Uncontrollable crying in adults

6 Signs Your Uncontrolled Crying Is Pseudobulbar Affect, Not Depression

Because undiagnosed or misdiagnosed PBA can mean that you’re not receiving the treatment that you need to manage the condition’s symptoms, it’s vital that you and your care team understand what makes it different from mood disorders such as depression. In addition, because people with PBA often experience depression along with PBA, they may need to be treated for both conditions.

The Problem of Missed or Undiagnosed PBA

The July 2011 issue of the journal Advances in Therapy included the results of a survey of people with a history of Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s disease, stroke, or traumatic brain injury — six of the most common conditions associated with PBA.

The survey found that while three-quarters of the respondents had reported episodes of inappropriate laughing or crying to their doctors, none of them were diagnosed with PBA. Instead, roughly one-third of them were given a diagnosis of depression, and 13 percent were said to have bipolar disorder.

Worse, because of this misdiagnosis of PBA, only 52 percent of respondents with the condition were receiving appropriate treatment at the time of the survey.

Because proper treatment can reduce the frequency and severity of PBA episodes, if people who have the condition are not diagnosed or are misdiagnosed, that can have a significant impact on their quality of life.

The Difference Between Depression and PBA

PBA is most commonly confused with depression, so it’s important to distinguish the two.

Depression is often described as a persistent feeling of sadness that affects how you feel, think, and behave. The condition may interfere with normal day-to-day activities, and may leave you feeling that life isn’t worth living.

Symptoms of depression may include:

  • Sadness, tearfulness, emptiness, or hopelessness
  • Angry outbursts, irritability, or frustration
  • Disinterest in most or all normal activities, such as sex or hobbies
  • Insomnia or excessive sleep
  • Fatigue and/or lack of energy
  • Changes in appetite and weight gain or loss
  • Anxiety, agitation, or restlessness
  • Feelings of worthlessness or guilt
  • Difficulty concentrating or making decisions
  • Memory loss
  • Suicidal thoughts
  • Unexplained pain or headaches

If you have PBA, however, you typically experience emotions normally, although you may have unexplained outbursts of laughter and/or crying at inappropriate times. These episodes may be frequent, involuntary, and uncontrollable, and they may seem exaggerated and disconnected from your emotional state at the time.

Research suggests that unexplained crying is more common in PBA than laughter, which is why the condition is commonly misdiagnosed as depression. But PBA episodes tend to be short in duration, while the symptoms of depression are typically more chronic or persistent.

Also, if you have PBA, you may not experience the sleep disturbances and change in appetite that are commonly associated with depression.

Says Dr. Zorowitz, “People with PBA will tell us, ‘I’m really not depressed, but I cry frequently nonetheless.’”

Finally, because PBA is most often related to an underlying neurological condition, such as Alzheimer’s, ALS, or MS, a full neurological exam is usually required for diagnosis. A primary care physician, on the other hand, can often accurately diagnose depression.

“When the emotional display of crying occurs, it’s quite possible to think that the patient may be suffering from depression rather than PBA, unless a thorough evaluation is conducted to distinguish the two different syndromes,” explains Edward Lauterbach, MD, a neuropsychiatrist and professor emeritus of psychiatry and neurology at Mercer University School of Medicine in Macon, Georgia, who has specialized in treating people with these conditions]. “Statistically, depression is far more common than PBA, hence a reflexive tendency on the part of doctors to assume that the emotional display is due to depression. Still, if you have a known or suspected brain disease, PBA should be excluded first as a potential diagnosis.”

According to Zorowitz, these are some signs you may have PBA rather than depression:

  1. You’ve experienced uncontrollable laughing in addition to crying.
  2. You can’t control the crying episodes. People with depression can control their episodes of crying, at least to an extent, and “can modulate intensity and duration,” Dr. Lauterbach says, whereas in PBA, crying can’t be modulated and “tends to be of similar or identical intensity and duration from episode to episode.”
  3. You have a neurological condition like MS, Parkinson’s disease, ALS, Alzheimer’s disease, stroke, or brain injury.
  4. You’ve had outbursts of laughing and/or crying at inappropriate times and places (that last no more than a few minutes).
  5. Your emotional outbursts are short (lasting just a few minutes).
  6. You haven’t experienced changes in appetite, weight, or sleep, or other symptoms related to depression.

Depression and PBA Together

Complicating the problem is research that suggests that depression is common among those who have PBA. A review published in November 2013 in Therapeutics and Clinical Risk Management suggests that as many as 35 percent of people with PBA are depressed.

This may be related to the feelings of embarrassment people with PBA have after an episode and their tendency to avoid social situations to keep others from seeing their outbursts—or because they’re dealing with depression simultaneously for reasons other than PBA.

So even if you’ve been diagnosed with PBA, it’s vital to talk to your doctor if you experience any symptoms of depression.

“PBA is always caused by a neurological condition, whereas depression can certainly develop in the context of a neurological condition — but it’s not requisite and is usually absent,” Lauterbach says. “Of course, some neurological patients have both PBA and depression, and both should be properly diagnosed and treated.”

Why Am I Crying For No Reason?

