Emotions are an organic and essential component of human life. They help individuals convey messages to others, reduce stress, and connect to the surroundings. However, in the case of some people, emotional responses are no longer in their control. Sometimes, the reactions can be excessive, inappropriate, or entirely out of place. This is known as pseudobulbar affect, which refers to an uncontrolled and sometimes exaggerated laughing or crying condition.

Although PBA itself is not a disease, it is closely related to neurological disorders and brain injuries. The effects of PBA can be distressing, but understanding its causes and treatment options can help manage its impact on daily life.

What Is Pseudobulbar Affect (PBA)?

PBA is a neurological condition that causes sudden, involuntary emotional outbursts. These episodes can manifest themselves through excessive laughing or crying that is inappropriate considering the context of the situation. These individuals experience extreme reactions with PBA, such as laughter during serious moments or tears in the absence of sadness, apparently without any emotional precipitate. These outbursts also occur for longer periods than may be expected in normal circumstances and are not easily controlled to see when or how long they occur.

Although PBA is not life-threatening, it can significantly affect a person's social and emotional well-being. People who experience PBA may find themselves embarrassed, frustrated, or isolated, as their emotional responses seem out of sync with their true feelings.

Studies estimate that up to 7 million Americans exhibit symptoms of PBA, and approximately 2 million individuals are diagnosed with the condition. PBA is most often seen in patients who have experienced a brain injury or suffer from neurological diseases. In some cases, PBA symptoms may be mistaken for mood disorders such as depression or anxiety, but the underlying causes are related to brain dysfunction rather than emotional instability.

What Causes PBA?

The root cause of pseudobulbar affect lies in the dysfunction of the central nervous system (CNS). More specifically, PBA results from damage to the brain's emotional regulation pathways, particularly the areas that control laughter and crying. Damage to these areas leads to involuntary emotional outbursts that are disconnected from the person’s actual feelings. Several neurological conditions can disrupt these pathways and increase the likelihood of developing PBA.

Here are five major conditions associated with PBA:

1. Stroke

A stroke occurs when blood flow to the brain is interrupted, depriving brain cells of oxygen and leading to their damage or death. This can result in physical disabilities, cognitive impairments, and emotional disturbances. Between 28% and 52% of stroke survivors experience PBA, with those assigned female at birth being at a higher risk. The symptoms of PBA are sometimes hard to differentiate from other effects that a stroke can bring.

Accurate diagnosis is very important. If you or someone you care about has had a stroke and cannot stop laughing or crying, you need to talk to a doctor, because these symptoms could mean PBA rather than a mood disorder.

2. Traumatic Brain Injury (TBI)

Traumatic brain injury often occurs due to external forces such as falls, car accidents, or sports injuries. TBIs can be a concussion or severe damage to the brain, and PBA is a common result of major head trauma. Studies have found that 5-48% of people with TBI develop symptoms of PBA, though this range varies due to underreporting and misdiagnosis.

Symptoms may be confused with another condition like depression or post-traumatic stress disorder, which can make them discuss emotional changes with a doctor who may have the patient referred for further neurology evaluation.

3. Multiple Sclerosis (MS)

Multiple sclerosis is an autoimmune disease in which the body's immune system fights against the protective covering of nerve fibers in the CNS, bringing about the disintegration of the communication process between the brain and the body. People with MS are more susceptible to developing PBA and have shown a prevalence rate of 10% from studies among patients with symptoms of involuntary laughter or crying.

MS-related brain lesions and the utilization of certain drugs can contribute to developing PBA. The lack of predictability of PBA can be especially problematic for an MS patient because it can create problems with social interactions as well as quality of life.

4. Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative disease that affects cells in the nerve responsible for controlling voluntary movements of the muscles. As the motor neurons degenerate, patients begin experiencing muscle weakness, loss of mobility, and eventually, a failure to breathe. About 10% of patients with ALS develop PBA, in which crying is more common than laughing.

While ALS itself inflicts much physical and emotional stress, PBA can make an already difficult emotional experience even worse for patients and their families to bear.

5. Parkinson's Disease and Dementia

Parkinson's disease is a progressive neurological disorder affecting movement. PBA often occurs in advanced Parkinson's disease. The prevalence of PBA symptoms among Parkinson's patients has been reported to be 3.6% to 42.5%. In addition, the cognitive decline in Alzheimer's disease can also lead to PBA, and the prevalence among these patients has been estimated to be as high as 40%.

These conditions often have fluctuations in mood, which could be mistaken for mood disorders, complicating the diagnosis. Therefore, identification of symptoms of PBA in patients with Parkinson's and dementia is essential to ensure that these patients get proper care and support.

Symptoms of PBA

The symptoms of PBA are varied but usually involve:

• Increased emotional reactions: Laughter or crying for longer durations or of more intensity than the situation requires.
• Inappropriate crying and laughing: Laughing without a reason, e.g., at a solemn ceremony, or crying without having the feeling of sadness.
• Abrupt start: Episodes of crying and laughing can start without an identifiable emotional trigger.
• Inability to stop the episode: Unlike typical emotional outbursts, individuals with PBA are not able to control or end the episode once started.
• Emotional changes: Crying can change quickly into laughing, or vice versa, without any recognizable trigger.

