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If you are like many stroke patients, you are going or have been through a range of emotions. These feelings are “normal” when you have faced such an overwhelming change. Like:

•           Shock

•           Anger

•           Guilt

•           Loss

•           Anxiety

•           Feeling low or depressed

•           Feeling in despair or suicidal

Sometimes some of them or all of them in a week!

I want to focus on our difficulty controlling our emotions. I was very stoic until the strokes. I would cry, get mad or laugh all the time, sometimes inappropriately! Just ask my boys and my wife.

After almost 13 years since the strokes, it has gotten better. My feelings are now more appropriate. I cry when I read a sad story. I get mad at an injustice. Or I laugh at a funny quip.

This condition is called emotionalism or more. Pseudobulbar Affect (PBA) is the latest name for a neurological condition also known as:

*Emotional lability

*Reflex crying

*Pathological laughing and crying

*Involuntary emotional expression disorder

*Compulsive laughing or weeping

*Emotional incontinence

*Involuntary emotional expression disorder, among others.

The reason I think many experts are using the term, Pseudobulbar Affect, is because it sounds more medical in nature, and it makes you think there must be a prescription. That’s MY opinion.

Those names are difficult even if you don’t have aphasia, like me! It means that our mood changes fast. We are more emotional than we used to be. We can feel something for no reason at all. Some people start to swear when they didn’t do so before their stroke.

It can be upsetting, especially if you weren’t an emotional person before your stroke. Like me. Some people feel embarrassed, so they stop going out or try to avoid social situations.

Let me say it again – Emotionalism is a neurological condition. It is sometimes incorrectly diagnosed as a mood disorder – especially depression or bipolar disorder.

Very important to hear that last part – if you are dealing with some depression. PAY ATTENTION. More on this topic of Emotionalism VS. Depression in a later post.

Again, Emotionalism occurs when there is a lack or loss of voluntary control over emotional responses. There are lots of diseases, disorders, or injuries which can cause Emotionalism as a sign of their primary ailment.

They are:

* Alzheimer’s disease and other forms of dementia

* Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease

* Brain tumors

* Cerebellar lesions (including spinocerebellar atrophy)

* Epilepsy

* Multiple sclerosis (MS)

* Neurosyphilis (an infection in the brain or spinal cord caused by spirochetes that causes syphilis)

* Parkinson’s disease

* Progressive supranuclear palsy (a brain disorder that causes problems with walking, balance, speech, thinking, vision, mood, and behavior)

* Stroke

* Traumatic brain injury

* Wilson disease (a disorder in which copper builds up in the brain, liver, and other organs)

What are the “official” symptoms of Emotionalism?

* Uncontrolled or sudden outbursts of laughing, anger, or crying, usually in response to a triggering event with emotion either appropriate or inappropriate to the event.

* Laughing, anger, or crying that is out of proportion to the trigger and mood or inner feelings of the person.

*The person may also start laughing, get angry, or cry for no apparent reason.

* Emotional outbursts that are more intense, frequent, or exaggerated than previously experienced by the individual before the stroke (if she or had one).

Emotionalism is common in the acute phase of the stroke. Studies show about one-fifth (20%) of stroke patients experience it.

It is estimated that between 2 and 7 million people in the United States have Emotionalism, depending on the severity of their signs. The lower number represents individuals with more severe symptoms. That means there are almost 60 million people which have Emotionalism worldwide. Wow!

The prefix pseudo in the ancient Greek language is used to represent something that is false. Pseudobulbar Affect (remember – Emotionalism is used for this condition) is appropriately named to describe an affect that may be incongruent with internal emotional states.

A likely reference to Emotionalism appeared in Charles Darwin’s 1872 book, The Expression of the Emotions in Man and Animals. Charles Darwin stated, “Certain brain diseases, such as hemiplegia, brain-wasting, and senile decay, have a special tendency to induce weeping.”

Although Emotionalism has been documented in the literature for centuries, it continues to be misdiagnosed and underdiagnosed.

I need to repeat – Emotionalism is a disorder of affect and major depression is a disorder of mood. The key to differentiating these two disorders is understanding the difference between affect and mood. Affect is an outward expression of a subjectively experienced emotion. A mood is experienced internally.

Affect has been defined as “the subjective and immediate experience of emotion attached to ideas or mental representations of objects. Affect is an outward manifestation that can be classified as restricted, blunted, flattened, broad, labile, appropriate, or inappropriate.”

Please seek professional help when you are concerned about your feelings!

This is part 1 of a 2 part article.

Sources: https://www.stroke.org.uk/effects-of-stroke/emotional-changes  https://pubmed.ncbi.nlm.nih.gov/31136206/  &  https://constanttherapyhealth.com/brainwire/identity-and-finding-meaning-after-stroke/