By Sarah Fader

Updated December 02, 2019

Reviewer Rashonda Douthit , LCSW

Crying For No Reason Could Be a Warning Sign of Something More Serious Find Out How To Cope With A Licensed Therapist Today

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When you burst into tears out of nowhere, and you can’t figure out why it can be alarming. You’re full of emotion, and you can’t seem to put your finger on why you’re so upset. Rest assured there is an answer, and you will find it.

I’m Crying, and I Don’t Understand Why

Tears are streaming down your face, and you can’t understand where they came from. Being overcome with emotion can make you feel out of control. If you know why you were having these feelings, it might be easier to cope with, but without a context for these feelings, you might feel frightened. What if you can’t determine the source of your pain. Remember that life is overwhelming and painful at times, and no matter what the reason is, you have a right to be sad. (Some people cry even when there’s nothing “wrong.”) Maybe you’ve had a bad day, perhaps you’re coping with a breakup, or it could be that you’re dealing with something more severe, like clinical depression. The good news is you’re in touch with your feelings and that matters. You can determine the source of your pain by looking inward and being honest about what’s going on. But how can you do that best?

According to the American Psychological Association, women appear to cry much more than men. According to a study conducted by the APA, It’s estimated that women cry 30 to 64 times a year as opposed to me who cry five to 17 times a year. Part of this has to do with the fact that women are encouraged to express their emotions and men are told by society to suppress sadness. The reality is that we all get sad from time to time and crying is normal and healthy. Regardless of your gender, if you find that you’re crying and you can’t put your finger on the reason, there’s nothing wrong with you, you’re human.

Physical Conditions

There are some medical conditions that can be taxing on your emotions, and affect your levels of hormones or other chemicals in the body. Some of these include:

  • Thyroid disorder
  • Vitamin deficiency
  • Hypoglycemia (low blood sugar)
  • Stroke
  • ALS
  • MS
  • Parkinson’s disease
  • Pseudobulbar affect (PBA)

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If you’re living with one of these conditions, it’s important to be monitored by a doctor and let your provider know what’s happening with you mentally and physically. If think you may have one of the above diagnoses, see your doctor and get evaluated as soon as possible.

Stress

Chronic stress can cause a variety of issues and affect your overall physical and emotional health. Some of the physical symptoms of stress include headaches, tension, nausea, and crying episodes. Everyone has stress in their lives, but it can affect people in different ways. Sometimes your body may surprise you with a crying episode out of nowhere. The best way to deal with this is to find the source of your stress, less ir or eliminate it, if possible. Sometimes it’s not possible to eradicate the source of your stress. For example, if you’re feeling stressed at work you can’t just quit your job without notice. But you can find healthy ways to relieve and manage stress such as exercise, yoga, or therapy.

Fatigue

When your body is tired, it can be hard to function at 100 percent. Fatigue, like stress, is part of everyone’s life at times. We need sleep to stay healthy, and if we do not get enough rest, our bodies react. Lack of sleep, forgetfulness and increased irritability can all be signs of fatigue. Fatigue can also occur because the body is exerting vast amounts of energy when you’re anxious. Here’s how stress and fatigue are related: when you feel stressed, you may have a hard time falling or staying asleep. If you don’t get enough sleep, you wake up not feeling groggy. Subsequently, you’re now under more stress as you go on with the demands of your day, which makes you tired. There are studies that indicate that a minimum of five hours of sleep each night is needed for most people in order to avoid potential crying episodes and negative mood changes. To prevent chronic episodes of crying, it’s essential to make sure you ideally get at least seven hours of sleep every day. If you’re having trouble sleeping, talk to your doctor about it. It may be a symptom of an underlying illness; mental or physical or possibly both.

Anxiety

Everyone worries, but anxiety is different than that. When you’re anxious, you can’t shut your brain off. You’re chronically worried, and sometimes afraid of the worst happening. Everyone gets anxious sometimes, but when it becomes excessive and begins to interfere with your day to day life, that’s a problem. Many people do not realize that anxiety also comes with physical symptoms. There are bodily signs of anxiety that can occur even when you don’t think you have a reason to be anxious. And there can be lasting physical effects of anxiety on your overall health. Similar to stress, anxiety affects our bodies in different ways and crying may be one of them. When you’re anxious these physical symptoms can manifest. Some of the other symptoms of anxiety may include:

  • Increased heart rate
  • Rapid breathing
  • Shaking or trembling
  • Weakness or fatigue
  • A headache
  • Nausea
  • Difficulty concentrating
  • Nervousness

Depression

One of the most common reasons for crying is depression. People who suffer from depression have feelings of hopelessness and sadness that persist. Depression may be situational and temporary, specific to an incident or scenario. Life events that sometimes lead to situational depression may include:

  • Illness
  • Death
  • Relationship problems
  • Situational changes such as moving, going away to school or retiring
  • Financial problems or job loss

Crying For No Reason Could Be a Warning Sign of Something More Serious Find Out How To Cope With A Licensed Therapist Today

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Depression can be severe when it’s clinical depression or major depressive disorder. People who suffer from clinical depression may feel emotionally numb and empty. They also tend to lose interest in activities they once enjoyed. Mental health professionals refer to this as “anhedonia”. Some of the other symptoms of clinical depression besides crying include:

  • Sadness that lasts for longer than two weeks
  • Extreme fatigue
  • Changes in appetite (eating less or more)
  • Changes in sleep (insomnia or sleeping too much)
  • Inability to concentrate
  • Lack of interest in favorite activities
  • Feelings of hopelessness or worthlessness
  • Difficulty in making decisions
  • Weight gain or loss
  • Suicidal feelings

The way you deal with stress can be largely affected by your previous life experience. People who have stressful childhoods, existing mental health issues, and several challenging circumstances at one time are at higher risk of depression. Biological factors (for example, if someone in your family has experienced depression) can also increase the likelihood of depression. Unfortunately, only approximately half of the people who are depressed ever seek treatment.