Treatment for PBA

Although PBA is not a life-threatening condition, it can be very disruptive. There are treatments available to help manage the symptoms. Dextromethorphan/quinidine (Nuedexta) is the only FDA-approved medication specifically for PBA. This drug works by changing the way certain neurotransmitters function in the brain, helping to control emotional outbursts. In addition, antidepressants may be prescribed off-label to help alleviate symptoms in some cases.

Beyond medication, therapy and support groups can be very helpful in managing the social and emotional challenges of living with PBA. Cognitive-behavioral therapy (CBT) may help individuals understand their emotional responses and develop coping strategies to reduce the impact of PBA on their lives.

Pseudobulbar affect is a condition that can result from several serious neurological disorders. While the involuntary laughing and crying symptoms themselves are disturbing, it's the connection of PBA to brain dysfunction that will eventually lead to proper treatment and support for the patient.

If your loved one or you have sudden uncontrollable outbursts emotionally, it's essential to seek a comprehensive evaluation from the healthcare professional. With the right diagnosis and management plan, individuals with PBA can improve their emotional regulation and continue to live fulfilling lives despite the challenges of their condition.

Pseudobulbar affect (PBA).Multiple Sclerosis Association of America. 2010.

Pseudobulbar aPseudobulbar affect (PBA)ffect (PBA). American Stroke Association.

We often associate stress with dramatic breakdowns, overwhelming work, or emotional turmoil. But what if the real danger lies in the tiny, everyday pressures we don’t even notice building up?

What Is Microstress and Why It Matters

“Stress is the most notorious yet underplayed disease,” says Alma Chopra, motivational speaker, disability rights activist and life coach. “It’s often thought of as an emotional onslaught that makes it difficult to function. But stress isn't just limited to our emotions; we can also become physically stressed from a chronic illness or an injury.”

Alma explains that microstresses are small, fleeting moments of stress that sneak into our daily routines. “Sometimes it creeps up through daily pressures until we hit our melting point. These are called microstresses,” she shares. These could include running late for a meeting or scrolling social media right after waking up. They may feel harmless in the moment but layer up to become chronic stress over time.

How Microstresses Mess With You

“These reactions feel minor and temporary, so they're quickly replaced by the next task or eased by a smiling face or a piece of cake,” says Alma. But the danger lies in how these minor stressors build up over time. “We tend to ignore these micro-stresses, but over time, they build low-level tension that will affect your sleep, focus, mood and health.”

Alma lists common microstressors and their effects:

• Alarm: “Jerks the body into a sudden state of alertness, disrupting natural rest.”
• Checking work email: “Doing this first thing in the morning puts us into a state of panic and anxiety.”
• Scrolling social media: “Overstimulates the brain and drains mental focus.”
• Confrontations: “Force us to deal with discomfort we’re not emotionally prepared for.”
• Unfinished tasks: “Juggling a long list without breaks builds pressure and leads to burnout.”
• Bruising your knee: “Even minor damage to the bone or soft tissue creates physical stress in the body.”

Alma advises recognising patterns and creating little routines to manage stress before it spirals. “Begin by recognising patterns, checking what drains you and creating little routines to relieve stress,” she says. “Start taking short breaks, creating boundaries and incorporating rejuvenating practices into your day.”

When Lifestyle Fuels Microstress

Sukirti Midha, spiritual wellness coach and founder of Sukh Yog, points out that microstress is a lifestyle issue. “Micro stress, as the name suggests, is small things we face as a working person or a householder. No gender age or designation we are discussing here; it’s the same for all,” she says.

According to Sukirti, “It’s in our lifestyle now; still, we are not aware of it.” She adds that people often don’t even feel it building up. “Do you think it happens overnight? No, nothing happens overnight except the sun comes out,” she jokes, adding a serious note that many people today don’t even see the sunrise, contributing to deficiencies like vitamin D.

Sukirti points out how society’s pressure to look good and maintain appearances feeds microstress. “When one gets conscious about looks, which include not only clothes but also touch-ups, make-up and hair. It’s not social pressure but created by us only.” She questions why people rely on external validation to feel good. “Why is it always important to look good to feel good?”

She also flags social media’s impact. “Many social media applications have filters to make you feel more beautiful and younger, which gives you plenty of stress when we look back in a basic mirror.” Comparing ourselves to others’ curated lives triggers a subtle but ongoing sense of inadequacy.

“Maintaining a status is a pressure these days,” she says. “Always remember as we shift from past to present or future to present, we learn happiness is about you & not the things or society status.”

The Simple Way Out

Both experts agree that while microstress can’t always be avoided, we can manage it better by slowing down, drawing boundaries and valuing simplicity. As Sukirti says, “Staying away from microstress isn’t easy, but preferring solace is an easy way out.”

