Delusional disorder

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Delusional_disorder 

Delusional disorder
Other names	Paranoid disorder
Painting by Théodore Géricault portraying an old man with a grandiose delusion of power and military command. Grandiose delusions are common in delusional disorder.
Specialty	Psychiatry, clinical psychology
Symptoms	Strong false belief(s) despite superior evidence to the contrary
Usual onset	18–90 years old (mean of about age 40)
Types	Erotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type, unspecified type
Causes	Genetic and environmental
Risk factors	Family history, chronic stress, low SES, substance abuse
Differential diagnosis	Paranoid personality disorder, schizophrenia, bipolar disorder, substance-induced psychosis
Frequency	estimated 0.3% of general population

Delusional disorder is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily generally seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.

For the diagnosis to be made, auditory and visual hallucinations cannot be prominent, though olfactory or tactile hallucinations related to the content of the delusion may be present. The delusions cannot be due to the effects of a drug, medication, or general medical condition, and delusional disorder cannot be diagnosed in an individual previously properly diagnosed with schizophrenia. A person with delusional disorder may be high functioning in daily life. Recent and comprehensive meta-analyses of scientific studies point to an association between a deterioration in aspects of IQ in psychotic patients, in particular perceptual reasoning, although, the between-group differences were small.

According to German psychiatrist Emil Kraepelin, patients with delusional disorder remain coherent, sensible and reasonable. The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines six subtypes of the disorder characterized as erotomanic (belief that someone is in love with one), grandiose (belief that one is the greatest, strongest, fastest, richest, or most intelligent person ever), jealous (belief that one is being cheated on), persecutory (delusions that the person or someone to whom the person is close is being malevolently treated in some way), somatic (belief that one has a disease or medical condition), and mixed, i.e., having features of more than one subtype.

Delusions also occur as symptoms of many other mental disorders, especially the other psychotic disorders.

The DSM-IV and psychologists agree that personal beliefs should be evaluated with great respect to cultural and religious differences, since some cultures have widely accepted beliefs that may be considered delusional in other cultures.

An earlier, now obsolete, nosological name for delusional disorder was "paranoia".

Classification

The International Classification of Diseases classifies delusional disorder as a mental and behavioural disorder. Diagnosis of a specific type of delusional disorder can sometimes be made based on the content of the delusions, to wit, the Diagnostic and Statistical Manual of Mental Disorders (DSM) enumerates seven types:

• Erotomanic type (erotomania): delusion that another person, often a prominent figure, is in love with the individual. The individual may breach the law as they try to obsessively make contact with the desired person.
• Grandiose type (megalomania): delusion of inflated worth, power, knowledge, identity or believing oneself to be a famous person, claiming the actual person is an impostor or an impersonator.
• Jealous type: delusion that the individual's sexual partner is unfaithful when it is untrue. The patient may follow the partner, check text messages, emails, phone calls etc. in an attempt to find "evidence" of the infidelity.
• Persecutory type: This delusion is a common subtype. It includes the belief that the person (or someone to whom the person is close) is being malevolently treated in some way. The patient may believe that they have been drugged, spied upon, harmed, harassed and so on and may seek "justice" by making reports, taking action or even acting violently.
• Somatic type: delusions that the person has some physical defect or general medical condition
• Mixed type: delusions with characteristics of more than one of the above types but with no one theme predominating.
• Unspecified type: delusions that cannot be clearly determined or characterized in any of the categories in the specific types.

Signs and symptoms

The following can indicate a delusion:

1. An individual expresses an idea or belief with unusual persistence or force, even when evidence suggests the contrary.
2. That idea appears to have an undue influence on the person's life, and the way of life is often altered to an inexplicable extent.
3. Despite their profound conviction, there is often a quality of secretiveness or suspicion when the person is questioned about it.
4. The individual tends to be humorless and oversensitive, especially about the belief.
5. There is a quality of centrality: no matter how unlikely it is that these strange things are happening to the person, he or she accepts them relatively unquestioningly.
6. An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility. They will not accept any other opinions.
7. The belief is, at the least, unlikely, and out of keeping with the individual's social, cultural, and religious background.
8. The person is emotionally over-invested in the idea and it overwhelms other elements of his or her psyche.
9. The delusion, if acted out, often leads to behaviors which are abnormal, and out of character, although perhaps understandable in light of the delusional beliefs.
10. Other people who know the individual observe that the belief and behavior are uncharacteristic and alien.

Additional features of delusional disorder include the following:

1. It is a primary disorder.
2. It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity.
3. The illness is chronic and frequently lifelong.
4. The delusions are logically constructed and internally consistent.
5. The delusions do not interfere with general logical reasoning (although within the delusional system the logic is perverted) and there is usually no general disturbance of behavior. If disturbed behavior does occur, it is directly related to the delusional beliefs.
6. The individual experiences a heightened sense of self-reference. Events which, to others, are nonsignificant are of enormous significance to him or her, and the atmosphere surrounding the delusions is highly charged.

However this should not be confused with gaslighting, where a person denies the truth, and causes the one being gaslit to think that they are being delusional.

Causes

The cause of delusional disorder is unknown, but genetic, biochemical, and environmental factors may play a significant role in its development. Some people with delusional disorders may have an imbalance in neurotransmitters, the chemicals that send and receive messages to the brain. There does seem to be some familial component, and immigration (generally for persecutory reasons), drug abuse, excessive stress, being married, being employed, low socioeconomic status, celibacy among men, and widowhood among women may also be risk factors. Delusional disorder is currently thought to be on the same spectrum or dimension as schizophrenia, but people with delusional disorder, in general, may have less symptomatology and functional disability.

Diagnosis

Differential diagnosis includes ruling out other causes such as drug-induced conditions, dementia, infections, metabolic disorders, and endocrine disorders. Other psychiatric disorders must then be ruled out. In delusional disorder, mood symptoms tend to be brief or absent, and unlike schizophrenia, delusions are non-bizarre and hallucinations are minimal or absent.

Interviews are important tools to obtain information about the patient's life situation and history to help make a diagnosis. Clinicians generally review earlier medical records to gather a full history. Clinicians also try to interview the patient's immediate family, as this can be helpful in determining the presence of delusions. The mental status examination is used to assess the patient's current mental condition.