Although only a licensed mental health professional can give you the official diagnosis, you can take an online depression quiz. Please keep in mind: while online quizzes and advice can be helpful, they are not a subsitute for talking with a licensenced therapist. They can be a conversation opener for discussing your mental health with a professional. However, quizzes should never be used to replace professional diagnosis or mental health treatment. If you have symptoms of depression, consult a professional.

If you’re experiencing stress, anxiety or depression, it’s crucial to know that you can get help. Cognitive behavioral therapy (CBT) is a common type of psychotherapy used to treat depression and anxiety, CBT is a way of training yourself to identify problematic negative thoughts, evaluate them, and if needed, replace them with more rational, helpful thoughts. You can also learn how to manage your feelings, stop worrisome thoughts from circling in your mind, and overcome your fears.

If you believe you may be suffering from anxiety or depression, call your physician or a therapist. You don’t have to suffer alone. There are online therapists at BetterHelp that can talk to you about feeling depressed either through chatting online or on the phone. Alternatively, you can find you a therapist near you if you want to see someone in person. However, some people don’t have time to sit in traffic or drive to an appointment during the work day; that’s where BetterHelp comes in. You can access BetterHelp from the comfort and privacy of your own home (or wherever you have an internet connection). Read below for some reviews of BetterHelp counselors, from people experiencing similar issues.

Counselor Reviews

“I’ve only met with Tonya once so far, but what really stood out to me was the fact that she gave me a safe space to just cry. And that meant everything to me!!! She gave me a different perspective on a few issues I was struggling with, which allowed me to see myself and the situations in a different light. I plan on continuing to see her for as long as I can. Thanks Tonya!!”

“I put off finding a therapist for a long time. I dreaded my first conversation with Neil and all the awkward, clunky explanations I’d have to give about my depression and anxiety. All of the things that felt like dirty little secrets that caused me so much pain. But I was so pleasantly surprised by the way Neil accurately picked up on what I was saying and gave me more insight into how my brain was working. It made my issue feel so much less of a personal problem and more of a universal problem we could examine together. He always gives me a thoughtful response within a day or two any time I send a message. I actually think we’ve made more progress in between sessions just by being able to communicate things that are coming up in real time. Neil is intelligent and kind. I really appreciate his communication style and highly recommend him.”

Conclusion

Life can be challenging, and if you’re emotionally overwhelmed and having bouts of tears, it’s okay to reach out for help. Crying isn’t a sign that there’s something wrong with you, but knowing the source of your pain can help you heal. Take the first step today.

I cry every day, or almost. Not because I’m sad (I’m not) or because I need attention (I do, but not like that) or because I need to assemble and reassemble my feelings in the kind of interlude that a really good cry provides. Most of the time, I am crying because of some small daily thing that happened, often something nice.

Occasionally, a friend (usually a guy) will e-mail or text to ask if I’m “okay” because I’ve posted something on Twitter about crying. This is always confusing to me, because of course I’m okay. I’m great. Most of the time, I stop and start within a minute. I come out of it with a feeling like I’ve been absorbed by and into the world.

I recently saw a Twitter post about an Elle article by writer Marisa Meltzer, who says she can’t cry. After noting that women cry two to ten times more than men do, Meltzer observed that crying is having “a bit of a feminist moment,” and that the atmosphere of shame around crying might be changing. “Crying a lot is like my SOURCE of power and happiness and achievement, duh,” I tweeted back, adding, for emphasis, a tear-shaped diamond emoji.

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Crying is confrontational, says Dr. Robert R. Provine, a neuroscientist, professor of psychology at the University of Maryland, Baltimore County and the author of Curious Behavior: Yawning, Laughing, Hiccupping, and Beyond. He says that someone else’s crying “is appealing to you to provide caregiving, and at least sympathy,” which can be emotionally tiring, if not exhausting. “Dealing with crying people can be ‘expensive’ in the sense that they have needs that you’ll be expected to meet,” says Provine.

I do think crying is inappropriate at work. It’s inefficient (not unlike talking endlessly about a home reno) and involves people outside of your emotional sphere. “Feelings” are inexorable from our professional selves, but expressing them should involve some sense of reverence. Yelling is inappropriate, too, but happens all the time (and is often accepted as impassioned behaviour). Same with passive-aggression, which is wildly emotional and so often done by the same people who find others’ tears embarrassing.

Provine says he’s not aware of anything “bad” happening if tears are repressed, and the common idea of crying making a person feel better is “complicated.” “Some people may report it feeling good, but the evidence about that is unclear,” says Provine.

I don’t know that I feel better when I cry, but I cry when I feel good. I cry when I’m with a couple of good friends, in high-speed conversation, with the friendship so perfectly realized, our conversations so fulfilling. I cried when I listened to an interview with an actor I like, who became successful late in life, because I’m proud of him. Dogs, kids, movies, art, music, feeling grateful, excited, whatever.

