What makes you cry uncontrollably?

Affect incontinence

Why do I have to cry for no reason?

Affect incontinence is a common consequence of strokes (Photo: Dilok Klaisataporn | 123RF)


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Stroke patients can experience sudden, uncontrollable outbursts of emotions that do not match the current mood or were provoked by external influences.

So it can happen, for example, that the person concerned suddenly starts crying, although he is actually not sad. But other affects such as laughter or aggression can suddenly break out of the person affected.

Even with a healthy person the feelings can sometimes “run away”, but afterwards he usually feels better and relieved. People who suffer from affect incontinence do not feel this relief. In addition, they are not able to control the duration or intensity of their emotional outbursts, or only to a limited extent.1

This is a stressful situation for patients as well as for their social environment. It is therefore important to receive answers, to understand what is behind the terms "Affect", "" Affect Lability "and" Affect Continence " hides.

What is an affect?

An affect is a brief, temporary and intense emotion (e.g. in case of joy or anger), mostly as a reaction to an external event. Emotional shocks can also lead to sudden emotions, such as severe fright, crying or even laughter. An affect is often associated with “normal” (physiological) side effects, such as sweating, facial flushing, tremors and muscular or emotional tension.

Conceptual the affect is differentiated from other emotions such as mood, emotion or general feeling. Affects therefore belong to the normal expression of a person and are characteristic of the individual personality.

What does affect lability or mood swings mean?

Synonyms: In connection with affect lability, the terms “affective lability”, “mood lability” are used.

Affect lability is triggered by minor stimuli from the environment. People are affected by sudden and sometimes severe fluctuations in their basic psychological mood. For example, crying when confronted with a sad event, with touching music or, quite banally, when the German national team scores a goal. The tendency to outbursts of anger or irascibility is also an expression of increased affect lability. The affected person is aware of the mood swings, but is not perceived as embarrassing or pathological. It is different with affect incontinence.

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What does affect incontinence mean?

synonym: The term “pseudobulbar affect disorder” (PBA) is used in connection with affect incontinence.

Affect incontinence is a disease-related decrease in the ability to control emotional expressions. The extent to which they are affected cannot be controlled by the person concerned, or only to a limited extent. For the person concerned, they can be irritating or even hurtful.

Affect incontinence is often found in the following diseases:

  • stroke
  • dementia
  • Alcohol abuse
  • Brain injuries
  • multiple sclerosis
  • i.a.

The main characteristics of affect incontinence are thus:

  • the emotions expressed do not match the situation
  • the feelings expressed do not correspond to the feelings felt
  • The duration and intensity of the emotional outburst cannot be controlled
  • no relief after the outburst

Frequency and causes of affect incontinence

It is estimated that between 20 and 50 percent of stroke patients suffer from affect incontinence.1,2 The exact number is difficult to determine because many patients with affective incontinence are mistakenly classified as depressed or not diagnosed at all. But other diseases that are associated with damage to the brain can also result in affect incontinence. These include multiple sclerosis or dementia.3

Neurological causes

It is assumed that affect incontinence is triggered by damage to the so-called raphe nucleus groups of nerve cells in the brain stem. The raphe nuclei produce the neurotransmitter serotonin in the central nervous system, which influences various functions of the brain.

Examples are perception, sleep, temperature regulation, pain perception and processing, etc.

Serotonin also affects mood. It conveys a feeling of inner calm, serenity and contentment. That is why serotonin is also known as the “happiness hormone”. It suppresses feelings of fear, aggressiveness, emotional pain or feelings of hunger. Depressive moods can often be traced back to a lack of serotonin.2,4

Another assumption isthat a stroke damages connections between different parts of the brain. From the creation to the living out of an affect or an emotion, this process runs through many different stations in the brain, including the cerebellum and the cerebrum.

The cerebrum represents our consciousness. In most cases, we can consciously decide which feelings we want to show and which we prefer to suppress. So the cerebrum has the final say. But if the “circulation” between the cerebellum and cerebrum is disturbed, it is possible that the commands from the cerebrum no longer arrive and the cerebellum releases random affects and emotions that the person concerned can then no longer consciously control.1

Affect Incontinence or Depression?