A psychological questionnaire used in the diagnosis of the delusional disorder is the Peters Delusion Inventory (PDI) which focuses on identifying and understanding delusional thinking. However, this questionnaire is more likely used in research than in clinical practice.

In terms of diagnosing a non-bizarre delusion as a delusion, ample support should be provided through fact checking. In case of non-bizarre delusions, Psych Central notes, "All of these situations could be true or possible, but the person suffering from this disorder knows them not to be (e.g., through fact-checking, third-person confirmation, etc.)."

Treatment

A challenge in the treatment of delusional disorders is that most patients have limited insight, and do not acknowledge that there is a problem. Most patients are treated as out-patients, although hospitalization may be required in some cases if there is a risk of harm to self or others. Individual psychotherapy is recommended rather than group psychotherapy, as patients are often quite suspicious and sensitive. Antipsychotics are not well tested in delusional disorder, but they do not seem to work very well, and often have no effect on the core delusional belief. Antipsychotics may be more useful in managing agitation that can accompany delusional disorder. Until further evidence is found, it seems reasonable to offer treatments which have efficacy in other psychotic disorders.

Psychotherapy for patients with delusional disorder can include cognitive therapy which is conducted with the use of empathy. During the process, the therapist can ask hypothetical questions in a form of therapeutic Socratic questioning. This therapy has been mostly studied in patients with the persecutory type. The combination of pharmacotherapy with cognitive therapy integrates treating the possible underlying biological problems and decreasing the symptoms with psychotherapy as well. Psychotherapy has been said to be the most useful form of treatment because of the trust formed in a patient and therapist relationship.

Supportive therapy has also been shown to be helpful. Its goal is to facilitate treatment adherence and provide education about the illness and its treatment.

Furthermore, providing social skills training has been found to be helpful for many people. It can promote interpersonal competence as well as confidence and comfort when interacting with those individuals perceived as a threat.

Insight-oriented therapy is rarely indicated or contraindicated; yet there are reports of successful treatment. Its goals are to develop therapeutic alliance, containment of projected feelings of hatred, powerlessness, and badness; measured interpretation as well as the development of a sense of creative doubt in the internal perception of the world. The latter requires empathy with the patient's defensive position.

Epidemiology

Delusional disorders are uncommon in psychiatric practice, though this may be an underestimation due to the fact that those with the condition lack insight and thus avoid psychiatric assessment. The prevalence of this condition stands at about 24 to 30 cases per 100,000 people while 0.7 to 3.0 new cases per 100,000 people are reported every year. Delusional disorder accounts for 1–2% of admissions to inpatient mental health facilities. The incidence of first admissions for delusional disorder is lower, from 0.001 to 0.003%.

Delusional disorder tends to appear in middle to late adult life, and for the most part first admissions to hospital for delusional disorder occur between age 33 and 55. It is more common in women than men, and immigrants seem to be at higher risk.

Criticism

In some situations the delusion may turn out to be true belief. For example, in delusional jealousy, where a person believes that the partner is being unfaithful (in extreme cases perhaps going so far as to follow the partner into the bathroom, believing the other to be seeing a lover even during the briefest of separations), it may actually be true that the partner is having sexual relations with another person. In this case, the delusion does not cease to be a delusion because the content later turns out to be verified as true or the partner actually chose to engage in the behavior of which they were being accused.

In other cases, the delusion may be mistakenly assumed to be false by a doctor or psychiatrist assessing the belief, just because it seems to be unlikely, bizarre or held with excessive conviction. Psychiatrists rarely have the time or resources to check the validity of a person's claims leading to some true beliefs to be erroneously classified as delusional. This is known as the Martha Mitchell effect, after the wife of the attorney general who alleged that illegal activity was taking place in the White House. At the time, her claims were thought to be signs of mental illness, and only after the Watergate scandal broke was she proved right (and hence sane).

Similar factors have led to criticisms of Jaspers' definition of true delusions as being ultimately 'un-understandable'. Critics (such as R. D. Laing) have argued that this leads to the diagnosis of delusions being based on the subjective understanding of a particular psychiatrist, who may not have access to all the information that might make a belief otherwise interpretable.

Another difficulty with the diagnosis of delusions is that almost all of these features can be found in "normal" beliefs. Many religious beliefs hold exactly the same features, yet are not universally considered delusional. For instance, if a person was holding a true belief then they will of course persist with it. This can cause the disorder to be misdiagnosed by psychiatrists. These factors have led the psychiatrist Anthony David to write that "there is no acceptable (rather than accepted) definition of a delusion."

In popular culture

In the 2010 psychological thriller Shutter Island, directed by Martin Scorsese and starring Leonardo DiCaprio, delusional disorder is portrayed along with other disorders. An Indian movie Anantaram (Thereafter) directed by Adoor Gopalakrishnan also portrays the complex nature of delusions. The plot of the French movie He Loves Me... He Loves Me Not revolves around a case of erotomania, as does the plot of the Ian McEwan novel, Enduring Love.

Commercialization of love

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Commercialization_of_love

Romance-themed jello

The notion of commercialization of love, that is not to be confused with prostitution (the commercialization of sexual activity), involves the definitions of romantic love and consumerism.

Sociological development

The commercialization of love is the ongoing process of infiltration of commercial and economical stimuli in the daily life of lovers and the association of monetary and non-monetary symbols and commodities in the love relationships.

The application of Habermas’ theory is helpful to fully understand the discussion of the relationship between the market and love. From the model of a two-tiered society postulated by Habermas (comprising the sphere of the systems and the life-world), Frankfurt School has affirmed that when romantic stimuli made with commercial proposes infiltrate the daily life of lovers it causes an undesired colonization of the life-world, thus reaffirming the irreducible contradiction between the economy and love.

In contemporary societies, the economy is present in several spheres of love, offering cultural products that embody its ideals and feelings and providing the contexts in which to experience the romantic rituals (i.e. love manuals, sex therapists and marriage crisis counselors).

Romantic love can be defined, according to Sérgio Costa, as a historical-cultural model that branches into five dimensions:

• In the field of the emotions, romantic love expresses itself in “a bond with the other that knows no more ardent desire than the yearning to lead one's own life in the body of the loved one”.
• As an idealization, it promises the individual full recognition of the others’ singularities (dimensions, peculiarities and individual idiosyncrasies).
• As a relationship model, it historically combines a fusion of sexual passion and emotional affection (i.e. marriage, love and family).
• As a cultural practice, romantic love corresponds to a repertoire of discourses, actions and rituals by means of which amorous emotions are evoked, perceived, transmitted and intensified.
• On the subject of social interactions, it corresponds to a radicalized form of what Luhmann described as "interpersonal interpenetration".