Being sensitive is considered a liability, even more so for men, who are socialized to only cry when high emotionality is part of their masculine performances: Winning a championship; welcoming a child; making a public apology. I, though, feel like being empathetic is the best thing about me.

I notice things and feel things that other people just don’t, or don’t want to. It’s an all-human super-power, one that I want to cultivate and use.

Dr. Provine explained that what I refer to as “crying” is actually either “emotional tearing” which he says is what most people would call weeping, or “vocal crying,” which is “like the boo-hoos.” (I do sometimes cry sad and hard: Probably the same amount, and for the same reasons, as non-daily criers.) Both emotional tearing and vocal crying are considered “honest signals,” because tears are hard to fake.

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It’s this honesty, or authenticity, that will do the most to destigmatize tears, as an excessive display or as weakness. Nothing could be more appealing, right now, than moments unmediated by immersive tech or the social conventions that feel increasingly redundant. Nothing feels better than crying and having it be just fine.

Wet face. Red eyes. Smudged mascara. It’s pretty easy to tell when someone’s been crying.

What’s not so clear? Why your body thinks sending salty liquid out of your eyes is an appropriate response to hearing that song that always reminds you of your ex. Does the world really need to know that you get that bent out of shape over Ed Sheeran?

Turns out, what happens when you cry is the result of an interesting chain reaction in your body. And once the process is triggered, it’s pretty hard to close the floodgates. Here’s a look at what goes on in your body when you cry—and the weird reason why you’ll probably feel better after your sobfest is over.

You feel an intense emotion—and the signals in your brain start flying.

Maybe you just got some really crappy news. Or your boss just dumped a ton of extra work on your plate, and you’re super overwhelmed. Or you just met your adorable baby niece for the first time.

Hardcore emotions like sadness, anger, stress, and even extreme happiness are processed in your body as a sign of danger, as if you were being chased by a bad guy or are about to be eaten by a bear. In the face of intense circumstances, the amygdala, an area of the brain that controls emotional processing, sends a signal to the hypothalamus—a pea-sized gland in your brain that’s connected to your autonomic nervous system, explains Ray Chan, M.D., an ophthalmologist at Texas Health Arlington Memorial Hospital. The autonomic nervous system handles functions that you don’t have any control over, like body temperature, hunger, thirst, and yup—crying.

Your heart starts to race, and you feel that lump in your throat.

The autonomic nervous system jump-starts the sympathetic nervous system and accelerates the fight-or-flight response. To help you prepare for impending doom, the fight-or-flight response tries to stop you from performing any nonessential functions, like eating or drinking. As a result, it causes your glottis—the opening between the vocal chords in your throat—to swell up, making your throat feel full and tight. “The body is trying to protect you so you don’t accidentally get any in your lungs,” says Patricia Salber, M.D., founder of The Doctor Weighs In.

With your fight-or-flight system fully alerted, you might also experience other symptoms normally associated with sheer terror. Your heart rate might increase, your lips start to quiver, and your voice gets shaky.

Then the waterworks begin to flow.

All this emotion tells your hypothalamus to produce the chemical messenger acetylcholine. Acetylcholine binds to receptors in your brain that send signals to the lachrymal glands—small glands that live beneath the bony rim of your eyes, explains Dr. Chan.

When these glands are stimulated, they start to produce tears. If you only shed a few, they might drain back into your punctums—the tiny tear duct openings at the inner corners of your eyes. But that reservoir fills up pretty quickly. And when it does, the tears will start to drip out of your eyes and stream down your face, Dr. Salber says. The tears will also start to flood your nasal cavity and come out of your nose.

Experts don’t completely know why intense emotions make us cry. But they have plenty of theories. Some evolutionary psychologists think that crying is used to send a signal to others that we’re in pain and need help. “Emotional tears have more protein, and there’s speculation that the protein makes the tears thicker, so they’re more likely to hang onto your cheek and send a signal of visual distress,” Dr. Salber says.

Brian Alexander writes:

The student naval aviator was flying in formation — a high pressure maneuver anytime, but especially when you’re still trying to make the grade — when he suddenly started laughing. Hysterically laughing. Laughing so hard he endangered the flight.

This wasn’t the first time the man had broken out in uncontrollable laughter at a seemingly strange moment. In fact, the young pilot had been waking up other members of his household in the middle of night as he, sound asleep, broke out in peals of laughter.

As it turned out, the pilot, who showed no other symptoms when he was documented with the problem in 1997, was experiencing a rare form of epileptic episode called gelastic seizure. The main symptom of a gelastic seizure is uncontrolled laughter.

Laughing or crying at inappropriate moments, or out of context to one’s circumstances — crying in the middle of a lecture, for example, or laughing at a funeral — is something most of us experience at least once.

However, as the case of the pilot illustrates, there can be a variety of underlying causes for these ill-timed outbursts. Multiple sclerosis, ALS (Lou Gehrig’s disease), stroke, Alzheimer’s disease, Parkinson’s disease or any number of conditions can cause brain lesions or damage the communications between different parts of the brain. The result is pathological laughing or crying, also sometimes called involuntary emotional expression disorder. Now, Cleveland Clinic researchers are testing an experimental treatment, a combination of two medications, dextromethorphan and low-dose quinidine, to help control the involuntary outbursts.

