1. Health
You can opt-out at any time. Please refer to our privacy policy for contact information.

An In-Depth Look at IEED in Multiple Sclerosis

Involuntary Emotional Expression Disorder as a Symptom of MS


Updated June 18, 2014

This article examines a symptom that affects approximately 10% of people with multiple sclerosis (MS). Involuntary emotional expression disorder (IEED), also known as pseudobulbar affect, is characterized by outbursts of crying or laughter, but without corresponding emotions behind these outbursts.

In order to understand a little of what this may be like, put yourself in a couple of imaginary situations. Imagine if, without warning, you suddenly started weeping at a dinner party where you didn’t know many people. Even be more upsetting might be if you began laughing hysterically at an inappropriate time, like in church during a particularly solemn service. How would you feel when all eyes turned to you? How would you explain it?

IEED is often missed by physicians treating people with MS, because they assume the crying outbursts are a manifestation of depression, an extremely common symptom of MS. Indeed, many people with IEED are confused, frustrated and angry about the problem and this further leads to difficulty communicating with their doctors about it.

Help your doctor make the right diagnosis. Make sure that you tell your doctor if:

  • Your emotions don’t match your reactions
  • You don’t have thoughts of helplessness, hopelessness or guilt
  • You are not experiencing problems or changes in sleep or appetite
  • Your crying (or laughing) comes on and ends very suddenly
On the other hand, if you are feeling sad much of the time, and experiencing some of the problems mentioned above, such as negative thoughts or problems sleeping or changes in appetite, that might mean you have depression. Treatment of depression in MS can be managed effectively and can help you feel better.

I am happy to bring you the following full-text article, which examines this frustrating symptom in detail, as well as some reasons why it is often missed by docs and some treatment research. Additional discussion, including my Discussion and Bottom Line, can be found after the text of the article on Page 4.

This article, originally published in Applied Neurology and appearing on ConsultantLive.com, is made available to About.com users through a special collaboration with CMPMedica, publishers of this and other professional medical journals. For more information from journals your doctor may read, try searching on Search Medica, the search engine for medical professionals.

Involuntary Emotional Expression Disorder Often Misdiagnosed and Untreated

Article from Applied Neurology; August 01, 2007 Vol. 3 No. 8

Thomas S. May

THOMAS S. MAY is a freelance medical science writer in Thornhill, Ontario.

Involuntary emotional expression disorder (IEED) tends to be underdiagnosed and misdiagnosed by physicians and often remains untreated, according to a recent study that used a novel method to estimate its prevalence among patients with several different neurological disorders.1

IEED, also known as pseudobulbar affect, emotional lability, and pathological laughing and crying, is characterized by uncontrollable episodes of crying or laughter that are exaggerated or incongruent with the underlying mood. In addition, sudden, angry outbursts may occur in IEED.2 These episodes are often embarrassing and can be socially debilitating for the patient.

IEED has been associated with multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Parkinson disease (PD), traumatic brain injury (TBI), stroke, and Alzheimer disease (AD) and other dementias. According to some estimates, nearly 2 million persons may be affected in the United States.1


In a study presented on May 1, 2007, at the 59th Annual Meeting of the American Academy of Neurology in Boston, a research team led by Walter Bradley, DM, professor and chairman emeritus of the Department of Neurology, Miller School of Medicine, University of Miami, surveyed over 2000 patients (or their caregivers) with neurological diseases or injuries associated with IEED to determine the prevalence of this disorder.

Bradley and colleagues1 adopted a novel approach, which was to work with Harris Interactive (best known for the Harris Poll) and its online database of a nationally representative sample of American adults. The researchers identified from the Harris Interactive Chronic Illness Panel 2318 patients in whom 1 of 6 underlying neurological conditions (MS, PD, ALS, TBI, stroke, and AD and other dementias) had been diagnosed. Patients or their caregivers were then invited to participate in an online survey designed to estimate the prevalence of IEED in the 6 underlying diseases. Data were weighted to match the disease populations in the United States.

"This way of selecting patients differs from the standard clinic chart review and is perhaps a better way of obtaining community-wide data related to individual diseases and symptoms," Bradley said in an interview with Applied Neurology.

The investigators used 2 clinically validated scales: the Pathological Laughing and Crying Scale (PLACS) and the Center for Neurological Study Lability Scale (CNS-LS) to establish the prevalence of IEED. The surveys also collected information about patient-physician interaction regarding potential diagnosis and treatment of IEED.

The researchers used a cutoff score of 13 on the PLACS and 21 on the CNS-LS to distinguish between persons with or without IEED. The overall prevalence of IEED in the 6 diseases was estimated to be 10.1% (based on a PLACS score of 13 or greater) and 9.5% (based on a CNS-LS score of 21 or greater). These data indicate that between 1.8 and 1.9 million patients with neurological disorders in the United States experience comorbid IEED, based on estimates from various professional and governmental organizations of the number of persons affected by the 6 underlying neurological disorders.

  1. About.com
  2. Health
  3. Multiple Sclerosis
  4. Signs & Symptoms
  5. An In-Depth Look at IEED in Multiple Sclerosis

©2014 About.com. All rights reserved.

We comply with the HONcode standard
for trustworthy health
information: verify here.