Two sociologists, in particular, have debated and analyzed in depth the theme of commercialization of love related to our society: Eva Illouz and Arlie R. Hochschild.

Eva Illouz

Eva Illouz is a professor of sociology at the Hebrew University of Jerusalem. Illouz's research has always focused on several different topics and themes such as the study of culture, communication and especially emotions. In particular, the theme of commercialization, or commodification, of love is well analyzed in her first book Consuming the Romantic Utopia, where indeed she describes how capitalism has transformed emotional patterns. At the beginning of the book, it is examined how romantic love has changed during time also due to the newly expanding mass markets of leisure. This change lead to the creation of a new process called romanticization of commodities, that is a process in which commodities played a crucial role in experiencing emotions such as love or romance. In the 1930s, commodities of any kind such as jewelry, household appliances and even basic generic products were advertised in newspapers, magazines and also in movies as essential indicators that will enable people to fully live and experience romance. Throughout the book, Illouz deals also with another process: the commodification of romance. She states that the practice of “dating” replaced the practice of “calling on a woman” and going to her parents’ house and it consequently moved romantic encounters from the home sphere to the sphere of consumption, that is going out on a date for example to the cinema or to have dinner in a fancy restaurant. The inscription of the romantic encounter into the leisure consumption’s sphere, due to the practice of dating, marked the entrance of romance in the market. All this was made possible, on one hand, by the availability of some goods and services such as cars or leisure travels that, until then, were reserved to the upper classes and, on the other, by the middle-classes’ adoption of the working class’ entertainments, such as going to the movie theatre.

A.R. Hochschild

Arlie Russell Hochschild is a sociologist and a professor emerita at the Berkeley University of California. During her career, she studied and examined topics like market culture, family global patterns of care work, and the relationships between culture and emotion.

She analyzed the linkage between love and market in several works, including The Outsourced Self: Intimate Life in Market Times (2012) and The Commercialization of Intimate Life: Notes from Home and Work (2003).

In her essay "The Commodity Frontier" (contained in The Commercialization of Intimate Life: Notes from Home and Work), she argued that the commodity frontier (the boundary between market commodities and emotions) has a double aspect: it is developed by both the market-place and the family. On the market side, this frontier represents for commercial companies an opportunity to develop new markets for products that in the past were associated with the familiar environment in the past (for example nannies, birthday party planners, personal chefs and so on). On the other hand, the supply of the products increases, with a growing number of families wants or desires to consume these services and goods. This particular market targets above all single men and women, or parents who spend most of their time working outside the house, without being able to devote their time to family or emotional relationships’ care. These services have become affordable for rich people, while on the other side, lower or middle class members occupy these jobs positions. Besides, “in their more recent incarnation, the commercial substitutes family activities often turn out to be better than the real thing”. Therefore, companies do not compete against each other, but with families. Commodification is moving into the domain of our private life and desires, creating an ambivalence; by purchasing goods and services that simulate family-like experience, we want, on one hand, to live some authentic experiences, like the one we experienced in the past with our family, but at the same time, we are enhancing the commodification of these practices by drawing upon these services.

Examples in modern society

Valentine’s day

Valentine's Day, also known as Saint Valentine's Day, is a religious celebration observed on 14 February each year, also if in some countries it is celebrated in different occasions. In Russia and in the Eastern Orthodox Church in general Valentines’ day is celebrated on 6 and 30 July, while in Brazil the Dia de São Valentim is recognized on 12 June. During this day, traditionally, lovers exchange symbols and commodities to show their sentiments to each other. This tradition developed during the 19th century in England, where people started to express their love for each other by donating flowers, offering sweets and exchanging handwritten greeting cards (known as "valentines"), that rapidly were replaced with mass-produced ones. In the later 20th and early 21st centuries, this Valentine's Day tradition spread to other countries, arriving in some East Asian countries with globalization and concentrated marketing strategies, becoming a worldwide celebration differentiated in each country with several peculiarities and behaviors.

Online dating

Internet has revolutionized courtship by becoming the biggest love mall around here. Nowadays finding love is considered a work and a lot of people do not think they are able to do it on their own. For this reason single people see dating websites as a support that will help them to find the perfect partner. Finding your soulmates and sexual chemistry are exactly the core ideas, the pillars at the bottom of love seekers’ industry. In fact, dating websites’ users behave like shoppers: they have a list of desired qualities and or physical characteristics they look for in a partner; you have only few seconds to brand yourself, make a good impression and be chosen among thousands of other people before being rejected with a click. Internet dating isn’t always as rewarding as it may appear: sometimes people remain hurt because they invest money, time and feelings in it but they still can’t find the “right” person or face problems with users who lie about their age, drug habits or marital status. Some websites, by embracing the spirit of capitalism and applying statistics to love, even provide their “clients” with surveys using pie charts, graph or rating systems such as ROI and CSI (Couple Satisfaction Index). The industry of love has also devoted some websites to matching daters by religion, ethnicity, sexual orientation, disabilities and even level of intelligence.

Outsourcing of care and love

In her essay “Love and Gold”, Hochschild explains that nowadays the world is facing a particular global trend: care and love importation from poor countries to rich nations is increasing sharply. Professionals from the developing countries leave their workplaces for better job opportunities and higher salaries in richer countries, usually in Europe or in the United States. However, this trend widens the gap between poor and rich countries. Today, there is a parallel trend, in which care workers started to leave developing countries to care for children, elders, and sick people in richer nations. Therefore, due to the growing demand for care workers, a large number of women is migrating in order to find jobs as nurses, nannies, and so on. These jobs allow women to send home enough money to sustain their families; in the words of Hochschild: “migration has become a private solution to a public problem”.

Half of the world's migrants are now constituted by women, who emigrate to find mostly domestic jobs. In this process, not only time and energy are involved, but also love; in this situation, we can consider love as a resource that is extracted from one place and "consumed" somewhere else. As reported by Hochschild : "If love is a resource, it's a renewable resource; it creates more of itself". Love and feelings are profitable resources, but we do not invest feelings, we find a new object towards to redirect it.