However, involuntary emotional expression disorder turns out to be something of a misnomer. In fact, true laughter and most crying are never voluntary, according to Robert Provine, author of “Laughter: A Scientific Investigation,” and a professor of psychologyand assistant director of the neuroscience program at the University of Maryland, Baltimore County

“All laughter is unconscious,” he said. “You do not chose to laugh the way you chose to speak.”

In the book, Provine relates an amazing tale of an incident that took place in 1962, in Tanganyika (now Tanzania). A group of schoolgirls began laughing. Other girls saw and heard their laughter and they started laughing. Soon, the entire school was giggling uncontrollably, so much so that school had to be dismissed. This epidemic of uncontrollable, contagious laughter went on for six months.

When someone with a brain lesion or neuron damage suffers fits of laughter or crying without feeling especially happy or sad, a skilled neurologist can point to a cause. Explaining why an otherwise healthy person might break into tears or start laughing is more difficult.

Dr. Josef Parvizi, a Stanford University neurologist who studies seizures and pathological crying and laughing, agrees that outbursts of laughter or crying are not really under our complete control, no matter how much we think they are.

Our brains are a dynamic set of interconnected structures with wiring forming a system that has evolved over millions of years, Parvizi said. The idea that human beings can exert complete control over this system the way we can program a computer is a relic of old-fashioned hubris and moralizing.

Crying and laughter depend on flexible interplay between these brain structures, some of which are evolutionarily ancient. That interplay often takes place without our conscious selves knowing anything about it, just as our brain tells our hearts to beat. So, just as something like a nerve communication foul-up can create a harmless momentary heart flutter, the brain regions involved in laughing or crying could evoke a sudden outburst.

Just as nerve communications cause our hearts to beat without us being aware of it, the sight of someone falling down the stairs can evoke a loud guffaw before we can stop it.

Neuroscientists have found that they can evoke crying jags by stimulating a structure called the subthalamic nucleus. When scientists used electrodes to stimulate a region called the anterior cingulate, they got smiles. By turning up the juice, they triggered long, hearty laughter. Yet the patient did not “feel” especially funny.

Most laughter is not the result of a joke, Provine said. It’s a form of social communication which is embedded in our brains. When chimps wrestle, they laugh. When mice are tickled, they laugh.

In reality, humor is a mystery, at least in the way it affects the brain. While it’s acceptable to laugh at slapstick and jokes, it’s not OK to laugh at funerals. One is socially acceptable; the other isn’t. Yet both can trigger laughter and we’re powerless to stop it.

This is not to say that our cortex, the reasoning part of our brains, cannot exert some control over an urge to cry or laugh. But although we tend to regard human beings as having free will, what we really have is some limited ability to deny or to act upon our brain’s desires.

“What the brain will want to do is not free,” Parvizi said. “The fact I want ice cream at this moment is out of my control.” He may or may not help himself to ice cream, but he can’t prevent his brain from wanting it.

Our conscious brain tries to control these desires according to the norms of our culture as we learn through experience what our emotional response ought to be to various situations.

“The circuitry that controls emotional expression first processes what is outside, the situation,” he said. “Then it relates this particular situation to past experiences and how the brain has learned to respond. Then it triggers the emotional response. It’s all to some extent involuntary and spontaneous.” Nobody knows exactly why this system might malfunction in the absence of a disease or injury.

But clearly something has gone momentarily haywire.

When such an inappropriate response is triggered, like when we are listening to great aunt Judy’s eulogy, Parvizi said about the best we can do is chalk it up to a “glitch” and hope the relatives don’t boot us out of the will.

Ever been unable to stop laughing or crying? Tell us your most embarassing outburst. Selected responses may be published.

Pseudobulbar Affect (PBA)

What is pseudobulbar affect (PBA)?

Pseudobulbar affect (PBA) is a neurological condition that causes outbursts of uncontrolled or inappropriate laughing or crying. It is also known by other names including emotional lability, pathological laughing and crying, involuntary emotional expression disorder, compulsive laughing or weeping, or emotional incontinence. PBA is sometimes incorrectly diagnosed as a mood disorder – especially depression or bipolar disorder.

Although episodes of laughing or crying may seem appropriate for the triggering event (a thought, seeing or hearing something funny or sad), they tend to be more difficult to restrain (are ‘closer to the surface’) and can be more intense and last longer than would ordinarily be expected. However, they can also be relatively minor and subtle, such as getting choked up or a brief giggle.

PBA can have a substantial impact on the lives of those experiencing the condition, and on their family members and caregivers. It can cause embarrassment and anxiety, leading to withdrawal and social isolation. It creates an additional burden for patients who already have a serious underlying neurologic condition.

How common is pseudobulbar affect (PBA)?

It is estimated that between 2 and 7 million people in the United States have PBA depending on the severity of symptoms, with the lower number representing individuals with more severe symptoms.

What are the symptoms of pseudobulbar affect (PBA)?

  • Uncontrolled or sudden outbursts of laughing or crying usually in response to a triggering event with an emotion either appropriate or inappropriate to the event.
  • Laughing or crying that is out of proportion to the trigger and mood or inner feelings of the person. The person may also start laughing or crying for no apparent reason.
  • Emotional outbursts that are more intense, frequent, or exaggerated than previously experienced by the individual.
  • Outbursts of anger or frustration may also occur.

