Table of ContentsView AllTable of ContentsDefinitionWhy Humans LaughCausesTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Definition
Why Humans Laugh
Causes
Treatment
Coping
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 withpseudobulbar affect(PBA), a syndrome that can follow changes in the brain fromstroke,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.
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.
Laughteris 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.
How to Treat and Manage a Laughing Disorder
What Causes Inappropriate Laughter?
Inappropriate laughter may be a symptom of a disorder known aspseudobulbar affect,which is associated with conditions of the brain and neurological system.
Neurologic disorders commonly associated with pseudobulbar affect and inappropriate laughter include:
Pseudobulbar affect has been described as a “disinhibition syndrome,” where the pathways that involve neurotransmitters (chemical messengers)serotoninandglutamateare interrupted.
What Are Neurotransmitters and What Do They Do?
Other Causes of Inappropriate Laughter
Pseudobulbar affect is sometimes misdiagnosed as a mental health condition, commonlydepressionorbipolar disorder. These and other conditions can, however, also be the reason for inappropriate laughter. They include:
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 orbrain imagingto 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) andtricyclic antidepressants.
A different drug, Neudexta, is a combination ofdextromethorphanand quinidine and has been shown to be effective in treating pseudobulbar affect.However, its side effects include dizziness,nausea, andheadaches. Less often, it can lead to a serious heart condition called prolonged Q-T syndrome.
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:
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.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Demas A, Tillot D.Pathological laughing and psychotic disorder: the medical evaluation of the Joker.Acta Neurol Belg. 2020 Dec;120(6):1379-1382. doi:10.1007/s13760-020-01332-3.Bryant GA, Bainbridge CM.Laughter and culture.Philos Trans R Soc Lond B Biol Sci. 2022 Nov 7;377(1863):20210179. doi: 10.1098/rstb.2021.0179.Wilson DM, Bykowski K, Chrzanowski AM, Knox M, Errasti-Ibarrondo B.A scoping research literature review to explore bereavement humor.Curr Psychol. 2022 Apr 2:1-12. doi:10.1007/s12144-022-03033-x.Tu S, Huang M, Caga J, Mahoney CJ, Kiernan MC.Brainstem Correlates of Pathological Laughter and Crying Frequency in ALS.Front Neurol. 2021 Jul 8;12:704059. doi:10.3389/fneur.2021.704059.Beckwith NL, Khil JC, Teng J, Liow KK, Smith A, Luna J.Inappropriate laughter and behaviours: how, what, and why? Case of an adult with undiagnosed gelastic seizure with hypothalamic hamartoma.Hawaii J Med Public Health. 2018;77(12):319–324.Allida S, Patel K, House A, Hackett ML.Pharmaceutical interventions for emotionalism after stroke.Cochrane Database Syst Rev. 2019 Mar 19;3(3):CD003690. doi:10.1002/14651858.CD003690.pub4.Garcia-Baran D, Johnson TM, Wagner J, Shen J, Geers M.Therapeutic Approach of a High Functioning Individual With Traumatic Brain Injury and Subsequent Emotional Volatility With Features of Pathological Laughter and Crying With Dextromethorphan/Quinidine.Medicine (Baltimore). 2016 Mar;95(12):e2886. doi: 10.1097/MD.0000000000002886.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Demas A, Tillot D.Pathological laughing and psychotic disorder: the medical evaluation of the Joker.Acta Neurol Belg. 2020 Dec;120(6):1379-1382. doi:10.1007/s13760-020-01332-3.Bryant GA, Bainbridge CM.Laughter and culture.Philos Trans R Soc Lond B Biol Sci. 2022 Nov 7;377(1863):20210179. doi: 10.1098/rstb.2021.0179.Wilson DM, Bykowski K, Chrzanowski AM, Knox M, Errasti-Ibarrondo B.A scoping research literature review to explore bereavement humor.Curr Psychol. 