Emotion Lability

Emotions connect us to our surrounding environments of others. They create a window into our souls. However, some conditions disrupt normal healthy communication provided through emotions. Emotions instead of providing a predictable resource for understanding ourselves and others become volatile, rapidly shifting between emotional states, inappropriately matched with the circumstances. In psychology this is referred to as emotion lability.

In psychology, rapidly shifting, exaggerated states of emotion, mismatching the context of the situation is referred to as emotional lability. The word lability comes from the Latin word labilis which means “transient, fleeting, or slippery.” Emotional lability in psychology is used to describe a condition of constantly fluctuating emotions. Several brain conditions and psychiatric disorders often incur emotional disturbances of transient emotions that dramatically and unpredictably shift.

A person with high emotional lability may express warm sentimental companionship one moment and the next quickly fly into a frightening rage. The unpredictable emotional shifts disrupts security. Those close to a person suffering from an ailment that induces emotional lability constantly walks on egg shells uncertain to when the next explosive fit of aggression will erupt.

​Two Types of Emotion Lability

There are two lines of research of emotional lability. They share similar symptoms of volatile, shifting emotions; but are unique in cause and expression.

Pseudobulbar Affect

Pseudobulbar affect is a psychological condition that may occur from diseases or physical trauma that damages the brain. It is also known as “pathological laughing or crying, emotionalism, emotional incontinence, and a host of other descriptors” (Ghaffar, et al., 2008).

Pseudobulbar is defined as involuntary crying, laughing, or both that are not congruent with mood or circumstances. “The presence of tears without sadness and laughter without mirth” is the common characteristics of pseudobulbar affect. Significantly, pseudobulbar affect is found in “diverse neurological conditions, including multiple sclerosis (MS), amyotrophic lateral sclerosis, stroke, traumatic brain injury, Alzheimer’s disease, and cerebral tumors” (2008).

An early theory of the cause to these involuntary displays of emotion was attributed to damage to the bulbar nuclei in the brain, interfering with top down cortical control that keeps mood and affect congruent (2008). With enhanced technology, brain examinations were unable to locate any structural or functional brain imaging that clearly identify a specific region for the disfunction.

Jeffery Cummings identified the following criteria for diagnosing pseudobulbar affect:

1. Episodes of emotional expression representing a change from a person’s usual emotional reactivity.
2. Emotional reactivity is inconsistent with the person’s mood or the corresponding mood state.
3. The emotional response is more than any provoking stimulus.
4. Repetitive episodic emotional disturbances cause significant distress or social or occupational impairment.
5. Sudden emotional occurrences of expression are nor accounted for by another psychiatric or neurological disorder.
6. The symptoms are not a result of the direct effect of a drug or medication use (Kazi & Anwar, 2022).

Mood and Psychiatric Disorders

Many mood and psychiatric disorders also include an element of emotional lability. While the pseudobulbar affect may unpredictably laugh and cry incongruent with mood and situation, the mood and psychiatric disorders the emotional valence is in congruence but the state of arousal is not, with outbursts far exceeding the appropriate reaction for the situation.

Kazi and Anwar explain that, “the difference between mood disorders and PBA (pseudobulbar affect) is the duration. Depression symptoms, including depressed mood, typically lasts weeks to months and years, while PBA episodes last seconds to minutes.” They add “crying, as a symptom of PBA, may be unrelated to mood, while crying is consistent with emotional state in depression” (2022).

Inappropriate expressions of emotion that are context appropriate (frustrated at a perceived frustrating event) but arousal inappropriate (throwing furniture because dinner is ten minutes late) may be caused by a combination of heightened sensitivity (emotional reactivity) and weakened executive controls (emotional regulatory skills). Overall, “emotional lability…can be thought of as an individual’s reactivity, while emotional regulation can be thought of as management of said emotional reaction” (Oattes, et al., 2018).

​Emotion Lability Symptoms

The main symptom of emotional lability is uncontrollable outbursts, typically of laughing or crying. These outbursts are often exaggerated and inappropriate to the circumstances. We divide Emotional lability symptoms into three categories:

Extreme and Sudden Shifts of Emotions

Emotional lability is easily identified by the rapid and dramatic shifts of emotional states. In mathematical terms, people suffering from emotional lability have a greater standard deviation from a balanced emotional state (homeostatic balance). They deviate further and more often from a balanced emotional state. They experience extreme highs and lows, and frequently shift from one emotional state to another, within short intervals of time. Emotionally labile people may shift through several extreme emotional states within a single day. Sometimes an external event may ignite a shift or sometimes, there may be no apparent reason for the dramatic emotional change.

