Emotional lability

What is emotional lability?

Emotional lability is a term used to refer to rapid and intense mood swings resulting from an instability and dysregulation of emotions. Emotional lability can result in sudden outbursts of intense emotion that may be inappropriate or unusual within the context or setting ^[1].

Emotional lability can occur due to several different causes, including mental and physical health conditions, substance use, or as a side effect of various medications.

Emotional lability symptoms

The signs and severity of emotional lability may vary depending on the cause. Commonly, emotional lability includes ^[1][2][3][4]:

• Sudden changes in mood, which might occur often throughout the day.
• Expression of intense and extreme emotions, including euphoria, sadness, anger, aggression, and anxiety.
• Inability to control emotions, such as crying, despite not feeling sad or extreme outbursts of anger without explanation.
• Overreactions to other people or situations. This might include responding to a mildly funny joke with loud and uncontrollable laughter. It could also involve becoming physically and verbally aggressive following a minor issue.
• Inappropriate reactions and emotions unsuitable for a particular context or circumstance. This could be laughing when someone is upset or when attending a funeral.

What causes emotional lability?

Emotional lability can be related to various physical and mental disorders and medications.

Brain damage

A traumatic brain injury, stroke, or neurological condition such as dementia or Parkinson’s can cause damage to the brain. Damage in areas of the brain responsible for emotion regulation, awareness, and expression can lead to emotional lability ^[3][5].

Emotional lability caused by brain damage can result in extreme emotional outbursts that occur without reason. Similarly, emotions may occur as a reasonable response but be expressed in a very excessive or uncontrolled way. This is also referred to as pseudobulbar affect (PSA) ^[5][6].

Bipolar disorder

Bipolar disorder is characterized by episodes of mania followed by episodes of depression. These episodes can last days, weeks, or months. They may vary in duration and severity depending on the type of bipolar ^[7].

Similarly, people can experience rapid changes in mood within an episode of mania or depression. It is common for people with bipolar to experience emotional lability involving anger, excitement, anxiety, and joy. Often, people with bipolar experience intense emotions and can feel that they are not in control of their mood and behavior ^[4][7].

Borderline personality disorder

Borderline personality disorder is characterized by emotional instability and dysregulation. As such, a common symptom of borderline personality disorder is emotional lability, including rapid and intense changes in emotion ^[7].

This can include sudden outbursts of anger and aggression, intense sadness and tearfulness, and guilt and anxiety. Similarly, there may be abrupt shifts to positive emotions, such as euphoria and feelings of love and intimacy ^[4][8].

A common feature of borderline personality disorder is unstable and chaotic interpersonal relationships. This means that individuals with borderline personality disorder can regularly and suddenly shift between feelings of love and hate toward their partner ^[7].

ADHD

Attention Deficit/Hyperactivity Disorder (ADHD) is characterized by hyperactivity, impulsivity, and inattention. Due to the symptoms of ADHD, including a lack of emotional inhibition, people with ADHD often struggle with regulating their emotional responses and intensity ^[9].

Commonly, children with ADHD have difficulties recognizing others’ emotions and regulating their own. This can result in a low tolerance for frustration and extreme emotional responses, such as irritability, anger, sadness, and elation.  

As such, emotional lability is a common symptom of ADHD in children. It can also continue into adulthood, depending on how the condition is treated and managed in childhood. Studies suggest that up to three-quarters of adults with ADHD experience emotional lability ^[9][10].

PTSD

Post-traumatic stress disorder (PTSD) often occurs following a severe traumatic experience, such as abuse or a life-threatening situation. PTSD can cause flashbacks, memories, or intrusive thoughts related to the traumatic event. This can result in emotional distress and reactivity ^[7].

As such, it is common for people to experience severe changes in emotional response and regulation following trauma. Emotional lability within the context of PTSD commonly includes a sudden onset of intense fear, anxiety, anger, or guilt. Emotional changes can be particularly severe when exposed to triggering stimuli ^[11].

Substance use

Sporadic use of alcohol and substances can cause temporary emotional lability, while a substance use disorder can result in severe changes in emotional regulation. Research shows a higher prevalence of emotional dysregulation amongst those with a substance use disorder than those without ^[12].

