What Is A Laughing Disorder, And How Can You Treat It?

Laughing disorder, also known as pseudobulbar affect (PBA), is a medical condition characterized by uncontrolled crying and laughing (via the Cleveland Clinic). According to the clinic, these heightened bouts of emotions, in most cases, do not match a person's inner feelings and are usually caused by certain neurological conditions. Statistics from Medical News Today show between 1.8 and 7.1 million Americans have PBA, with the total number of people in the U.S. with neurological disorders ranging from 9.4% to 37.5%. PBA Info reiterates that although only 2 million people with brain conditions are diagnosed with pseudobulbar affect, the condition is extremely common — over 7 million people in the United States exhibit symptoms that might suggest they have PBA. 

Due to how PBA symptoms manifest, people find the condition rather disruptive and embarrassing. According to Mayo Clinic, people with PBA express themselves inappropriately and exaggeratedly, which differs greatly from their typical demeanor. Medical News Today explains that diagnosing PBA involves using scales (the Crying Scale and the Pathological Laughter Scale) to measure the symptoms. 

Causes of pseudobulbar affect

According to WebMD, PBA is most often a result of extreme damage to the prefrontal cortex, the part of the brain that controls emotions. The prefrontal cortex, or PFC, forms part of the frontal lobe, says the Science Of Psychotherapy. This part of our brain has been conditioned solely to orchestrate our actions and thoughts, ensuring they follow our internal goals. The human brain also has a region known as the cerebro-ponto-cerebellar pathway. According to the Cleveland Clinic, this region of the brain might also be affected in people with PBA.

It's very easy to mistake PBA for depression or bipolar disorder, says Medical News Today states. On the contrary, PBA isn't considered a mental health condition, but rather a neurological disorder that drastically affects the brain. According to the source, people who experience PBA can also be victims of depression, which can cause confusion when diagnosing the condition.

Conditions associated with PBA

As explained by Stroke.org, PBA is a neurological medical condition that can also occur due to neurological diseases. Some associated conditions include Parkinson's, stroke, traumatic brain injury, amyotrophic lateral sclerosis, multiple sclerosis, and brain tumors. Some conditions where extreme emotions are expressed can also mimic PBA. For example, anxious people, when going through an episode, tend to laugh nervously, especially when they find themselves in high-stress situations, says Medical News Today. According to the source, various mental health conditions like schizophrenia can also trigger unusual or inappropriate laughter.

Another condition where unusual laughter is expressed is autism. Healthline describes autism spectrum disorder as a neurodevelopmental condition often characterized by differences in social interaction and communication. According to the source, people with autism often exhibit repetitive and restricted interest, which shows itself in varying behavior patterns. A 2002 study published in the British Journal of Psychology reiterates that inexplicable laughter is common in children with autism

Symptoms of pseudobulbar affect

The primary symptom associated with PBA is regular uncontrollable and involuntary outbursts of laughter or tears, explains the Mayo Clinic. These outbursts are often not connected to a person's current emotional state and are highly exaggerated. The laughter can then turn into tears; usually, tears are more rampant than laughter (per Mayo Clinic). Between these two extreme emotions, people with the condition might experience moments of normalcy where there's no overreaction whatsoever. The normal periods as well as episodes, the source explains, can happen at any time.

Medical News Today reiterates that sudden and short emotional reactions might include laughing, crying, or a mixture of the two. According to the source, these associated symptoms of PBA can last several seconds to minutes. Due to their unpredictable nature, these symptoms usually occur as a reaction or response to a trigger that can be anything from a sad to a slightly amusing situation. In extreme cases, the PBA symptoms can occur without any trigger and range from mild to seizure-like episodes.

According to WebMD, the symptoms of PBA vary. Beyond consistent outbursts of anger and frustration, other signs include facial expressions that don't match a person's emotions and, sometimes, laughs or tears that have no direct correlation with a person's current situation.

Diagnosis and treatment

Due to its neurological nature, pseudobulbar affect can be tough to diagnose, says the Cleveland Clinic. Since the symptoms are similar to those of depression and mood disorders, healthcare providers are more prone to misdiagnose a PBA as bipolar disorder, per the clinic. According to the clinic, there's no way to test for a PBA. They can only offer a proper diagnosis after a closer look at your medical history, the symptoms you exhibit, your mental health history, and in some cases, a physical exam.

While there's no fixed cure for PBA, several medications can help manage it when consumed. According to the Cleveland Clinic, these medicines are designed to reduce the frequency and severity of any episode a person might experience. In some cases, antidepressants might also be prescribed. According to WebMD, the most commonly prescribed antidepressant is FDA-approved Nuedexta — the formulation combines the cough suppressant dextromethorphan with quinine sulfate, a drug used to treat cardiac arrhythmias. Other treatment options include selective serotonin reuptake inhibitors (SSRIs), which reduce the severity of PBA episodes, per the Barrow Neurological Institute.

Tips for coping with pseudobulbar affect

If PBA hinders your day-to-day living and social life, it's important to seek medical attention. Also, if PBA is accompanied by other symptoms, including hallucinations or extreme anxiety, or sudden bouts of laughter where the trigger isn't clear, it might be best to speak to a doctor.

To cope with the symptoms, Cleveland Clinic advises focusing on or thinking about something else during an episode. It's also advisable to educate friends or family about the condition, letting them know exactly what to expect. Furthermore, if your PBA medications have unpleasant side effects or aren't helping with symptoms, please speak with your doctor. WebMD advises tracking episodes, clearly listing evident triggers and the duration of symptoms. Lastly, it is always a good idea to talk with other people with PBA. According to WebMD, such conversations will enlighten you on certain coping mechanisms you might not discover alone.