Causes and Treatments for Inappropriate Laughter
Medically reviewed by Steven Gans, MD
Inappropriate laughter occurs when a person laughs in ways that disrupt their everyday life, with an upsetting response in the “wrong” time or social context, or an over-the-top response to something trivial. It can be a sign of a neurological problem or a mental health condition like anxiety or a psychotic disorder.
This type of laughing (along with inappropriate crying) is associated with pseudobulbar affect (PBA), a syndrome that can follow changes in the brain from stroke, multiple sclerosis, and other problems. Research suggests it affects some 10% of people after traumatic brain injury.
This article discusses inappropriate laughter and its possible causes. It presents strategies for treatment and coping skills you can discuss with a healthcare provider.
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Definition of Inappropriate Laughter
Inappropriate laughter can be defined as uncontrollable laughing that is above and beyond the expected response. Sometimes it is referred to as pathological laughter.
One important thing to keep in mind is that laughter that seems inappropriate can be the exact opposite of the felt mood and is very difficult or impossible to control—for example, laughing uncontrollably at a funeral or even at something trivial.
Why Humans Laugh
Humans laugh, and there has never been an observed culture in which people do not laugh. It is a type of vocalization that evolved, just as distress or fear are expressed in response to brain signals.
A laughing disorder is out of a person’s control, however, and can be a sign of a brain or neurological issue. But just because someone is laughing at an inappropriate time does not mean they have something neurological going on.
Sometimes people laugh nervously in uncomfortable situations, in the face of stress and anxiety. For instance, researchers have suggested that when faced with extreme emotions (as with death and bereavement), people rely on humor even when they are sad.
Takeaway
Laughter is a way to help restore emotional balance. Further, what is identified as inappropriate laughter as a sign of something deeper going on, like a neurological issue, has its nuances. Research on inappropriate laughter is ongoing.
Related: How to Treat and Manage a Laughing Disorder
What Causes Inappropriate Laughter?
Inappropriate laughter may be a symptom of a disorder known as pseudobulbar affect, which is associated with conditions of the brain and neurological system.
The most common disorders of laughing are due to pseudobulbar palsy, in which pathological laughter can be triggered by something trivial and be out of line with the underlying mood. It may also be in combination with crying.
Neurologic disorders commonly associated with pseudobulbar affect and inappropriate laughter include:
Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
Extrapyramidal and cerebellar disorders (affecting the brain)
Gelastic seizures, a rare type often associated with brain lesions including hypothalamic hamartomas
Pseudobulbar affect has been described as a “disinhibition syndrome,” where the pathways that involve neurotransmitters (chemical messengers) serotonin and glutamate are interrupted.
Related: What Are Neurotransmitters and What Do They Do?
Other Causes of Inappropriate Laughter
Pseudobulbar affect is sometimes misdiagnosed as a mental health condition, commonly depression or bipolar disorder. These and other conditions can, however, also be the reason for inappropriate laughter. They include:
Psychogenic seizures, caused by depression, borderline personality disorder, anxiety, and other mental health diagnoses
Poisoning and toxic exposure
Alcohol or substance intoxication, especially cannabis and lysergic acid diethylamide (LSD)
Angelman syndrome, a rare genetic disorder
Takeaway
To put it simply, conditions that affect the brain and neurological function may impact the parts that are responsible for triggering laughter.
Treatment for Inappropriate Laughter
Treatment for inappropriate laughter can depend on the cause. In some cases, it may require emergency care to address an injury or illness, like a rapid urine test to evaluate substance use or brain imaging to assess neurological status.
In other cases, the pathological laughter can be evaluated using tests like the Pathological Laughter and Crying Scale (PLCS) or the Center for Neurologic Study-Lability Scale (CNS-LS), which has been effective with people diagnosed with ALS disease. Or, a mental health diagnosis may be made based on the "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition" (DMS-5).
An underlying condition requires care. For example, options for treating a gelastic seizure can include medication but it often requires surgery. Antidepressants have been shown to be an effective treatment in cases where neurotransmitter function plays a role. Effective antidepressants include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants.
A different drug, Neudexta, is a combination of dextromethorphan and quinidine and has been shown to be effective in treating pseudobulbar affect. However, its side effects include dizziness, nausea, and headaches. Less often, it can lead to a serious heart condition called prolonged Q-T syndrome.
Related: What to Know About Long QT Syndrome (LQTS)
Coping With Inappropriate Laughter
Studies show that people experiencing uncontrollable laughter (or crying) after a stroke tend to become more withdrawn. Their PBA causes embarrassment and they're uncomfortable among family, friends, or in public. The isolation affects quality of life and, in some cases, overall health and recovery.
Your healthcare provider can offer advice or interventions that can help. You can try:
Explaining your symptoms to loved ones and trusted friends who can help you navigate social settings and tasks
Avoiding a situation or context that leads to symptoms, if possible
Practicing relaxation techniques, like deep breathing exercises
Reducing stress and anxiety with healthy lifestyle habits (like exercise and sleep hygiene)
Related: 7 Positive Lifestyle Factors That Promote Good Health
Summary
Inappropriate laughter, sometimes called pathological laughter, often has an underlying medical cause related to brain function. This can include stroke, traumatic brain injury, or other conditions that impact pseudobulbar affect and lead to symptoms that include laughter.
In some cases, the laughter (or crying) may be related to a mental health condition or substance use disorder. A healthcare provider can diagnose the cause through tests and other assessments.
Treatment will depend on the cause. Medications are often used, though surgery may be needed in some cases. Therapy for a neurological disorder or mental health condition also may help.
Read the original article on Verywell Health.