What causes pseudobulbar affect (PBA)?

It is not completely known why pseudobulbar affect (PBA) occurs, but it is essentially always associated with neurological disorders or diseases that cause brain damage or injury. Disorders, diseases, or injuries that are associated with PBA include:

  • Alzheimer’s disease and other forms of dementia
  • Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
  • Brain tumors
  • Cerebellar lesions (including spinocerebellar atrophy)
  • Epilepsy
  • Multiple sclerosis (MS)
  • Neurosyphilis (an infection in the brain or spinal cord caused by spirochetes that causes syphilis)
  • Parkinson’s disease
  • Progressive supranuclear palsy (a brain disorder that causes problems with walking, balance, speech, thinking, vision, mood and behavior)
  • Stroke
  • Traumatic brain injury
  • Wilson disease (a disorder in which copper builds up in the brain, liver and other organs)

PBA occurs when there is a lack or loss of voluntary control over emotional responses. Various brain regions along a cerebro-ponto-cerebellar pathway are likely responsible for a loss of inhibitory or regulatory control on expression of emotions. Part of this pathway includes the cerebellum, which plays a key role in modulating or monitoring emotional responses and ensures they are appropriate to the social situation. Disruption of the neural (nerve) pathways from certain areas of the brain to the cerebellum may lead to a loss or lack of control over emotional expression.

Neurotransmitters, such as serotonin, norepinephrine, dopamine, and glutamate, are also thought to play a role in PBA.

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Pseudobulbar Affect Versus Depression: Issues in Diagnosis and Treatment

Pseudobulbar affect (PBA) is a neurologic condition that is characterized by brief episodes of uncontrollable, sudden, and inappropriate emotions. The syndrome consists of uncontrollable crying or laughing, which usually is incongruent with the patient’s mood. Unfortunately, these involuntary emotional outbursts may be mistaken for symptoms of a mood disorder, such as major depression. Pseudobulbar affect often occurs secondary to a neurologic disorder, such as stroke, Alzheimer disease, traumatic brain injury, multiple sclerosis, and amyotrophic lateral sclerosis.

The prefix pseudo in ancient Greek language is used to represent something that is false. Pseudobulbar affect is appropriately named to describe an affect that may be incongruent with internal emotional states. This disorder was previously called emotional incontinence, pathological crying, and emotional lability. A likely reference to PBA appeared in Charles Darwin’s 1872 book, The Expression of the Emotions in Man and Animals. Charles Darwin stated, “Certain brain diseases, such as hemiplegia, brain-wasting, and senile decay, have a special tendency to induce weeping.”1 Although PBA has been documented in the literature for centuries, it continues to be misdiagnosed and underdiagnosed.

CASE VIGNETTE

Mr. A, aged 52 years, was admitted to the ICU following an ischemic stroke. During the hospitalization he began having sudden, brief, uncontrollable crying episodes. A psychiatric consultation was obtained, and he was started on sertraline for MDD. Unfortunately, he had minimal response to the medication. He continued to have crying episodes at home and was unable to identify a trigger for these outbursts.

Mr. A had no previous psychiatric history; he had a family history of major depression in an aunt. He reported a depressed mood that began shortly after the onset of his unexplained emotional outbursts. Mr. A’s wife was present at all medical visits and insisted that he was depressed as a consequence of the stroke. She believed that he was in denial about his feelings. Mr. A reported that he previously enjoyed spending time with family, friends, and outdoors. However, he began spending all of his time at home and declined family gatherings. Mr. A attributed these behavioral changes to wanting to avoid the embarrassment of an uncontrolled crying episode in public.

AThese symptoms persisted for months, and he obtained a second consultation. During this consultation, his symptoms were further elucidated. The crying outbursts were sudden, involuntary, unpredictable, excessive, and incongruent with mood.

Pseudobulbar affect was diagnosed and Mr. A was started on a new treatment regimen. The symptoms decreased in frequency and intensity. His family and friends were educated about the condition, which decreased his embarrassment when an outburst occurred. Mr. A was able to resume spending time with family, friends, and restarted his outdoor activities.

What’s Causing My Uncontrollable Crying?

There’s still a lot that we don’t know about crying, who cries more, and why. Even large studies on crying and its effects rely on people to self-report, which makes results less consistent.

Crying is a tool to communicate an emotional response. It shows people around you that you’re feeling something. You may cry more or less, depending on how sensitive you are to stimuli and how comfortable you feel openly showing your emotions.

Many scientists have worked to find out if “a good cry” that leaves you feeling refreshed is actually possible. Overall, the research is split. It may also depend a lot on how supportive your environment is to showing emotion.

A large study of men and women from around the world found that people report crying one to 10 times per month. In the United States, women reported crying 3.5 times and men reported crying 1.9 times.

This is higher than the global averages, which were 2.7 times for women and 1 time for men. These are just averages and other studies have found different results.

Hormones

Since women commonly report crying more than men, it’s a solid theory that hormones affect crying differences among people. Testosterone, a hormone higher in men, may prohibit crying, while prolactin, which is higher in women, may promote crying.