The richest/upper-class families invite nannies to displace their love towards their own children; many families welcome the fact that the nanny would import her native culture values. They identify their care practices as more relaxed, patient and joyful.

Love as a resource is not just extracted from poor countries and then imported in the richest ones. It is created, or rather assembled, with elements that come from both cultural environments. The love that nannies express, once migrated, towards children i is partially produced in the richer countries, and it is also the outcome of money, ideology, loneliness and yearning for their sons and daughters. The suffering of these women is not visible to the nannies’ employers; they just focus on the love that nannies show towards their children. Therefore, nanny’s love becomes a "thing itself. It is unique, private – fetishized". While objectifying a concept, we start to consider it outside its natural context. By isolating the concept of care from the context in which is produced, we unconsciously separate the logic of nanny love from the economic and capitalist context in which is created.

Broken heart

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Broken_heart 

 

1938 poster for an adaptation of Avery Hopwood's Why Men Leave Home, showing a physically cracked heart symbol as a metaphor for unhappiness in love

Broken heart (also known as a heartbreak or heartache) is a metaphor for the intense emotional stress or pain one feels at experiencing great and deep longing. The concept is cross-cultural, often cited with reference to unreciprocated or lost love.

Failed romantic love can be extremely painful; people with a broken heart may succumb to depression, anxiety and, in more extreme cases, post-traumatic stress disorder.

Physiology

The intense pain of a broken heart is believed to be part of the survival instinct. The "social-attachment system" uses the "pain system" to encourage humans to maintain their close social relationships by causing pain when those relationships are lost. Psychologists Geoff MacDonald of the University of Queensland and Mark Leary of Wake Forest University proposed in 2005 the evolution of common mechanisms for both physical and emotional pain responses and argue that such expressions are "more than just a metaphor". The concept is believed to be universal, with many cultures using the same words to describe both physical pain and the feelings associated with relationship loss.

The neurological process involved in the perception of heartache is not known, but is thought to involve the anterior cingulate cortex of the brain, which during stress may overstimulate the vagus nerve causing pain, nausea or muscle tightness in the chest. Research by Naomi Eisenberger and Matthew Lieberman of the University of California from 2008 showed that rejection is associated with activation of the dorsal anterior cingulate cortex and right-ventral pre-frontal cortex, areas established as being involved in processing of pain, including empathizing with pain experienced by others. The same researchers mention effect of social stressors on the heart, and personality on perception of pain.

A 2011 study showed that the same regions of the brain that become active in response to painful sensory experiences are activated during intense social rejection or social loss in general. Social psychologist Ethan Kross from University of Michigan, who was heavily involved in the study, said, "These results give new meaning to the idea that social rejection hurts". The research implicates the secondary somatosensory cortex and the dorsal posterior insula.

Psychology

Uncomplicated grief

For most bereaved individuals, the journey through grief will ultimately culminate in an acceptable level of adjustment to a life without their loved one. The Kübler-Ross model postulates that there are five stages of grief after the loss of a loved-one: denial, anger, bargaining, depression and acceptance. And while it is recognized that mourners go through initial period of numbness leading to depression and finally to reorganization and recovery, most modern grief specialists recognize the variations and fluidity of grief experiences differ considerably in intensity and length among cultural groups, individually from person to person as well as depending on the amount of investment put into the relationship.

Ruminating, or having intrusive thoughts that are continuous, uncontrollable, and distressing, is often a component of grieving. John Bowlby's concept of "searching for the lost object" is about the anxiety and mounting frustration as the mourner remains lost, frequently sifting through memories of the departed, and perhaps fleeting perceptions of spectral visitations by the lost individual. When the loss involves 'being left' or 'unrequited love', in addition to the above, this mental searching is accompanied by obsessive thoughts about factors leading to the breakup, and possibilities for reuniting with the lost individual. When rejection is involved, shame may also be involved – the painful feeling of being inherently unacceptable, disposable, unworthy.

The physical signs of grieving include:

1. Exhaustion, muscle tightness or weakness, body pains, fidgety restlessness, lack of energy
2. Insomnia, sleeping too much, disturbing dreams
3. Loss of appetite, overeating, nausea, "hollow stomach", indigestion, intestinal disorders like diarrhea, excessive weight gain or loss
4. Headaches, short of breath, chest pressure, tightness or heaviness in the throat

Depression

A broken heart is a major stressor and has been found to precipitate episodes of major depression. In one study (death of a spouse), 24% of mourners were depressed at two months, 23% at seven months, 16% at 13 months and 14% at 25 months.

Although there are overlapping symptoms, uncomplicated grief can be distinguished from a full depressive episode. Major depression tends to be more pervasive and is characterized by significant difficulty in experiencing self-validating and positive feelings. Major depression is composed of a recognizable and stable cluster of debilitating symptoms, accompanied by a protracted, enduring low mood. It tends to be persistent and associated with poor work and social functioning, pathological immunological function, and other neurobiological changes unless treated.

In relationship breakups, mourners may turn their anger over the rejection toward themselves. This can deepen their depression and cause narcissistic wounding. The process of self-attack can range from mild self-doubt to scathing self-recrimination which leaves a lasting imprint on an individual's self-worth and causes them to doubt their lovability, personality-efficacy, and attachment worthiness going forward.

Psychological trauma

In severe cases, the depression of a broken heart can create a sustained type of stress that constitutes an emotional trauma which can be severe enough to leave an emotional imprint on individuals' psychobiological functioning, affecting future choices and responses to rejection, loss, or disconnection. A contributing factor to the trauma-producing event is that 'being left' can trigger primal separation fear – the fear of being left with no one to take care of one's vital needs.

Mourners may also experience the intense stress of helplessness. If they make repeated attempts to compel their loved one to return and are unsuccessful, they will feel helpless and inadequate to the task. Feeling one's 'limited capacity' can produce a fault line in the psyche which renders the person prone to heightened emotional responses within primary relationships.

Another factor contributing to the traumatic conditions is the stress of losing someone with whom the mourner has come to rely in ways they did not realize. For instance, in time, couples can become external regulators for one another, attuned on many levels: pupils dilated in synchrony, echoing one another's speech patterns, movements, and even cardiac and EEG rhythms. Couples can function like a mutual bio-feedback system, stimulating and modulating each other's bio rhythms, responding to one another's pheromones, and be addicted due to the steady trickle of endogenous opiates induced by the relationship.

