- Thriving Guide
- Posts
- How to Recognize and Manage a Laughing Disorder
How to Recognize and Manage a Laughing Disorder
Pseudobulbar affect can be emotionally distressing, but understanding the condition is the first step toward better control.

Occasionally laughing at the wrong moment might seem harmless, but for people living with a condition called pseudobulbar affect (PBA), sudden, uncontrollable fits of laughter or crying can disrupt daily life and lead to isolation, embarrassment, and emotional stress.
While often misunderstood or misdiagnosed, PBA is a real neurological condition that affects how emotions are expressed not how they’re actually felt. Here's what you need to know about managing a laughing disorder and how treatment can make a meaningful difference.
What Is Pseudobulbar Affect?
Pseudobulbar affect is characterized by sudden, involuntary episodes of laughing or crying that are exaggerated or mismatched to the person’s internal emotional state. Someone may laugh uncontrollably during a serious conversation or cry during a moment of joy.
These emotional outbursts are not something the individual can consciously control. In fact, the person may not feel particularly sad or amused they simply cannot stop the response once it starts.
What Causes It?
PBA typically occurs in individuals who already have an underlying neurological condition or brain injury. These issues disrupt the brain pathways that regulate emotional expression. Common conditions linked to PBA include:
Stroke
Traumatic brain injury (TBI)
Multiple sclerosis (MS)
Amyotrophic lateral sclerosis (ALS)
Alzheimer’s disease or other forms of dementia
Parkinson’s disease
Epilepsy or seizure disorders
Although PBA may seem like a mental health issue, it’s actually rooted in changes to the brain’s nervous system not the result of mood disorders like depression or bipolar disorder.
How PBA Is Diagnosed
PBA is often underdiagnosed or mistaken for depression or anxiety because the symptoms look similar on the surface. However, PBA is distinct in that the emotional response is involuntary and doesn’t match the person’s actual feelings.
Diagnosis usually involves a neurological evaluation, a review of your medical history, and symptom questionnaires such as:
The Center for Neurologic Study–Lability Scale (CNS-LS)
The Pathological Laughing and Crying Scale
Healthcare providers also consider medication side effects and other health conditions that may contribute to similar symptoms.
Treatments That Can Help
The goal of treating PBA is to reduce both the frequency and intensity of emotional outbursts. Fortunately, there are medications and strategies that can help:
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants, are often used at low doses even if the person isn’t clinically depressed.
Neudexta (dextromethorphan/quinidine) is the only FDA-approved medication specifically developed for treating PBA. It works by regulating certain brain chemicals that control emotional expression.
Treatment is often tailored based on the individual’s overall neurological health and other existing conditions.
Living with PBA can be deeply stressful not just for the person affected, but also for their caregivers and family. Emotional outbursts can feel embarrassing or misunderstood, leading to:
Social withdrawal
Avoidance of previously enjoyable activities
Increased anxiety about triggering an episode
Strained personal or professional relationships
This isolation and stress can also contribute to secondary mental health issues, such as depression or chronic anxiety even though these aren’t the root cause of the emotional outbursts.
Coping Strategies to Try
Although medication is central to managing PBA, lifestyle adjustments and support can help reduce its emotional toll. Here are some helpful strategies:
Communicate openly with friends, family, and coworkers about your condition so they understand what’s happening and how to support you.
Identify and avoid triggers when possible, whether it’s a specific setting, conversation, or type of content.
Practice deep breathing and other grounding techniques to reduce anxiety when you feel an episode coming on.
Distract your mind or body by changing your position, focusing your attention elsewhere, or stepping away from the situation.
Seek mental health support to manage the emotional aftermath of social discomfort or isolation.
Living with PBA
Although PBA can’t be cured, it is highly manageable with the right treatment approach. When emotional outbursts are reduced, many people feel more confident returning to activities they once enjoyed without the constant fear of an episode.
If you or someone you love experiences seemingly uncontrollable laughing or crying, especially in the context of a known neurological condition, don’t brush it off. Speak to a healthcare provider to explore treatment options and improve quality of life.
If this article helped you better understand a difficult condition, please consider sharing it or subscribing to our newsletter for more content on living well with neurological and emotional health challenges.