Hormones dictate much of how your body functions and their levels can cause a wide array of symptoms. If anything has been affecting your hormones, such as sleep, stress, or medications, it can likely affect how much you cry.

Crying in pregnancy

Being pregnant is a lot of work and crying more is a common occurrence. Both happy and sad feelings can trigger a lot of tears if you’re pregnant.

Reasons you might have uncontrollable crying in pregnancy are:

  • major hormonal changes in your body
  • exhaustion from physical changes in your body
  • feeling overwhelmed with all of the preparations to have a baby
  • increased occurrence of depression

Crying spells with anxiety and stress

Stress is a normal reaction to some of life’s everyday events. Stress makes your body and mind alert to what’s going on. However, constant stress can be the sign of an anxiety disorder. Anxiety can prevent you from doing the things you want to do and living life as you desire.

A 2016 study looked at crying tendencies in adults and how it related to their sense of attachment, safety, and connection to others. People with anxiety were more likely to say that crying feels helpful but uncontrollable. If you have anxiety, you might cry often or uncontrollably.

Other signs of anxiety include:

  • racing thoughts
  • excess fear and worry
  • sweaty palms and increased heart rate
  • panic
  • trouble sleeping
  • tense muscles
  • being easily distracted
  • digestion issues

Exhaustion

A lot of people report being quicker to cry when they’re really tired. If you’ve been crying a lot more lately and you know you’re not getting enough sleep, you should get more rest. It can take a long time to come back from sleep deficit.

Adults need seven to nine hours of sleep every night. Sleeping at unusual times also doesn’t help because your natural hormones make your brain tired and need sleep over the course of the night.

Anxiety and stress can make you more tired, so these might go together for you. But it’s certainly possible to be exhausted without having an underlying mental health condition.

To start making up for your loss of sleep, cancel your weekend plans and sleep in at least three hours. Then, go to bed an hour or two early every night for the rest of the week. If it’s hard to change this habit, make it a point to be in bed and reading something calm with your phone and email turned off. Shutting down like this can help you settle in and you might fall asleep easier.

Depression crying spells

Depression is a medical condition that often looks like sadness, exhaustion, or anger. It looks different in everyone. While it’s normal to be sad sometimes, people with depression have an unexplained heaviness for two weeks or more.

Depression is a mental health condition with many potential treatments. Unexplained crying can be a sign of depression.

Other symptoms include:

  • significant change in eating and sleeping patterns and weight
  • anxiety
  • irritability
  • pessimism or apathy
  • exhaustion or lethargy
  • feelings of guilt
  • inability to focus
  • lack of desire for social engagement
  • loss of interest in things you used to enjoy
  • recurring thoughts of death or suicide

Depression can look vastly different from person to person. It can happen to anyone, though it’s more common in women and usually occurs between ages 25 to 44.

Working with a doctor can help you figure out what you’re experiencing and how to treat it. In about 80 percent of all cases of depression, people who seek treatment will see significant improvement of their symptoms.

Bipolar crying spells

Bipolar disorder is a common cause of uncontrollable crying. Also called manic-depression, bipolar disorder is characterized by extreme changes in mood from high to low feelings. It affects more than 2 million adults in the United States.

The depressive states of bipolar disorder can look like depression, but it’s otherwise a very different condition. People with bipolar disorder will also experience times of manic excitement and energy.

Other symptoms include:

  • extreme and unpredictable mood swings
  • irritability
  • impulsiveness
  • racing speech and thoughts
  • need for less sleep without getting fatigue
  • delusions of grandeur
  • hallucinations

Bipolar disorder can occur in anyone of any age and ethnicity, and it’s commonly passed down in families. A doctor can offer many options to treat it.

Pseudobulbar affect

Uncontrollable crying can be caused by pseudobulbar affect, also called emotional lability. There have been reports of this uncontrollable laughing or crying since the 19th century.

Pseudobulbar affect is marked by laughing or crying that seems inappropriate to the environment or stimuli. It’s believed to be caused by damage to the brain, though more research is needed to fully understand this condition.

The U.S. Food and Drug Administration has recently approved one of the first forms of treatment for pseudobulbar affect. If you have uncontrollable crying at unexpected times and no other symptoms, speak with a doctor.

● Relax your facial muscles. Ms. Driver said that your inner eyebrows pull together and up when you are genuinely sad, and that loosening those muscles will “lock up” your tears.

● Breathe deeply. Theresa Nguyen, a mindfulness and success coach who founded More Time More You life coaching in Dallas, said that focusing on your breath can help you step away from your emotions — and stop you from saying anything you might regret later. “Take a deep breath in through your nose for four seconds and hold it for two seconds,” Ms. Nguyen said. “Then, through pursed lips, breathe out for another eight seconds.”

● Give yourself a hard pinch. If you can hide your hands, Ms. Driver suggested: “Simply pinch the skin between your thumb and pointer finger and voilà, you will instantly stop crying.”

Make the tears disappear

Once the waterworks have ended, you may well find yourself with a flushed face and red, puffy eyes. Dr. Deanne Mraz Robinson, a board-certified dermatologist and founding partner of Modern Dermatology, a dermatology practice in Westport, Conn., said that we hold our breath when we cry. That makes the oxygen levels in our blood drop, turning it a darker shade of red and causing that telltale blotchiness that accompanies a good cry. To get rid of the flush, start by taking big, deep breaths.

