Mental Health A-Z What to Know About Laughing Disorders (Pseudobulbar Affect) By Elizabeth Plumptre Elizabeth Plumptre LinkedIn Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences. Learn about our editorial process Updated on July 01, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Tim Robberts / Getty Images Table of Contents View All Table of Contents What Are Laughing Disorders? Symptoms Diagnosis Causes Treatment What Are Laughing Disorders? Laughing Disorder (aka Pseudobulbar Affect) Laughing disorders, aka pseudobulbar affect, involve episodes of uncontrollable laughter or crying during situations that do not warrant that reaction. These episodes are commonly intense, and may be inappropriate or exaggerated given the social setting. Other terms to describe laughing disorders include involuntary emotional expression disorder, emotional lability, pathological laughter, crying, or emotional incontinence. This condition typically occurs in people living with existing neurological disorders. It is believed to affect between 1.8 and 7 million people in the United States. However, it is often misunderstood by loved ones, and under-recognized by medical experts. For anyone that experiences frequent and severe cases of uncontrollable laughter or crying, these events can be incredibly disruptive to daily functioning. Symptoms of Laughing Disorders When a person lives with pseudobulbar affect, it isn’t uncommon for them to burst into unexpected fits of laughter or crying. These incidents typically occur without any relation to their current mood. These tears or laughter may go on for a considerable period of time with the affected person unable to suppress their reaction. The event is usually distressing to the person affected. In other cases, a person may have reason to laugh or cry at a comment or occurrence. However, this expression of humor or sadness is usually extreme and does not reflect their true experience of the event. Pathological laughter or crying may also lead to more frequent and extreme emotional outbursts. These may, in turn, increase fits of anger or frustration. While emotional incontinence can involve laughter and/or crying—crying is more commonly seen in people living with this condition. Diagnosis of Laughing Disorder Pseudobulbar affect is very commonly undiagnosed, underdiagnosed, or misdiagnosed as a mood disorder such as depression. This is particularly observed where crying is the dominant expression of the condition. For a correct evaluation, clinicians will evaluate the behavior of the individual suspected of living with laughing disorder. This assessment may be determined using the following criteria: An inappropriate emotional response A disparity between the individual’s feelings and how they respond to a situation The length of time spent reacting and the severity of the reaction is uncontrollable The emotional response does not produce relief The response does not correspond to the individual’s mood The reaction does not depend on a prompt The reaction is in excess of the stimulation The response is not due to a drug No medical condition is responsible for the response The laughing or crying causes distress Pseudobulbar affect may also be measured using scales or questionnaires. The Center for Neurologic Study—Lability Scale (CNS-LS) and the Pathological Laughter and Crying Scale are administered to patients to determine the reason behind the emotional outbursts. Causes of Pseudobulbar Affect A definite cause of laughing disorder is yet to be established. However, this disorder is commonly observed in people with neurological conditions. Depending on diagnostic frameworks and other factors, an estimated 5% to 50% of people with neurological illnesses live with pseudobulbar affect. These include disorders such as: Amyotrophic lateral sclerosisCerebellar disordersMultiple sclerosisTraumatic brain injuriesAlzheimer’s diseaseStrokeBrain tumorEpilepsyParkinson’s diseaseStroke A lack of voluntary control over emotions is likely responsible for laughing disorders. Playing a key role in this is the cerebellum. This part of the brain regulates emotional responses to correspond with social situations and mood. Where there is a disruption to the cerebellum circuitry, this may affect voluntary control over emotions. Likewise, neurotransmitters such as serotonin and glutamate can impact the development of emotional incontinence. This is because of the vital role they play in cerebellar pathways in the brain. Laughing Disorder Treatment The treatment of laughing disorder is focused on reducing the severity and frequency of uncontrollable outbursts. To achieve this, oral medications are commonly recommended. Antidepressants The main objective of these medications is to improve serotonin levels in the brain. This is achieved using selective serotonin reuptake inhibitors (SSRIs) such as citalopram, fluoxetine, and sertraline. Likewise, tricyclic antidepressants (TCAs) like amitriptyline and nortriptyline, or norepinephrine/serotonin reuptake inhibitors such as venlafaxine or duloxetine can reduce the intensity of these episodes. SSRIs and TCAs may be effective in managing pseudobulbar affect due to the serotonin boost they provide. Dextromethorphan The combination of dextromethorphan (brand name: Nuedexta) and quinidine are the only FDA-approved medications for managing pseudobulbar affect. While dextromethorphan belongs to a class of medications called central nervous system agents, quinidine is grouped under antiarrhythmics. The combination of these medications is able to increase the amount of dextromethorphan in the body. This pairing helps to manage laughing disorders. A Word From Verywell Bursting into uncontrollable tears, or entering fits of laughter at mildly sad/funny scenes can be distressing. Pseudobulbar affect can affect everyday interactions and may cause normal communication to become difficult. However, despite the difficulties caused by this condition, it is manageable with the right treatment method. After receiving a correct diagnosis from a professional, it’s important to follow the right directives when using medication to manage this disorder. 6 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Ahmed A, Simmons Z. Pseudobulbar affect: prevalence and management. Ther Clin Risk Manag. 2013;9:483-489. doi:10.2147/TCRM.S53906 Wortzel HS, Oster TJ, Anderson CA, Arciniegas DB. Pathological laughing and crying : epidemiology, pathophysiology and treatment. CNS Drugs. 2008;22(7):531-545. doi:10.2165/00023210-200822070-00001 Cleveland Clinic. Pseudobulbar Affect (PBA). Schraa-Tam CK, Rietdijk WJ, Verbeke WJ, et al. fMRI activities in the emotional cerebellum: a preference for negative stimuli and goal-directed behavior. Cerebellum. 2012;11(1):233-245. doi:10.1007/s12311-011-0301-2 Chen JJ. Pharmacotherapeutic management of pseudobulbar affect. Am J Manag Care. 2017;23(18 Suppl):S345-S350. MedlinePlus. Dextromethorphan and Quinidine. By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. 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