2022 Apr 2:1-12. doi:10.1007/s12144-022-03033-x.Tu S, Huang M, Caga J, Mahoney CJ, Kiernan MC.Brainstem Correlates of Pathological Laughter and Crying Frequency in ALS.Front Neurol. 2021 Jul 8;12:704059. doi:10.3389/fneur.2021.704059.Beckwith NL, Khil JC, Teng J, Liow KK, Smith A, Luna J.Inappropriate laughter and behaviours: how, what, and why? Case of an adult with undiagnosed gelastic seizure with hypothalamic hamartoma.Hawaii J Med Public Health. 2018;77(12):319–324.Allida S, Patel K, House A, Hackett ML.Pharmaceutical interventions for emotionalism after stroke.Cochrane Database Syst Rev. 2019 Mar 19;3(3):CD003690. doi:10.1002/14651858.CD003690.pub4.Garcia-Baran D, Johnson TM, Wagner J, Shen J, Geers M.Therapeutic Approach of a High Functioning Individual With Traumatic Brain Injury and Subsequent Emotional Volatility With Features of Pathological Laughter and Crying With Dextromethorphan/Quinidine.Medicine (Baltimore). 2016 Mar;95(12):e2886. doi: 10.1097/MD.0000000000002886.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Demas A, Tillot D.Pathological laughing and psychotic disorder: the medical evaluation of the Joker.Acta Neurol Belg. 2020 Dec;120(6):1379-1382. doi:10.1007/s13760-020-01332-3.Bryant GA, Bainbridge CM.Laughter and culture.Philos Trans R Soc Lond B Biol Sci. 2022 Nov 7;377(1863):20210179. doi: 10.1098/rstb.2021.0179.Wilson DM, Bykowski K, Chrzanowski AM, Knox M, Errasti-Ibarrondo B.A scoping research literature review to explore bereavement humor.Curr Psychol. 2022 Apr 2:1-12. doi:10.1007/s12144-022-03033-x.Tu S, Huang M, Caga J, Mahoney CJ, Kiernan MC.Brainstem Correlates of Pathological Laughter and Crying Frequency in ALS.Front Neurol. 2021 Jul 8;12:704059. doi:10.3389/fneur.2021.704059.Beckwith NL, Khil JC, Teng J, Liow KK, Smith A, Luna J.Inappropriate laughter and behaviours: how, what, and why? Case of an adult with undiagnosed gelastic seizure with hypothalamic hamartoma.Hawaii J Med Public Health. 2018;77(12):319–324.Allida S, Patel K, House A, Hackett ML.Pharmaceutical interventions for emotionalism after stroke.Cochrane Database Syst Rev. 2019 Mar 19;3(3):CD003690. doi:10.1002/14651858.CD003690.pub4.Garcia-Baran D, Johnson TM, Wagner J, Shen J, Geers M.Therapeutic Approach of a High Functioning Individual With Traumatic Brain Injury and Subsequent Emotional Volatility With Features of Pathological Laughter and Crying With Dextromethorphan/Quinidine.Medicine (Baltimore). 2016 Mar;95(12):e2886. doi: 10.1097/MD.0000000000002886.
Demas A, Tillot D.Pathological laughing and psychotic disorder: the medical evaluation of the Joker.Acta Neurol Belg. 2020 Dec;120(6):1379-1382. doi:10.1007/s13760-020-01332-3.
Bryant GA, Bainbridge CM.Laughter and culture.Philos Trans R Soc Lond B Biol Sci. 2022 Nov 7;377(1863):20210179. doi: 10.1098/rstb.2021.0179.
Wilson DM, Bykowski K, Chrzanowski AM, Knox M, Errasti-Ibarrondo B.A scoping research literature review to explore bereavement humor.Curr Psychol. 2022 Apr 2:1-12. doi:10.1007/s12144-022-03033-x.
Tu S, Huang M, Caga J, Mahoney CJ, Kiernan MC.Brainstem Correlates of Pathological Laughter and Crying Frequency in ALS.Front Neurol. 2021 Jul 8;12:704059. doi:10.3389/fneur.2021.704059.
Beckwith NL, Khil JC, Teng J, Liow KK, Smith A, Luna J.Inappropriate laughter and behaviours: how, what, and why? Case of an adult with undiagnosed gelastic seizure with hypothalamic hamartoma.Hawaii J Med Public Health. 2018;77(12):319–324.
Allida S, Patel K, House A, Hackett ML.Pharmaceutical interventions for emotionalism after stroke.Cochrane Database Syst Rev. 2019 Mar 19;3(3):CD003690. doi:10.1002/14651858.CD003690.pub4.
Garcia-Baran D, Johnson TM, Wagner J, Shen J, Geers M.Therapeutic Approach of a High Functioning Individual With Traumatic Brain Injury and Subsequent Emotional Volatility With Features of Pathological Laughter and Crying With Dextromethorphan/Quinidine.Medicine (Baltimore). 2016 Mar;95(12):e2886. doi: 10.1097/MD.0000000000002886.
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