My friend suffers from a psychological disorder with emotional lability. She is constantly thrown by life’s small challenges. One morning she was bouncing with excitement over a promotion (legitimate positive arousal). An hour later, she was in a tirade over part of her lunch being eaten from the company refrigerator (legitimate frustration). However, her shift from one emotion (a large positive) to the next (a small negative) in a short period of time, completely abandoning the greater overall benefit of a promotion and raise in salary to the lousy loss of a bag of chips and a small sense of violation exhibits a lack of synchrony with the over all balance of life experiences.

Inappropriate Emotions

We cry at funerals and laugh at comedies. Culture generally sets emotional norms for emotional expression. When a disease, brain injury, or other condition intrudes, creating emotional lability, the individual loses appropriateness in emotional expressions. The individual may burst into uncontrollable fits of laughter at a funeral, or cry during a hilarious skit on Saturday Night Live.

It appears that the body experiences emotion but doesn’t know how to correctly translate the emotion to fit the situation. Zamfira Parincu remarks, “these behaviors can be confusing or embarrassing” (2022).

Difficulty with Regulating Emotions

Experience of emotion and regulating of emotion go hand in hand. We often experience emotion and then invoke cognitive executive functions to appropriately regulate expressions to fit the situation.

​People who experience emotional lability have limited or no control over the intensity of their feelings. As a result, the emotional reactivity reigns, dominating any self-control of expression. Explicitly, Arlin Cuncic emphasizes that”they can’t ‘snap out’ of negative moods quickly even when they want to which can make it harder to maintain friendships and relationships” (2021).

​Other Common Names Used to Describe Emotion Lability

Throughout research literature emotional lability has been referred to by a variety of other names:

• emotion dysregulation
• deficient emotional self-regulation
• severe mood dysregulation
• mood instability
• disruptive mood dysregulation

Markedly “all these terms have in common descriptions of inappropriate levels of low frustration tolerance, negative mood, chronic irritability, and tempter outbursts” (Overgaard, et al., 2018).

​What Causes Emotion Lability?

Emotional lability may be a reaction to a medication, neurological disorder, or a psychological disorder.

Medication and Addiction

Medication often is designed to intervene in neuronal communications. Occasionally, the medication includes an unwanted side affects, causing emotional lability. Emotional lability is occasionally a side affect of some antidepressants (SSRIs), or a reaction to discontinuing a medication or chemical substance (2012).

In addition, consumption of substances such as alcohol, marijuana, ecstasy, and PCP may lead to emotional lability. Chemical substances, prescribed or not, may lead to side affects resembling the pseudobulbar affect, psychiatric disorders, or both.

There is also the possibility that the medication. or cessation of medication, creates a heightened demand on cognitive functions, leaving less energy for normal regulation of emotion. This is known as ego depletion in psychology. Have you ever upset a person who is two days into a nicotine detox?

Neurological Disorders

Emotion lability is often caused by neuroglial causes—the pseudobulbar affect.

Diseases:

• Alzheimer’s disease
• dementia
• multiple sclerosis (MS)
• ALS (Lou Gehrig’s disease)
• Parkinson’s Disease

Brain Injury (TBI):

• blunt force head trauma
• skull fracture
• coup-countercoup injury
• contusion
• hematoma
• laceration
• penetrating injury
• infection
• brain swelling
• oxygen deprivation (Parincu, 2022)

Brain diseases or injuries can impact affect arousal, the ability to regulate, or both.

Psychological Disorders

Emotional lability is tied to several psychological disorders. DSM-5 defines emotional lability as “unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.”

​Disorders that List Emotion Lability as a Symptom

In the DSM-5, emotional lability is listed as a symptom in several disorders:

• Borderline personality disorder (BPD),
• Bipolar disorder (BP)
• Substance use
• Attention-deficit/hyperactivity disorder (ADHD)
• Post-traumatic stress disorder (PTSD)

​Does Emotion Lability Have a Biological or Environmental Cause?

Because emotion lability is a symptom of a variety of diseases, injuries and disorders, the cause differs between cases. When emotional lability is a symptom of  the pseudobulbar affect, most likely the lability has stronger biological causes.