“To combat puffy eyes, apply cold to the under eye to help constrict the blood vessels,” Dr. Mraz Robinson said. “If you’re at home, wash your face with cold water or apply an eye mask or a bag of frozen peas from the freezer. If you’re out and about, try wetting your fingers with cold water from the sink and then gently pat under your eyes.”

Dr. Rhonda Klein, who co-founded Modern Dermatology, said that a moisturizer containing niacinamide, a form of vitamin B3 that has anti-inflammatory properties, can help soothe irritated, post-crying skin. She also recommends applying green-toned makeup concealer to neutralize flushing, and using redness-reducing eye drops like Visine.

“You can also apply Afrin — a popular nasal decongestant — topically to the skin to reduce redness,” Dr. Klein said. “The active ingredient in Afrin, oxymetazoline, works by constricting blood vessels, blocking blood from traveling to them and therefore reducing redness.”

If you’ve ever asked yourself, “Why do I cry so much?” you’re definitely not alone. Whether it’s over a breakup, a disappointing review at work, or the loss of a loved one, shedding a tear or two is a normal aspect of life. “Crying is an excellent way of releasing emotions and processing difficult situations,” says Dr. Gail Saltz, associate professor of psychiatry at the NY Presbyterian Hospital Weill-Cornell School of Medicine. But when people begin to feel they don’t have control over their emotions, it can signify something more serious is going on.

Here, we asked experts to break down the psychology behind constant crying.

1. Depression

Depression is a mood disorder marked by persistent feelings of sadness or numbness that can lead to unusual crying. “If you’ve had a change in how much you’re crying and it’s consistent with your mood, then you should think about depression,” says Dr. Saltz says. She adds that signs of depression include feelings of sadness, hopelessness, or emptiness, a loss of interest, sleep disturbances, and fatigue.

2. Anxiety

With an anxiety disorder comes excessive worrying, irritability, difficulty concentrating, and … tears. According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental health illness in the U.S., affecting over 18% of the population. If you suspect that you’re experiencing excess feelings of anxiety, consult with a professional, who may recommend therapy, medication, complementary medicine, or lifestyle changes.

Justin CaseGetty Images

3. Early Trauma

According to Dr. Kate Cummins, Psy.D., women who had a traumatic childhood or have experienced extreme traumatic events will often cry more than what is considered a normalized response: “This is because their sympathetic nervous system experiences trauma or anxiety in the same somatic responsive way, regardless of the scale of how traumatic the event actually is,” Dr. Cummins says.

4. Stress

According to Dr. Sharon Saline, the effort it may take you to ward off sadness, anxiety, bad news, or something that disturbs you could be compromised when you’re stressed. “When the body is dealing with these strong feelings, the feeling brain takes over the thinking brain and rules the day, allowing tears to flow more readily,” Dr. Saline says. Stress also increases levels of cortisol, which Dr. Saltz says can increase hypersensitivity and reactivity to a challenging or stressful situation.

5. Personality

Everyone has his or her own unique personality, which is your collection of behaviors, traits, and cognitions. Biological differences in brain structure and physiology can impact your personality and emotional sensitivitywhich could lead to more tears. According to Dr. Forrest Talley, Ph.D., neuroscientists aren’t exactly sure the neuroanatomy behind crying, but they know it involves the limbic system: “Just as people who are more anxious have differences in sensitivity of their amygdala, so too differences in crying are linked to genetic differences in sensitivity of the limbic system.”

And some people just have more sensitive personalities than others. According to Dr. Elaine Aron, Ph.D., about 15 to 20% of the population has this personality trait. “A highly sensitive person is more sensitive to their surroundings, to other people’s feelings, the good, and the bad of that,” Dr. Saltz says. “They’re more affected by the attitudes and comments of others.”

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6. Hormones

Hormones are the chemical messengers that control bodily functions like hunger, reproduction, emotions, and mood. “Anything that causes a shift in hormones, like premenstrual time, postpartum, or menopause, may cause women to cry more easily,” Dr. Saltz says. According to Saltz, you’ll be able to tell if your hormones are shifting, because it’s a sudden onset.

7. Socialization

According to Dr. Cummins, women generally experience their feelings in a greater capacity than men: “Women are socialized to explore, talk about, and show their feelings from a young age more than men. This means that crying, a typical expression of sadness, grief, or vulnerability is more familiar to them.” Cultural norms make it tougher for the men to express their emotions. “I see many boys in middle and high school who fight back tears, while girls of the same age will openly cry,” she adds.

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8. PseudoBulbar affect

PseudoBulbar affect (PBA) is a neurological condition that affects your emotions after a traumatic brain injury or disturbance to the part of the brain that controls emotion. “If you didn’t used to be a crier, but are having crying fits, uncontrollable laughter, or anger that are not consistent with your mood, then it could be PseudoBulbar affect,” Dr. Saltz says. “It can be due to any number of brain injury situations, like a stroke, organic injury, dementia, and more.” She says it’s extremely rare, but it’s important to watch out for signs of it, which includes fits of crying.

Nicol Natale Freelance Editorial Assistant Nicol is a freelance Editorial Assistant at WomansDay.com and is a Manhattan-based journalist who specializes in health, wellness, beauty, fashion, business, and lifestyle.

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