Some time ago I had a discussion with an acquaintance involving the most perplexing, yet mysteriously interesting behavior. What had been a mystery for this family was revealed a month ago. Their loved one had exhibited inappropriate laughter, crying spells, and emotional outbursts that weren’t connected to a mood or psychotic disorder. He also seemed quite delusional at times as well.

Pseudo-bulbar affect (PBA) is a condition (a puzzle) that had this family emotionally drained for years. It is currently defined as a neurological condition characterized by unpredictable and uncontrollable emotional outbursts involving laughter and crying during inappropriate times.

PBA is often the result of strokes, traumatic brain injury, multiple sclerosis, Parkinson’s Disease, or dementia/Alzheimer’s Disease. This neurological condition can masquerade as a mental illness. The reason this topic is so important for us  is because holistic healthcare is vital. Likewise, many medical conditions have been diagnosed as mental illnesses.


Considering medical conditions before diagnosing a mental illness often takes a backseat in counseling. Unfortunately, therapists are trained to focus on both the psychological and emotional components of a presenting concern, not the medical. The most a therapist can do is offer you a referral, but you will have to ask for one. Medical conditions masquerade as psychological or emotional strain more than we think. For example:

  • chronic migraine headaches
    • could be depression/low levels of serotonin
  • anxiety
    • could involve poor diet, thyroid problems, or low blood pressure
  • depression
    • could reflect anemia, low levels of D or B vitamins, or thyroid problems
  • ADHD-like symptoms
    • could be the result of imbalanced diet, and
  • hallucinations or delusions
    • could be a medication side effect or epilepsy


I encourage you to develop a holistic perspective and  keep an eye out for underlying medical causes to psychiatric symptoms. Even if you have been diagnosed with a mental illness, keep in mind that you can still contribute to the improvement of your illness by eating right, exercising, and paying attention to your health.


If you’d like to learn more, visit PBA Facts  or view a free PBA webinar. Read more about PBA and strokes at the National Stroke Association


Stay Informed!


Reference (n.d.). Pseudobulbar affect: Just another name for depression? Retrieved February 2, 2013,



Creative Commons License photo credit: sanja gjenero