What to Know About Laughing Disorders (Pseudobulbar Affect)

What Are Laughing Disorders?

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.

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 sclerosis
• Cerebellar disorders
• Multiple sclerosis
• Traumatic brain injuries
• Alzheimer’s disease
• Stroke
• Brain tumor
• Epilepsy
• Parkinson’s disease
• Stroke

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.

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.