Table 1.
Symptoms associated with disorders of crying and/or laughing
| Condition | Description of crying episodes | Description of laughing episodes | Description of mood | Is crying or laughing congruent and appropriate with current mood? | Hallmarks of condition |
|---|---|---|---|---|---|
| PBA | Sudden outburst that is out of proportion or greatly exaggerated compared with patient’s mooda | Sudden outburst that is out of proportion or greatly exaggerated compared with patient’s mooda | May or may not be appropriate for context | No | Sudden outbursts of crying or laughing that are uncontrollable, stereotyped, and incongruent with or greatly exaggerated compared with what the individual is feelingb |
| Depression | Appropriately reflects person’s mood and person has some control over their motoric expression | Decreased number (or absence) of laughing episodes because of sad or blunted mood | Sad and/or blunted due to anhedonia | Yes | A mood of sadness or “blues” or a lack of affect accompanied by a loss of interest or pleasure (anhedonia) |
| PTSD | Appropriately reflects person’s mood but presents as a part of an emotional reaction to a traumatic memory | Not applicable | Hyperarousal with a feeling of helplessness, intense fear, or horror | Yes | Experiencing or witnessing a traumatic event that is associated with hyperarousal and “flashbacks” |
| Essential crying | Appropriately reflects context and person’s mood, and person will have a lifelong predisposition | Not applicable | Appropriate for context | Yes | Having an existing (lifelong) lower threshold for crying compared with social norms |
| Witzelsuchtc,18 | Not applicable | Appropriately reflects mood and inappropriately reflects context | Frequently and inappropriately find situations funny that others do not | Yes | Insensitive to humor by others around them; frequent use of puns and slapstick humor |
Notes:
a
Either crying or laughing must be present, but having both is not necessary for diagnosis of the condition
b
the initial affect may appropriately match the person’s mood; however, it will progress to an exaggerated response
c
this diagnosis needs to be included in the differential for those presenting with involuntary laughter.
Abbreviations: PBA, pseudobulbar affect; PTSD, post-traumatic stress disorder.