As a single mom trying to make ends meet, I rented a room to a 20-something who worked in the same building as I did. He had suffered a severe closed-head injury in a car accident a decade earlier and had a number of permanent physical problems such as aphasia, thick speech, and an altered gait. His father, nearing retirement, spent a lot of time with him. One of the most trying aspects of the experience proved to be the young man’s tendency to burst into tears at inappropriate times. Neither his family nor I understood that he probably suffered from emotional incontinence. His doctors apparently didn’t catch it either.
Overview
Patients with emotional incontinence suffer from a neurological condition that also goes by several other names, the most common of which is pseudobulbar affect (PBA), according to PBA. In the past, doctors also referred to the disorder as pathological laughing and crying and involuntary emotional expression disorder, The Washington Post reports. Up to 1 million Americans exhibit signs of the affliction.
Although the condition is frequently overlooked and largely understood, many of its victims have experienced severe head injuries. It also appears in stroke patients and those suffering from multiple sclerosis, Alzheimer’s disease, amyotrophic lateral sclerosis (Lou Gehrig’s disease), and a few other neurological disorders.
English scientist Charles Darwin described emotional incontinence in 1872. However, researchers still see it as an unsolved puzzle. They suspect that faulty chemical signaling in the brain disrupts the neural pathways that control a person’s emotional expression. This type of short circuiting causes patients to laugh or cry uncontrollably, often at socially inappropriate times.
In 2010, the Brain Injury Association of America surveyed its constituents regarding the effects of PBA. Nearly half responded that they were affected by the disorder on a regular basis. Four in 10 indicated that their emotional episodes contributed to becoming home-bound.
Secondary Effects
Though family members often become accustomed to these outbursts, social settings are frequently challenging for affected patients. Outbursts in public places are typically the source of embarrassment, which leads to anxiety. As a result, many patients become increasingly isolated from social contact.
One of the most challenging aspects of emotional incontinence is that its episodes resemble depression to both sufferers and health care providers. According to the Post, doctors treated a New York man with a severe brain injury for years with a number of antidepressants and anti-seizure drugs to try to control his outbursts before realizing he suffered from PBA. Adding to doctors’ difficulty is the fact that the disorder and depression can co-exist in some patients.
Treatment
Until recently, medical providers had little to offer emotional incontinence patients in the way of treatment except antidepressants. In 2010, the FDA approved Nuedexta, manufactured by Avanir, as the first drug to treat the condition. Concerns about potential heart problems led to rejection of an earlier version in 2006.
More recent research indicated that the drug resulted in diminished episodes in individuals suffering from multiple sclerosis and Lou Gehrig’s disease. Nuedexta is a combination of a common cough suppressant and a substance used to treat irregular heartbeats.
Experts believe that the cough suppressant, dextromethorphan, binds to brain receptors to cut the amount of laughing and crying. Quinidine, used to regulate heartbeats, assists the process by slowing the breakdown of dextromethorphan, research suggests.
This treatment has resulted in dramatic improvement for some patients suffering from emotional incontinence. For others, however the struggle to find and maintain a quality of life continues.
Sources:
http://www.pbainfo.org/underlying-conditions
http://www.washingtonpost.com/national/health-science/medical-mysteries-was-crying-caused-by-mans-severe-depression/2012/01/19/gIQAg5wmPR_story.html
http://www.biausa.org/AnnouncementRetrieve.aspx?ID=63586&A=SearchResult&SearchID=3516851&ObjectID=63586&ObjectType=7
Personal experience