Post-traumatic stress disorder

Research has shown that in extreme cases, some who experience a broken heart go on to develop posttraumatic stress disorder (PTSD).

There are various predisposing psycho-biological and environmental factors that determine whether one's earlier emotional trauma might lead to the development of a true clinical picture of posttraumatic stress disorder. This would lower their threshold for becoming aroused and make them more likely to become anxious when they encounter stresses in life that are reminiscent of childhood separations and fears, hence more prone to becoming posttraumatic.

Another factor is that insecure attachments in childhood have shown to predispose the individuals to difficulties in forming secure attachments in adulthood and to having heightened responses to rejection and loss.

There is also variation in individuals' neurochemical systems that govern the stress regulation. Depending on the severity of the stress response induced in an individual by an event (i.e. a romantic breakup), certain concentrations of stress hormones including CRF, ACTH, and cortisol work to intensify the imprinting of an emotional memory of the event, indelibly inscribing its fears and other sensations in the amygdala (to serve as a warning for future events), while the same stress hormones can act to impede.

Medical complications

Broken heart syndrome

Main article: Takotsubo cardiomyopathy

In many legends and fictional tales, characters die after suffering a devastating loss; however, even in reality people die from what appears to be a broken heart. Takotsubo cardiomyopathy or Broken heart syndrome is commonly described as a physical pain in the chest or heart or stomach area, which is due to the emotional stress caused by a traumatic breakup or the death of a loved one.

Broken heart syndrome mimics symptoms of a heart attack, but it is clinically different from a heart attack because the patients have few risk factors for heart disease and were previously healthy prior to the heart muscles weakening. Some echocardiograms expressed how the left ventricle, of people with the broken heart syndrome, was contracting normally but the middle and upper sides of the heart muscle had weaker contractions due to inverted T waves and longer Q-T intervals that are associated with stress. Magnetic resonance images suggested that the recovery rates for those with broken heart syndrome are faster than those who had heart attacks and complete recovery to the heart is achieved within two months.

Endocrine and immune dysfunction

Physiological and biochemical changes that contribute to higher physical illnesses and heart disease have been found in individuals that have high levels of anxiety and depression. Some individuals who have divorced have compromised immune systems because of inflammatory cytokines followed by a state of depression.

Cultural references

The sentiment is expressed in a collection of Sumerian proverbs:

May Inana pour oil on my heart that aches.

Biblical references to the pain of a broken heart date back to 1015 BC.

Insults have broken my heart and left me weak, I looked for sympathy but there was none; I found no one to comfort me

— Psalm 69:20

Rudaki, regarded as the first great genius of Persian poetry, used broken heart imagery in his writing.

Look at the cloud, how it cries like a grieving man
Thunder moans like a lover with a broken heart.

Shakespeare's play Antony and Cleopatra features a character, Enobarbus, who dies of a broken heart after betraying a friend. Lady Montague dies of a broken heart after the banishment of her son in Romeo and Juliet.

Frida Kahlo's 1937 painting Memory, the Heart portrays the artist's heartbreak during and after an affair between her husband and her sister.

Euphemism

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Euphemism

Sign in a Rite Aid drugstore using common euphemisms for (from top) contraceptives, douches, pads and tampons, and adult diapers, respectively

A euphemism (/ˈjuːfɪˌmɪzəm/) is an innocuous word or expression used in place of one that is deemed offensive or suggests something unpleasant. Some euphemisms are intended to amuse, while others use bland, inoffensive terms for concepts that the user wishes to downplay. Euphemisms may be used to mask profanity or refer to topics some consider taboo such as disability, sex, excretion, or death in a polite way.

Etymology

Euphemism comes from the Greek word euphemia (εὐφημία) which refers to the use of 'words of good omen'; it is a compound of eû (εὖ), meaning 'good, well', and phḗmē (φήμη), meaning 'prophetic speech; rumour, talk'. Eupheme is a reference to the female Greek spirit of words of praise and positivity, etc. The term euphemism itself was used as a euphemism by the ancient Greeks; with the meaning "to keep a holy silence" (speaking well by not speaking at all).

Purpose

Avoidance

Reasons for using euphemisms vary by context and intent. Commonly, euphemisms are used to avoid directly addressing subjects that might be deemed negative or embarrassing, e.g. death, sex, excretory bodily functions. They may be created for innocent, well-intentioned purposes or nefariously and cynically, intentionally to deceive and confuse.

Mitigation

Euphemisms are also used to mitigate, soften or downplay the gravity of large-scale injustices, war crimes, or other events that warrant a pattern of avoidance in official statements or documents. For instance, one reason for the comparative scarcity of written evidence documenting the exterminations at Auschwitz, relative to their sheer number, is "directives for the extermination process obscured in bureaucratic euphemisms".

Euphemisms are sometimes used to lessen the opposition to a political move. For example, according to linguist Ghil'ad Zuckermann, former Israeli Prime Minister Benjamin Netanyahu used the neutral Hebrew lexical item פעימות peimót ("beatings (of the heart)"), rather than נסיגה nesigá ("withdrawal"), to refer to the stages in the Israeli withdrawal from the West Bank (see Wye River Memorandum), in order to lessen the opposition of right-wing Israelis to such a move. The lexical item פעימות peimót, which literally means "beatings (of the heart)" is thus a euphemism for "withdrawal".

Rhetoric

Euphemism may be used as a rhetorical strategy, in which case its goal is to change the valence of a description.

Controversial use

The act of labeling a term as a euphemism can in itself be controversial, as in the following two examples:

• Affirmative action, meaning a preference for minorities or the historically disadvantaged, usually in employment or academic admissions. This term is sometimes said to be a euphemism for reverse discrimination, or, in the UK, positive discrimination, which suggests an intentional bias that might be legally prohibited, or otherwise unpalatable.
• Enhanced interrogation is sometimes said to be a euphemism for torture. For example, columnist David Brooks called the use of this term for practices at Abu Ghraib, Guantánamo, and elsewhere an effort to "dull the moral sensibility".

Formation methods

Phonetic modification

Phonetic euphemism is used to replace profanities and blasphemies, diminishing their intensity. Modifications include:

• Shortening or "clipping" the term, such as Jeez (Jesus) and what the— ("what the hell").
• Mispronunciations, such as oh my gosh ("oh my God"), frickin ("fucking"), darn ("damn") or oh shoot ("oh shit"). This is also referred to as a minced oath.
• Using acronyms as replacements, such as SOB ("son of a bitch"). Sometimes, the word "word" or "bomb" is added after it, such as F-word ("fuck"), etc. Also, the letter can be phonetically respelled.

