Monday, July 1, 2013

Pseudobulbar affect (PBA)

There are a serious of issues addressed on my stroke resource page that I wanted to give further individual attention to various conditions I wish doctors would more readily address.
Pseudobulbar affect (PBA), also known as pathological laughing and crying or emotional incontinence, is, "The phenomenon of laughing and crying out of proportion to the underlying feelings of sadness or happiness was recognized by clinicians in the late 19th century as a common manifestation of acquired brain damage, especially stroke." (Wilson SAK. Some problems in neurology. Ii: Pathological laughing and crying. J Neurol Psychopathol. 1923;4:299-333.)  Around the 6-10 month marks, I described this phenomenon as having "two brains."

An outstanding, brief video explanation that is quite clear and in depth (I so wish I could find a way to directly post this much watch video here) is available on Facebook at or I could get to it from YouTube (but Blogger tells me it doesn't exist when I try to directly imbed here) by going directly to Also visit the National Stroke Association PBA assessment and information page at Another good information page is

I also said (probably around the 1 to 1 1/2 years marks), "I've been complaining about a few melt-downs per day, or sometimes even per week. Reading information, I am thankful to have it so "easy" as some people deal with these episodes over 100 times per day. :( Still, it is not fun. I would say the emotional fall-out of PBA has been MUCH harder to deal with than even the frustration over the inability to walk all these months. PBA happens, depending on what statics you read, in about 20-60% of strokes. It has been a major part of what I have perceived to be fractures in our marriage. My husband is a saint to walk with me through this exhausting and constant, endless process!

After about a year and a half of over-expressing emotions, often inappropriately, I now find myself almost always totally unable to cry, even when I need to or really should. (If I do get crying now, watch out, but it usually just cannot happen.) It would seem that this is yet another expression (lack of expression as the case may be) of emotional disconnect. For us, personally (differs greatly for each person!), the hardest season, including daily shouting, screaming, sobbing out of control melt downs, usually with my husband being my greatest target, was from about 4-10 months, peaking at its worse around 6 months.

From another stroke page, "PBA is triggered by damage to areas of the brain during a stroke. It is thought to affect more than 1 million people in the U.S... PBA is often mistaken for depression, causing it to be under-diagnosed, under-treated and sometimes inappropriately treated."
Random quote that seems applicable here: ~ The first screw to get loose in your head is the one that holds your tongue in place. ~

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