Lability (Emotional Lability)

Emotional lability means moods or emotional expression that change quickly, strongly and out of proportion to what set them off: tears, laughter or anger that arrive suddenly and are hard to control. “Lability” means instability. It’s a symptom, not a diagnosis. Causes range from stroke and brain injury to bipolar disorder, borderline personality disorder and plain exhaustion.

Also called: labile mood; labile affect; mood lability; mood swings, in everyday speech. When it follows a stroke or brain injury, doctors also call it emotionalism, pathological crying or laughing, or pseudobulbar affect.

Signs and symptoms

Crying or laughing that starts suddenly, is hard to stop, and feels bigger than the moment calls for
Irritability or anger that flares at small things
Moods that swing several times in a day, or within an hour
Feeling embarrassed afterwards, and avoiding people in case it happens again
Strain in relationships, and trouble at work or in class

In the form that follows brain injury, the outburst often doesn’t match what you feel inside: you may cry without feeling sad, or laugh at something that isn’t funny.

Causes

Stroke, head injury and brain diseases: damage to the pathways that control emotional expression can cause uncontrollable crying or laughing, known as pseudobulbar affect. It’s described after stroke and traumatic brain injury and in multiple sclerosis, motor neurone disease and Parkinson’s disease. It’s often mistaken for depression.
Bipolar disorder: during mania, mood can shift suddenly, with irritability or uncontrollable laughing alongside the high.
Borderline personality disorder: intense emotions and severe mood swings over a short space of time are a core feature.
Depression, anxiety and stress: tearfulness and a short fuse are common when you’re worn down.
Lack of sleep, alcohol and drugs: all make emotions harder to hold.

Coping

Tell the people close to you what’s happening and why. An outburst is easier for everyone when nobody has to guess.
Notice what sets it off: tiredness, hunger, particular topics, crowds. Plan around the ones you can.
Protect sleep. Keep regular sleeping and waking times, and cut back on alcohol and drugs.
When an episode starts, slow your breathing, change position or step out of the room for a minute. It often passes faster than it feels.
Learn emotion-regulation skills with a therapist. CBT and related therapies teach you to catch a feeling early and choose what to do with it.

Treatment

Treatment depends on the cause. After a stroke, antidepressants may reduce how often crying or laughing episodes happen, though the trials are small and the evidence is weak. In bipolar disorder, a psychiatrist may prescribe mood stabilisers, with talking therapy and a steady routine. In borderline personality disorder, talking therapy is the main treatment, and DBT teaches skills for managing emotions. Where the cause is stress, sleep loss or low mood, treating those usually settles the moods.

In Nigeria

Sudden crying or laughing can be read as weakness, drama or something spiritual. In south-west Nigeria, supernatural causes are among the commonest lay beliefs about mental illness. After a stroke, families sometimes say the person is “not themselves”. The emotion is real, but it’s the injury talking, not the person’s character, and it’s not something they can simply stop.

Emotional lability vs ordinary moodiness, bipolar disorder and BPD

Ordinary moodiness follows events and settles on its own. Everyone has bad days.
Pseudobulbar affect is about expression: brief, sudden episodes, often without a matching feeling, after damage to the brain.
Bipolar disorder comes in episodes. High or low moods usually last days or weeks at a time, with stable stretches between.
Borderline personality disorder brings swings within a day: despair in the morning, feeling reasonably all right by evening, usually set off by something in a relationship.

When to get help

If the swings include thoughts of harming yourself, or someone you love is talking about ending their life, get help now: call 112 (or 767 in Lagos), or Safe Place Nigeria on 0800 800 2000. The full list is on our helplines page.

See a doctor if emotional changes began after a stroke, a head injury or a new illness, or came with confusion. Talk to a therapist if the swings are frequent, upsetting, or affecting work or relationships. You can book a licensed therapist on Mytherapist.ng for general mental health or personality disorders.