If you have ever colour-coded your wardrobe, wiped the kitchen slabs repeatedly just because a speck of dust exists, or straightened a slightly off-centre painting on the wall, someone has probably laughed and said, I am so OCD too. But the thing is that you are probably not. And neither are they.

Somewhere along the way, we all misunderstood Obsessive Compulsive Disorder (OCD), a serious mental health condition, and casually said it. OCD has become shorthand for being neat, organised, or a lover of clean aesthetics. But as mental health professionals and those who actually live with OCD will tell you, that stereotype could not be further from the truth.

OCD is a clinically diagnosed anxiety disorder. It is not just about being extra clean or a control freak. It involves a cycle of obsessions, which are intrusive, unwanted thoughts and compulsions, which are repetitive behaviours or mental acts done to try to neutralise those thoughts.

Imagine being haunted by a constant fear that your loved one will die unless you tap the light switch exactly five times. Or being plagued by the thought that you have hit someone with your car, even though there is no evidence of it happening, and then going back to the same stretch of road again and again to check. That is the lived reality of OCD. It is not cute, it is not fun, and it definitely does not feel satisfying or neat.

The Cleanliness Myth

Yes, some people with OCD have cleanliness-related compulsions. But not everyone with OCD is a neat freak, and not all neat freaks have OCD. The need to wash your hands repeatedly until they are raw is not about loving cleanliness; it is about desperately trying to get rid of a feeling that something is terribly wrong. Often, the compulsion is not even rationally linked to the obsession. It is about trying to regain control over overwhelming anxiety, even if only temporarily.

In fact, OCD themes can be disturbingly varied, from fears of harming others to taboo thoughts to symmetry to morality. The common thing is that the thoughts are distressing, the anxiety is debilitating, and the rituals are exhausting.

Why It is Harmful To Mislabel Yourself As “OCD”

Calling yourself “OCD” because you like your stuff arranged by colour might seem harmless. But this kind of throwaway comment does a real disservice to people living with the actual condition. It trivialises their experiences and contributes to misinformation.

It also prevents those who might truly be struggling with OCD from recognising their symptoms and seeking help. Because if society keeps painting OCD as a personality problem, why would anyone think it is a serious problem?

What OCD Actually Feels Like

Ask anyone with OCD, and they will tell you it is not fun. It is not satisfying to double-check the lock for the 17th time. It is not enjoyable to feel like you are going to vomit because of a thought you did not ask for and cannot get rid of. It is a relentless loop of “what ifs” and “just in cases” that can take over your entire life.

OCD can interfere with relationships, work, sleep, and basic daily functioning. It is often accompanied by shame and secrecy because people worry others would not understand, or worse, will think they are dangerous or irrational.

Time To Rethink The Label

You might just be tidy. Or meticulous. Or even perfectionistic. And that is fine. But OCD? That is a diagnosis. A tough, often debilitating one that deserves respect. If you think you might actually have OCD, then help is available. Cognitive Behavioural Therapy (CBT), particularly Exposure and Response Prevention (ERP), has been proven to be effective. But it starts with understanding what OCD really is.

In vitro fertilisation (IVF) is not just about science, syringes and success rates. What lies behind the walls of fertility clinics is a deeply personal journey filled with hope, heartbreak and resilience, making it more than just a medical procedure. Beyond the social taboos, infertility brings huge stress to the patients. And while IVF offers hope, it does not come easy. It is a rollercoaster ride that patients experience as they take on the road to this procedure; highs and lows can take a severe mental toll on them.

However, for those unversed, infertility has been classified by the World Health Organisation as a disease like diabetes or hypertension; the social taboo around it still persists. Over the years, advancements in reproductive science have made IVF treatments more patient-friendly and significantly improved outcomes. Yet, the focus often leans heavily on science, expertise and clinic proficiency, while the mental and emotional toll on the couple is overlooked.

For many, the psychological impact of IVF can match that of the death of a family member or going through a divorce. Although many people find IVF very stressful, every patient experiences it differently. Personalities and life experiences play a big role in determining how one handles the process and what part of IVF they find most difficult.

Why Is IVF So Emotionally Draining?

We ask an expert to break down several key factors that contribute to the immense stress IVF brings:

• Uncertainty of Outcomes

• Physical Strain

• Societal Pressure

• Guilt and Shame

• Depression After Failed Attempts

• Relationship Strain

Learning to Cope with Support Systems That Help

There is light at the end of the tunnel, and as Dr Saple says, there are several strategies that can help couples better cope with the IVF process.

• Psychological Counselling

• Support Groups

• Mind–Body Practices

Setting Realistic Expectations

“IVF may take more than one cycle to succeed,” she explains. Being mentally prepared for the outcome, while knowing you have done your best, helps couples accept results with resilience.

It is Okay to Ask for Help

As Dr Saple reminds us, mental and emotional health are as important as physical health during IVF. Prioritising emotional wellbeing not only makes the journey more bearable but can also improve the overall outcome. “Seeking help is a sign of strength, not weakness,” she says.