Emotional outbursts? Mood swings? These can also be symptoms of depression. How do you distinguish between affect incontinence? There are two clear indications that allow the distinction to be made.

Affect or depressive mood?

A clear indication of affect incontinence is when the affect and mood do not match. So it can happen that an actually satisfied patient bursts into tears without warning. This does not happen out of a sad mood.

Even a patient suffering from depression can suddenly burst into tears. In this case, however, the outburst of emotion is associated with a depressed mood.

Seconds or months? Duration of affect incontinence

The symptoms of affect incontinence usually only last a few seconds to minutes. Depression, on the other hand, can drag on for months. If the patient does not feel down, hopeless or depressed between the outbursts of feelings, one can assume that he is suffering from affect incontinence.1

What can you and your loved ones do?

You have already taken the first and most important step. You inform yourself. The most important thing for you and your loved ones is to realize that affect incontinence is an expression of a physical illness. It is no longer possible to control the affects.

As a loved one, if you are certain that you have affect incontinence, try to understand that the emotional outbursts have nothing to do with your real mood or character, or with you. The more you accept this quirk and talk to each other, the better.

Here are a few tips:

  1. In a quiet minute, ask the person affected what wishes they have with regard to your behavior during and after their emotional outbursts. For example, does he want to be left alone or get some fresh air?
  2. Show him that he need not be ashamed in front of you and that you are by his side despite all the changes.
  3. React as calmly as possible, even if it is difficult. Try not to reply.

Affect incontinence is particularly difficult for you as the person affected to accept. Mainly because everything seems to be normal between the outbursts of emotion. The feeling of failure arises when suddenly you are no longer in control of your affects.

So be understanding to yourself and don't be ashamed of the emotional outbursts. It's not your fault or any change in your character.

It can be helpful if you also inform those around you - e.g. your employer - about your problem so that they are prepared in the event of an emergency.

Should I see a doctor?

In any case, if you notice unusual and disturbing emotional outbursts after the stroke, you should consult a neurologist. He will find out if you really have affect incontinence.

What can the neurologist do?

If you feel that the unwanted emotional outbursts in your daily life are too stressful for you, the neurologist can prescribe medication that can provide relief.

Affect incontinence is treated with drugs that are also prescribed for depressive moods (so-called antidepessants). So-called selective serotonin reuptake inhibitors (SSRIs) are predominantly used.2,4

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Authors


with the cooperation of stud. med. Katharina Püchner

Prof. Dr. med. Hans Joachim von Büdingen is a resident specialist in neurology and psychiatry at the Ravensburg Neurocenter. As chief physician, he headed the Department of Neurology and Clinical Neurophysiology at the St. Elisabeth Hospital in Ravensburg. The main focus of his work is the diagnosis and treatment of strokes. [more]

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  1. Pseudobulbar Affect Versus Depression: Issues in Diagnosis and Treatment - Authors: Jeannie D. Lochhead, MD, Gerald A. Maguire, MD, Michele A. Nelson, MD - Publication: Psychiatric Times Vol 35, Issue 7 - Url: https://www.psychiatrictimes.com/view/pseudobulbar-affect-versus-depression-issues-diagnosis-and-treatment
  2. Treatment of Uncontrolled Crying After Stroke - Author: Grethe Andersen - publication: Drugs & Aging volume 6, pages105–111 (1995) - DOI: 10.2165/00002512-199506020-00003
  3. Affect incontinence - author: Karl C. Mayer, specialist in neurology, psychiatry and specialist in psychotherapeutic medicine, psychoanalysis - publication: Neuro24 - Url: http://www.neuro24.de/show_glossar.php?id=44
  4. Serotonin 5HT1A receptor availability and pathological crying after stroke - Authors: M. Møller G. Andersen A. Gjedde - publication: Acta Neurologica Scandinavica - DOI: 10.1111 / j.1600-0404.2007.00869.x