Pseudobulbar Affect

Pseudobulbar affect (pronounced: su-do-bul-bar aff-ect) or PBA, is also known as emotional lability or emotional incontinence. It can happen after a stroke or traumatic brain injury, or because of neurological conditions such as dementia, Parkinson’s, ALS, and multiple sclerosis. People suffering from PBA experience sudden crying or laughing (or both) that they can’t control. This can cause embarrassment, confusion, frustration and social isolation.

Sometimes, PBA is misdiagnosed as a psychiatric condition, such as depression or bipolar disorder – but PBA is almost always caused by damage to the brain, particularly in the neural pathways to the parts of the brain which regulate emotion. The term mood describes how we feel inside while the term “affect” describes how we display our emotions to the outside world. In PBA, there is a disconnect between mood and affect. Someone with PBA may laugh out loud at something that is sad, cry about something that is funny, or have an emotional overreaction to something relatively minor.

PBA is under-recognized and under-treated. PBA is diagnosed through a neurological evaluation and the use of standardized questionnaires that measure severity and frequency of crying or laughing episodes. While there is no cure for PBA, the condition can be treated with oral medications.

If you have suffered a stroke and are frustrated by not being able to control your crying or laughing, talk your doctor about PBA.

Take this quiz to help determine if you have symptoms and to start a conversation with your doctor about PBA.


  • Give details, let your Doctor know things like:
    • How often you have a crying and/or laughing spell
    • Whether your spells match how you feel, which can help your Doctor determine if they’re caused by depression, PBA or something else
  • Come prepared:
    • Write down any questions beforehand
    • Bring a friend or family member to your appointment
  • Don’t be afraid to ask: The only bad questions are the ones you don’t ask.