Pronunciation

To alter the pronunciation or spelling of a taboo word (such as a swear word) to form a euphemism is known as taboo deformation, or a minced oath. Feck is a minced oath originating in Hiberno-English and popularised outside of Ireland by the British sitcom Father Ted. Some examples of Cockney rhyming slang may serve the same purpose: to call a person a berk sounds less offensive than to call a person a cunt, though berk is short for Berkeley Hunt, which rhymes with cunt.

Understatement

Euphemisms formed from understatements include: asleep for dead and drinking for consuming alcohol. "Tired and emotional" is a notorious British euphemism for "drunk", one of many recurring jokes popularised by the satirical magazine Private Eye; it has been used by MPs to avoid unparliamentary language.

Substitution

Pleasant, positive, worthy, neutral, or nondescript terms are often substituted for explicit or unpleasant ones, with many substituted terms deliberately coined by sociopolitical movements, marketing, public relations, or advertising initiatives, including:

• "meat packing company" for "slaughter-house" (avoids entirely the subject of killing); "natural issue" or "love child" for "bastard"; "let go" for "fired", etc.

Over time, it becomes socially unacceptable to use the latter word, as one is effectively downgrading the matter concerned to its former lower status, and the euphemism becomes dominant, due to a wish not to offend.

Metaphor

• Metaphors (beat the meat, choke the chicken, or jerkin' the gherkin for masturbation; take a dump and take a leak for defecation and urination, respectively)
• Comparisons (buns for buttocks, weed for cannabis)
• Metonymy (men's room for "men's toilet")

Slang

See also: Slang

The use of a term with a softer connotation, though it shares the same meaning. For instance, screwed up is a euphemism for fucked up; hook-up and laid are euphemisms for sexual intercourse.

Foreign words

Expressions or words from a foreign language may be imported for use as euphemism. For example, the French word enceinte was sometimes used instead of the English word pregnant; abattoir for "slaughter-house", although in French the word retains its explicit violent meaning "a place for beating down", conveniently lost on non-French speakers. "Entrepreneur" for "business-man", adds glamour; "douche" (French: shower) for vaginal irrigation device; "bidet" (French: little pony) for "vessel for intimate ablutions". Ironically, although in English physical "handicaps" are almost always described with euphemism, in French the English word "handicap" is used as a euphemism for their problematic words "infirmité" or "invalidité".

Periphrasis/circumlocution

Periphrasis, or circumlocution, is one of the most common: to "speak around" a given word, implying it without saying it. Over time, circumlocutions become recognized as established euphemisms for particular words or ideas.

Doublespeak

Main article: Doublespeak

Bureaucracies frequently spawn euphemisms intentionally, as doublespeak expressions. For example, in the past, the US military used the term "sunshine units" for contamination by radioactive isotopes. Even today, the United States Central Intelligence Agency refers to systematic torture as "enhanced interrogation techniques". An effective death sentence in the Soviet Union during the Great Purge often used the clause "imprisonment without right to correspondence": the person sentenced would be shot soon after conviction. As early as 1939, Nazi official Reinhard Heydrich used the term Sonderbehandlung ("special treatment") to mean summary execution of persons viewed as "disciplinary problems" by the Nazis even before commencing the systematic extermination of the Jews. Heinrich Himmler, aware that the word had come to be known to mean murder, replaced that euphemism with one in which Jews would be "guided" (to their deaths) through the slave-labor and extermination camps after having been "evacuated" to their doom. Such was part of the formulation of Endlösung der Judenfrage (the "Final Solution to the Jewish Question"), which became known to the outside world during the Nuremberg Trials.

Lifespan

Negro is an example of a once-innocuous euphemism that has become outdated and offensive.

Frequently, over time, euphemisms themselves become taboo words, through the linguistic process of semantic change known as pejoration, which University of Oregon linguist Sharon Henderson Taylor dubbed the "euphemism cycle" in 1974, also frequently referred to as the "euphemism treadmill". For instance, the act of human defecation is possibly the most needy candidate for a euphemism in all eras. Toilet is an 18th-century euphemism, replacing the older euphemism house-of-office, which in turn replaced the even older euphemisms privy-house and bog-house. In the 20th century, where the old euphemisms lavatory (a place where one washes) or toilet (a place where one dresses) had grown from widespread usage (e.g., in the United States) to being synonymous with the crude act they sought to deflect, they were sometimes replaced with bathroom (a place where one bathes), washroom (a place where one washes), or restroom (a place where one rests) or even by the extreme form powder room (a place where one applies facial cosmetics). The form water closet, which in turn became euphemised to W.C., is a less deflective form.

Another example in American English is the replacement of "colored people" with "Negro" (euphemism by foreign language), which itself came to be replaced by either "African American" or "Black".

Venereal disease, which associated shameful bacterial infection with a seemingly worthy ailment emanating from Venus the goddess of love, soon lost its deflective force in the post-classical education era, as "VD", which was replaced by the three-letter initialism "STD" (sexually transmitted disease); later, "STD" was replaced by "STI" (sexually transmitted infection). (This disease/infection is not the only one that is transmissible through sexual contact, so the terms STD and STI are also more general.)

The word shit appears to have originally been a euphemism for defecation in Pre-Germanic, as the Proto-Indo-European root *sḱeyd-, from which it was derived, meant 'to cut off'.

Mentally disabled people were originally defined with words such as "morons" or "imbeciles", which then became commonly used insults. The medical diagnosis was changed to "mentally retarded", which morphed into a pejorative against those with mental disabilities. To avoid the negative connotations of their diagnoses, students who need accommodations because of such conditions are often labeled as "special needs" instead, although the word "special" has begun to crop up as a schoolyard insult. As of August 2013, the Social Security Administration replaced the term "mental retardation" with "intellectual disability". Since 2012, that change in terminology has been adopted by the National Institutes of Health and the medical industry at large. There are numerous disability-related euphemisms that have negative connotations.