When emotional lability is a symptom of a psychological disorder, then it could be attributed to either biology, environment, or both. The diathesis stress model, which theorizes “that disorders develop as a result of interactions between pre-dispositional vulnerabilities (the diathesis), and stress caused by life experiences” (Murphy, 2021) may also be involved in developing disorders that include emotional lability as a symptoms. For this purpose, emotion lability may be treated in a number of ways, addressing both behavioral and biological correlates.

Reciprocal Determinism

Another applicable theory is Albert Bandura’s reciprocal determination that theorizes an interactive relationship between behavior and environmental responses. “Bandura’s model is more representative of the dynamic impact of the different forces involved in behavior” (Murphy, 2021a).

​For example, a young child, perhaps diagnosed with ADHD, and is extremely emotional lability, regularly throwing tantrums in anger. Subsequently, the child’s behaviors impact his parents and caregivers response to the child, contributing to the development of the child. Research confirms this interactive relationship with children exhibiting volatile emotional lability. “Children’s intense negative emotions and concordant behavioral outbursts increase parental demands, which exacerbate global parenting stress.” This heightened stress bouncing between parent and child is “associated with poor child and parent outcomes…” (Walerius, et al., 2016).

​​A Few Final Words by Psychology Fanatic

In conclusion, emotion lability can destroy opportunities, relationships, and health. Treatments may provide some relief. However, depending on the cause of the lability, medications, therapies, and mindfulness may improve symptoms.

References:

Banaschewski, T., Jennen‐Steinmetz, C., Brandeis, D., Buitelaar, J., Kuntsi, J., Poustka, L., Sergeant, J., Sonuga‐Barke, E., Frazier‐Wood, A., Albrecht, B., Chen, W., Uebel, H., Schlotz, W., van der Meere, J., Gill, M., Manor, I., Miranda, A., Mulas, F., Oades, R., Roeyers, H., Rothenberger, A., Steinhausen, H., Faraone, S., & Asherson, P. (2012). Neuropsychological correlates of emotional lability in children with ADHD. The Journal of Child Psychology and Psychiatry, 53(11).

Cuncic, Arlin (2021). What is Emotional Lability. Verywellmind. Published 9-26-2021. Accessed 9-13-2022.

Ghaffar, O., Chamelian, L., & Feinstein, A. (2008). Neuroanatomy of pseudobulbar affect. Journal of Neurology, 255(3), 406-412.

Hill, C., & Updegraff, J. (2012). Mindfulness and Its Relationship to Emotional Regulation. Emotion, 12(1), 81-90.

Kazi, S., & Anwar, A. (2022). Pseudobulbar Affect Presenting as Aggressive Behavior. Cureus, 14(2).

Murphy, T. Franklin (2021). Diathesis Stress Model. Psychology Fanatic. Published 9-7-2021. Accessed 9-15-2022.

Murphy, T. Franklin (2021a) Reciprocal Determinism. Psychology Fanatic. Published 12-4-2021. Accessed 9-15-2022.

Oattes, N., Kosmerly, S., & Rogers, M. (2018). Parent Emotional Well-being and Emotion Lability in Young Children. Journal of Child and Family Studies, 27(11), 3658-3671.

​Overgaard, K., Oerbeck, B., Aase, H., Torgersen, S., Reichborn-Kjennerud, T., & Zeiner, P. (2018). Emotional Lability in Preschoolers With Symptoms of ADHD. Journal of Attention Disorders, 22(8), 787-795.​

Parincu, Zamfira  (2022). Emotional Lability: Definition, Symptoms, & Causes. Berkley Well-Being Institute. Accessed 9-13-2022

Schoenleber, M., Berghoff, C., Tull, M., DiLillo, D., Messman-Moore, T., & Gratz, K. (2016). Emotional Lability and Affective Synchrony in Borderline Personality Disorder. Personality Disorders: Theory, Research, and Treatment, 7(3), 211-220.

Walerius, D., Fogleman, N., & Rosen, P. (2016). The Role of ADHD and Negative Emotional Lability in Predicting Changes in Parenting Daily Hassles. Journal of Child and Family Studies, 25(7), 2279-2291.

(2012). Your medication information. The Brown University Psychopharmacology Update, 23(S4), I-II.

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