Studies also show that alcohol use disorder can cause more severe emotional lability than other substance use disorders. This includes reactions, awareness, control, and acceptance of emotions. Similarly, evidence shows that a higher frequency of substance use, particularly alcohol and cannabis, causes more severe emotional dysregulation ^[13][14].

However, it is common for people with a substance use disorder to have an underlying mental health condition, which may be a contributing cause of their substance use and emotional lability. Similarly, it may be that experiencing severe emotional lability leads to substance use as a form of self-medication or a numbing of emotions ^[12][13].

Medication

Many physical health medications can cause changes in mood and emotional regulation. Side effects of medications can include depression, anxiety, euphoria, suicidal ideation, and irritability. These side effects can be caused by several types of ^[15]:

• Antibiotics
• Cardiovascular medications
• Immune system modulators
• Medications for Parkinson’s
• Anti-epileptics
• HIV medications
• Hormonal contraceptives

Similarly, many mental health medications can cause these side effects when starting, during, or withdrawing from treatment. This includes various types of ^[16]:

• Antidepressants
• Anxiolytics
• Mood stabilizers
• Antipsychotics

How to manage emotional lability

There are several ways in which emotional lability can be managed, including therapy, medication, and self-care. Treatment will vary depending on the cause and severity of these symptoms.

Therapy

Various types of therapy can be effective at managing emotional lability, such as ^{[2][5][9][11][12]}:

• Cognitive behavioral therapy (DBT) and dialectical behavior therapy (DBT): CBT and DBT are often effective at managing emotional lability in various conditions. These types of treatment involve learning how to recognize and alter harmful thoughts and behaviors and developing coping strategies.
• Anger management therapy: When emotional dysregulation results in extreme anger and aggression, it can be helpful to attend anger management therapy. This can help with learning how to manage a sudden onset of anger, reduce negative moods and behaviors, and improve symptoms of emotional lability.
• Mindfulness-based therapy: Mindfulness involves focusing on the present, including recognizing current thoughts and feelings. This practice, both in a therapeutic setting and at home, has been shown to be effective at reducing emotional difficulties and dysregulation.
• Exposure therapy: Exposure therapy can be used to treat PTSD, helping to reduce extreme emotional responses to triggering situations.

Medication

The use of different types of medications can help manage emotional lability, depending on the cause. For example ^{[5][9][16][17]}:

• Antidepressants: Antidepressants can help to regulate emotions in the context of neurological conditions, borderline personality disorder, and PTSD.
• Mood stabilizers: Mood stabilizers can help to reduce emotional lability in the context of bipolar disorder and borderline personality disorder.
• Anxiolytics: Anxiolytics such as benzodiazepines and tranquilizers can help reduce emotional lability worsened by anxiety and poor sleep. As such, they can be helpful in several physical and mental health conditions. However, they should only be used short-term due to the risk of abuse and dependence.
• Stimulants: Stimulants are typically used to treat symptoms of ADHD, including emotional lability.

As many medications can contribute to the dysregulation of emotions, it is essential always to take medications exactly as prescribed. Also, you should consult with your doctor if you experience any troubling side effects.

Self-care

It may be possible to manage the severity of emotional lability with the use of various self-help techniques, such as ^{[2][3][5][6][12]}:

• Learning triggers: Triggers include people, places, tiredness, and anxiety. By recognizing triggers of emotional lability, it is possible to avoid or manage these circumstances.
• Telling others: Letting others know about your emotional lability might be helpful. For example, if you experience pseudobulbar affect, you could tell people not to be shocked if you suddenly laugh uncontrollably. You could also inform them how best to manage this situation.
• Managing stress: As stress can trigger emotional lability, it can be useful to utilize relaxation, mindfulness, or breathing techniques. These techniques can help to reduce stress, emotional instability, and outbursts.
• Using exercise or distractions: It can be helpful to utilize distractions if you feel your emotions are becoming unmanageable, such as going for a walk or listening to music. Engaging in regular exercise can also reduce symptoms of emotional lability by improving your overall physical and mental well-being.
• Avoiding drugs and alcohol: Substances can cause or worsen emotional dysregulation, particularly emotions such as anger and aggression. As such, avoiding alcohol and drugs can help in managing emotional lability.
• Getting plenty of sleep: Sleep is vital for physical and mental well-being. A lack of sleep can lead to negative emotions and sensitivity, worsening emotional lability.