Pseudobulbar affect

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Pseudobulbar_affect

Pseudobulbar affect
Other names	Emotional incontinence
Specialty	Psychiatry, neurology
Causes	Brain trauma, ALS

Pseudobulbar affect (PBA), or emotional incontinence, is a type of emotional disturbance characterized by uncontrollable episodes of crying, laughing, anger or other emotional displays. PBA occurs secondary to a neurologic disorder or brain injury. Patients may find themselves crying uncontrollably at something that is only moderately sad, being unable to stop themselves for several minutes. Episodes may also be mood-incongruent: a patient may laugh uncontrollably when angry or frustrated, for example. Sometimes, the episodes may switch between emotional states, resulting in the patient crying uncontrollably before dissolving into fits of laughter.

The pseudobulbar affect, also referred to as emotional lability, should not be confused with labile mood or labile emotions that stem from emotional instability – affective dysregulation – commonly seen in mental illnesses and certain personality disorders.

Signs and symptoms

The cardinal feature of the disorder is a pathologically lowered threshold for exhibiting the behavioral response of laughter, crying, anger or all of the above. An affected individual exhibits episodes of laughter, crying, anger or a combination of these without an apparent motivating stimulus or in response to stimuli that would not have elicited such an emotional response before the onset of their underlying neurologic disorder. In some patients, the emotional response is exaggerated in intensity but is provoked by a stimulus with an emotional valence congruent with the character of the emotional display. For example, a sad stimulus provokes a pathologically exaggerated weeping response instead of a sigh, which the patient normally would have exhibited in that particular instance.

However, in some other patients, the character of the emotional display can be incongruent with, and even contradictory to, the emotional valence of the provoking stimulus or may be incited by a stimulus with no clear valence. For example, a patient may laugh in response to sad news or cry in response to stimuli with no emotional undertone, or, once provoked, the episodes may switch from laughing to crying or vice versa.

The symptoms of PBA can be severe, with persistent and unremitting episodes. Characteristics include:

• The onset can be sudden and unpredictable, and has been described by some patients as coming on like a seizure;
• The outbursts have a typical duration of a few seconds to several minutes; and,
• The outbursts may happen several times a day.

Many people with neurologic disorders exhibit uncontrollable episodes of laughing, crying, or anger that are either exaggerated or contradictory to the context in which they occur. Where patients have significant cognitive deficits (e.g., Alzheimer's) it can be unclear whether it is true PBA as opposed to a grosser form of emotional dysregulation, but patients with intact cognition often report the symptom as disturbing. Patients report that their episodes are at best only partially amenable to voluntary control, and unless they experience a severe change of mental status, as in traumatic brain injury they often have insight into their problem and judge their emotional displays as inappropriate and out of character. The clinical effect of PBA can be severe, with unremitting and persistent symptoms that can be disabling to patients, and may significantly affect quality of life for caregivers.

Social impact

While not as profoundly disabling as the physical symptoms of these diseases, PBA may significantly influence individuals' social functioning and their relationships with others. Such sudden, frequent, extreme, uncontrollable emotional outbursts may lead to social withdrawal and interfere with activities of daily living, social and professional pursuits, and reduce overall healthcare. For example, patients with ALS and MS are often cognitively normal. However, the appearance of uncontrollable emotions is commonly associated with many additional neurological disorders such as attention deficit/hyperactivity disorder, Parkinson's disease, cerebral palsy, autism, epilepsy, and migraines. This may lead to avoidance of social interactions for the patient, which in turn impairs their coping mechanisms and their careers.

Several criteria exist to differentiate between PBA and depression.

Depression

PBA may often be misdiagnosed as clinical depression or bipolar disorder; however, many clear distinctions exist.

In depressive and bipolar disorders, crying, anger or laughter are typically indicative of mood, whereas the pathological displays of crying which occur in PBA are often in contrast to the underlying mood, or greatly in excess of the mood or eliciting stimulus. In addition, a key to differentiating depression from PBA is duration: PBA episodes are sudden, occurring in an episodic manner, while crying in depression is a more sustained presentation and closely relates to the underlying mood state. The level of control that one has over the crying, anger or other emotional displays in PBA is minimal or nonexistent, whereas for those with depression, the emotional expression (typically crying) can be modulated by the situation. Similarly, the trigger for episodes of crying in patients with PBA may be nonspecific, minimal or inappropriate to the situation, but in depression the stimulus is specific to the mood-related condition. These differences are outlined in the adjacent Table.

In some cases, depressed mood and PBA may co-exist. Since depression is one of the most common emotional changes in patients with neurodegenerative disease or post-stroke sequelae, it is often comorbid with PBA. Comorbidity implies that depression is distinct from PBA and is not necessary for, nor does it exclude, a diagnosis of PBA.

Causes

The specific pathophysiology involved in this frequently debilitating condition is still under investigation; the primary pathogenic mechanisms of PBA remain controversial. One hypothesis, established by early researchers such as Wilson and Oppenheim, placed emphasis on the role of the corticobulbar pathways in modulating emotional expression in a top-down model, and theorized that PBA occurs when bilateral lesions in the descending corticobulbar tract cause failure of voluntary control of emotion, which leads to the disinhibition, or release, of laughing/crying centers in the brainstem. Other theories implicate the prefrontal cortex.

Secondary condition

PBA is a condition that occurs secondary to neurological disease or brain injury, and is thought to result from disruptions of neural networks that control the generation and regulation of motor output of emotions. PBA is most commonly observed in people with neurologic injuries such as traumatic brain injury (TBI) and stroke, and neurologic diseases such as dementias including Alzheimer's disease, attention deficit/hyperactivity disorder (ADHD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and Parkinson's disease (PD). It has been reported as a symptom of hyperthyroidism, Graves' disease, or hypothyroidism in combination with depression.

PBA has also been observed in association with a variety of other brain disorders, including brain tumors, Wilson's disease, syphilitic pseudobulbar palsy, and various encephalitides. Rarer conditions associated with PBA include gelastic epilepsy, dacrystic epilepsy, central pontine myelinolysis, olivopontinocerebellar atrophy, lipid storage diseases, chemical exposure (e.g., nitrous oxide and insecticides), fou rire prodromique, and Angelman syndrome.

It is hypothesized that these primary neurologic injuries and diseases affect chemical signaling in the brain, which in turn disrupts the neurologic pathways that control emotional expression.

