crying that don’t match how a person feels or that is out of place in a given situation. Outbursts of laughter or crying can range in duration and severity and can occur up to several times a day. Other symptoms of PBA include inability to control laughing or crying, excessive laughing or crying when something is only mildly funny or sad and intrusion of thoughts that cause excessive laughing or crying.

PBA develops when damage is present in the area of the brain responsible for controlling what is considered to be normal expression of emotion. The damage can affect brain signaling system which causes involuntary crying or laughing. Damage occurs when there is a neurological condition or brain injury, making the condition common among people with ALS. For those with ALS and PBA, bouts of crying are more common than laughter. People with ALS can also have frontotemporal dementia (FTD), which is another condition common with diseases like ALS that cause neurological damage.

Learn more about frontotemporal dementia (FTD)

If an individual with ALS feels that their laughter or crying are extreme or don’t match what they feel they should track their symptoms by noting how often episodes occur and how long they last. A neurological exam administered by a doctor confirms a PBA diagnosis.

Due to involuntary over-expression caused by PBA, it can sometimes be confused with or misdiagnosed as a mood disorder such as depression or bipolar. Because PBA is neurological, it is different than an altered psychological emotional or mental state. It is possible for a person with ALS to have both PBA and a mood disorder because they are caused by different things and happen in different parts of the brain. Both are separate from each other and need to be managed differently.


It is not uncommon for people with PBA to feel embarrassed or feel a need to isolate themselves to avoid causing discomfort to others in situations where their outbursts might seem inappropriate. People with PBA might worry about causing confusion switching between laughing and crying, especially when it’s not cause by anything they feel. In addition to ALS, which is a disease that carries its own discomforts and struggles, this can be difficult to maintain. However, certain medications are available that can help reduce the frequency and severity of PBA episodes.

Take this quiz if you think you or someone you know might have PBA

It’s important for friends, families and caregivers to be understanding with someone with PBA, especially when it’s coupled with ALS. Here is a list of tips that people with ALS and caregivers can consider to make it easier:

  • Educate others so they can understand how it affects people in addition to ALS
  • If you feel a crying or laughing episode coming on, try focusing on something else and distract yourself
  • Try to relax yourself when you feel a PBA episode approaching
  • Show patience with yourself and others who are experiencing a PBA episode

These are recommendations and should not substitute advice from your doctor. If you think you or someone you know might have PBA, discuss options with your doctor and learn more from this website: https://www.pbainfo.org/

For more information on ALS and The ALS Association St. Louis Regional Chapter, visit www.alsa-stl.org.

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