Crying female patient with PseudoBulbar Affect (PBA)

What is PseudoBulbar Affect (PBA)?

PBA is a condition that causes uncontrollable crying and/or laughing that happens suddenly and frequently. It can happen in people with a brain injury or certain neurologic conditions.

A person having a PBA crying spell may cry when they don’t feel sad or when they only feel a little bit sad. Someone having a PBA laughing spell may laugh when they don’t feel amused or when they only feel a little bit amused.

PBA is more common than you think.

While there are almost 2 million people in the US with neurologic conditions or traumatic brain injury who have PBA, over 7 million people in the US have symptoms that may suggest PBA*:

Percent of people with common neurologic conditions who have PBA symptoms

TBI (Traumatic Brain Injury)
Alzheimer's Disease/Dementia
MS (Multiple Sclerosis)
ALS (Lou Gehrig's Disease)
Parkinson's Disease

*When considering patients with any of 6 common neurologic conditions associated with PBA, it is estimated that 37%, or an estimated 7.1 million Americans, have symptoms suggestive of PBA as defined by a CNS-LS (Center for Neurologic Study-Lability Scale) score ≥13 and 9.4% of patients, or an estimated 1.8 million Americans, with CNS-LS scores ≥21. The presence of PBA symptoms was defined as a CNS-LS score ≥13 and a more restrictive definition was also evaluated using CNS-LS ≥21. The CNS-LS was validated as a PBA screening tool in ALS and MS populations. A CNS-LS score ≥13 merits further diagnostic assessment.

†Centers for Disease Control and National Center for Injury Prevention and Control, American Stroke Association, National Institute of Neurological Disorders and Stroke, National MS Society, The ALS Association, Parkinson’s Disease Foundation, and Work SS, Colamonico JA, Bradley WG, Kaye RE. Pseudobulbar affect: an under-recognized and under-treated neurological disorder. Adv Ther. 2011;28:586-601.

PBA is a condition of emotional expression—crying and/or laughing that's exaggerated or doesn't match how you feel. It's different from depression.

PBA is neurologic which means it's caused by damage to the nervous system.
Conditions like depression are psychological which means they're related to a person's emotional or mental state.

It's possible to have PBA and depression at the same time, but the two are separate conditions that should be diagnosed and managed separately.

There are ways to manage PBA.

Find out more

What makes PBA different from Depression*

PBA: You also have a neurologic condition or brain injury
Depression: You may or may not have a neurologic condition or brain injury
PBA: You have sudden, frequent crying and/or laughing
Depression: You may or may not have crying †Tearfulness/crying is not a diagnostic hallmark for depression diagnosis.
PBA: Your crying and/or laughing spells are uncontrollable
Depression: You may have control over crying
PBA: Your crying and/or laughing is exaggerated or doesn't match how you feel
Depression: Your crying matches how you feel
PBA: Your crying and/or laughing episode lasts seconds to minutes
Depression: Crying is part of your depression that can last weeks to months

*Formal diagnosis of PBA or depression can only be made by a qualified healthcare professional (HCP). These are not all of the diagnostic features of depression or PBA. PBA occurs in the context of a neurologic condition/injury affecting the brain and is not explained by other causes such as medication use.

PBA episodes and everyday life*

The impact of a PBA episode goes beyond crying and laughing.

  • It can be frustrating, because you're not sad, despite how it looks. Or things aren't as funny as they may seem
  • Because PBA symptoms always happen as a result of another neurologic condition or brain injury, they can feel like yet another difficulty to deal with

*Colamonico J, Formella A, Bradley W. Pseudobulbar affect: burden of illness in the USA. Adv Ther. 2012;29:775-798.

Caregiver and loved one with PseudoBulbar Affect (PBA)

People with PBA say an episode can cause:

It’s a struggle not to have people think I’m crazy! I’ll just bust out laughing and crying. I don’t understand how you can be so happy…and then bawling.
Personal discouragement:
He really gets down on himself about it…He doesn’t feel he’s the same person.
Embarrassment from the situation:
You’ll be somewhere and stand out. You’re different and people look at you differently.

PBA is a real condition that you can do something about. Ask your doctor how PBA can be managed.

See More about the Impact
Caregiver comforting PBA patient

Wondering if you or someone you love might have PBA?

Answer these questions, then talk to your doctor about your options.

Remember: PBA is different from depression, but it's possible to have both at the same time. The two should be diagnosed and managed separately.

Need help explaining your symptoms to your doctor?

Get tips for starting the conversation

PBA may be described by many names

Other names are sometimes used to describe PBA. Many of these don't accurately describe the condition or its symptoms. You may hear others refer to PBA as:

Emotional lability Emotional incontinence Inappropriate or labile affect
Forced crying and laughing Pathological crying and laughing Involuntary Emotional Expression Disorder (IEED)



Could it be PBA?

Answer these 7 questions and discuss your results with your doctor.