Stroke

PBA is one of the most frequently reported post-stroke behavioral disorders, with a range of reported prevalence rates from 28% to 52%. The higher prevalence rates tend to be reported in stroke patients who are older or who have a history of prior stroke. The relationship between post-stroke depression and PBA is complicated, because the depressive syndrome also occurs with high frequency in stroke survivors. Post-stroke patients with PBA are more depressed than post-stroke patients without PBA, and the presence of a depressive syndrome may exacerbate the weeping side of PBA symptoms.

Multiple sclerosis

Recent studies suggest that approximately 10% of patients with multiple sclerosis (MS) will experience at least one episode of emotional lability. PBA is generally associated with later stages of the disease (chronic progressive phase). PBA in MS patients is associated with more severe intellectual deterioration, physical disability, and neurological disability.

Amyotrophic lateral sclerosis

A study designed specifically to survey for prevalence found that 49% of patients with amyotrophic lateral sclerosis (ALS) also had PBA. PBA does not appear to be associated with duration of ALS. It is a symptom of ALS that many patients are unaware of and do not receive information about from their physician.

Traumatic brain injury

One study of 301 consecutive cases in a clinic setting reported a 5% prevalence. PBA occurred in patients with more severe head injury, and coincided with other neurological features suggestive of pseudobulbar palsy.

The Brain Injury Association of America (BIAA) indicates that approximately 80% of survey respondents experience symptoms of PBA. Results from a recent investigation estimate the prevalence of PBA associated with traumatic brain injury to exceed more than 55% of survivors.

Treatment

Education of patients, families, and caregivers is an important component of the appropriate treatment of PBA. Crying associated with PBA may be incorrectly interpreted as depression; laughter may be embarrassing, anger can be debilitating. It is therefore critical for families and caregivers to recognize the pathological nature of PBA and the reassurance that this is an involuntary syndrome that is manageable. Traditionally, antidepressants such as sertraline, fluoxetine, citalopram, nortriptyline and amitriptyline have been prescribed with some efficacy.

Medication

Dextromethorphan hydrobromide affects the signals in the brain that trigger the cough reflex. It is used as a cough suppressant, although it can sometimes be used, medicinally, as a pain reliever, and is also used as a recreational drug.

Quinidine sulfate affects the way the heart beats, and is generally used in people with certain heart rhythm disorders. It is also used to treat malaria. Quinidine sulfate, as a metabolic inhibitor, "increases plasma levels of dextromethorphan by competitively inhibiting cytochrome P450 2D6, which catalyzes a major biotransformation pathway for dextromethorphan," enabling therapeutic dextromethorphan concentrations.

Dextromethorphan/quinidine is a combination of these two generic drugs, and is the first FDA-approved drug for the treatment of PBA, approved on October 29, 2010.

For this multicenter study, the "Objectives...[were] to evaluate the safety, tolerability, and efficacy of two different doses of AVP-923 [Dextromethorphan/quinidine combination]...when compared to placebo." The conditions and results of that study are as follows:

At one study site, a total of 326 participants received one of three dose options. "METHODS: In a 12-week randomized, double-blind trial, ALS and MS patients with clinically significant PBA" were given a twice-daily dose of one of the following:

• placebo (N=109)
• dextromethorphan hydrobromide 30 mg/quinidine sulfate 10 mg (N=110)
• Nuedexta – dextromethorphan hydrobromide 20 mg/quinidine sulfate 10 mg (N=107)

283 patients (86.8%) completed the study. The number of PBA episodes (laughing, crying or aggressive outbursts) were 47% and 49% lower (based on the trial's outcome measures), respectively, for the drug-combination options than for the placebo. The "mean CNS-LS scores" decreased by 8.2 points for both drug-combination options, vs a decrease of 5.7 points for the placebo.

Overall, the trial showed a statistically significant benefit from taking a combination of dextromethorphan and quinidine, with both dosages being safe and well tolerated. For a secondary objective measuring a participant's "perceived health status...measuring eight health concepts: vitality, physical functioning, bodily pain, general health perceptions, physical role-, emotional role-, social role functioning, and mental health," the higher dosage showed improvement, especially on measures of social functioning and mental health.

Epidemiology

Prevalence estimates place the number of people with PBA between 1.5 and 2 million in the United States alone, which would be less than 1% of the U.S. population even at the high end of the estimate. Some argue that the number is probably higher and that clinicians underdiagnose PBA. However, the prevalence estimate of 2 million is based on an online survey. Self-selected computer-savvy patients in at-risk groups evaluated their own symptoms and submitted their self-diagnoses. No doctor or clinic confirmed the data. Motivation to participate could have been influenced by the presence of symptoms, which would have skewed the results. The actual prevalence could very well be quite a bit lower than estimated.

History

The Expression of the Emotions in Man and Animals by Charles Darwin was published in 1872. In Chapter VI, "Special Expressions of Man: Suffering and Weeping", Darwin discusses cultural variations in the acceptability of weeping and the wide differences in individual responses to suffering. The chapter contains the following sentence:

We must not, however, lay too much stress on the copious shedding of tears by the insane, as being due to the lack of all restraint; for certain brain-diseases, as hemiplegia, brain-wasting, and senile decay, have a special tendency to induce weeping.

Terminology

Historically, there have been a variety of terms used for the disorder, including pseudobulbar affect, pathological laughter and crying, emotional lability, emotionalism, emotional dysregulation, or more recently, involuntary emotional expression disorder. The term pseudobulbar (pseudo- + bulbar) came from the idea that the symptoms seemed similar to those caused by a bulbar lesion (that is, a lesion in the medulla oblongata).

Terms such as forced crying, involuntary crying, pathological emotionality, and emotional incontinence have also been used, although less frequently.

In popular culture

Arthur Fleck, the central character of the 2019 film Joker, displays signs of pseudobulbar affect, which are said to be what Joaquin Phoenix used as inspiration for his character's signature laugh.

In the 2019 movie Parasite, the character Ki-woo sustains head trauma, and although it is not clearly mentioned that he's affected by pseudobulbar affect, he mentions not being able to stop laughing when thinking about all the events that occur in the movie.

In the medical television show House, season 7, episode 8 ("Small Sacrifices"), the character Ramon Silva, played by Kuno Becker displays pseudobulbar affect, with uncontrollable incongruent laughter, while having the Marburg variety of multiple sclerosis.

In season 3, episode 9 of The Good Fight, the character Brenda DeCarlo, an external auditor, displays pseudobulbar affect, with uncontrollable incongruent laughter.