Emotional Lability: Definition, Symptoms, & Causes

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In the 2019 movie Joker, starring Joaquin Phoenix as Arthur Fleck, we notice a recurring pattern: he suddenly starts laughing uncontrollably at odd moments. It seems incredibly difficult to control his laughter whenever he has an outburst, either at his stand-up comedy act or on a bus.

In one scene, Arthur is entertaining a child on the bus by making funny faces, which only makes the child giggle more. The child’s caregiver asks Arthur to stop, but instead, he starts laughing uncontrollably. While Arthur tries very hard to stop and explain what is happening, he simply cannot control it. Although he takes out a note that says, “Forgive my laughter. I have a condition.”, the strangers on the bus are not reassured and scowl at his behavior.

If you’d like to watch the scene, check out the video below:

Emotional lability is a rapid and intense change in a person’s emotions or mood, typically inappropriate to the setting (Posner et al., 2014). For example, a person can suddenly start crying uncontrollably because of any strong emotion, even though they do not feel sad, frustrated, or happy. 

However, emotional lability can also be an over-expression of positive emotions, such as enthusiasm or energy, either disproportionate to the event or improper to the circumstance (Posner et al., 2014). One example is when a person suddenly laughs uncontrollably at a funeral or when they hear bad news.

Although emotional lability is typically short, lasting minutes to hours, both the positive and negative emotions can be confusing to peers. Also, it means that a person may have little control over their emotions, even though these emotions do not have to be associated with anything specific. 

The term originally comes from the Latin word labilis, meaning “transient, fleeting, slippery” (World of Dictionary), which highlights the dramatic and frequent shift between emotional experiences.
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You can watch the short video below to learn more about emotional lability and to hear some more examples on this condition.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013) is a tool health professionals use to classify and diagnose mental health disorders. 

According to the DSM-5, emotional lability is defined as the “unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.” (p. 461)

In the DSM-5, emotional lability appears as a symptom in various disorders, including:

• Borderline personality disorder (BPD), a mental illness characterized by unstable moods, impulsive behavior, and problems in relationships. 
• Bipolar disorder (BP), which is a mood disorder characterized by episodes of intense mood swings, with depressive lows and manic highs. In Bipolar disorder, emotional lability often lasts longer (e.g., days-weeks; Posner et al., 2014) 
• Substance use, which can include alcohol or any illicit drugs.
• Attention-deficit/hyperactivity disorder (ADHD), a common psychiatric disorder defined by inattention, hyperactivity, and impulsivity.
• Post-traumatic stress disorder (PTSD), a disorder in which a person struggles to recover after witnessing or experiencing a traumatic event.

Emotional lability is characterized by rapid and dramatic shifts in emotions, usually inappropriate to the setting in which they happen.

Here are the most common symptoms of emotional lability:

• Extreme emotions and sudden mood shifts. For example, those suffering from emotional lability experience intense feelings that change rapidly and often fluctuate through the day.
• Improper reactions. If a person laughs uncontrollably at a funeral, it is a sign of emotional lability, as it refers to inappropriate reactions.
• Difficulty controlling emotions. People who experience emotional lability may have little control of their feelings, which can make it more difficult to stop them.  

​Emotional lability can negatively impact a person’s daily life and functioning. These behaviors can be confusing or embarrassing. If emotional lability symptoms interfere with daily activities for you or a loved one, it is essential to talk to a healthcare provider about treatment options. 

Emotional lability has been documented in many conditions, such as:

• Borderline personality disorder (BPD) 
• Bipolar disorder (BP) 
• Post-traumatic stress disorder (PTSD) 
• Pseudobulbar affect (PBA) 
• Neurological disorders or brain injuries (e.g., Dementia, Alzheimer, Multiple sclerosis, Parkinson’s, stroke) 
• Attention-deficit/hyperactivity disorder (ADHD).

One cause for emotional lability is the pseudobulbar affect (PBA). PBA is a neurologic condition caused by damage to the nervous system, either by a neurologic disorder or brain injuries, such as traumatic brain injury, stroke, or multiple sclerosis. This condition is characterized by uncontrollable crying or laughing and happens “out of the blue” and the exaggerated emotion does not match how you feel (Ahmed & Simmons, 2013). 

Arthur Fleck in Joker suffers from PBA. It is said that the movie’s director and co-writer, Todd Phillips, was inspired by PBA and even showed Joaquin Pheonix a video of someone with the same condition (Vincenty, 2020).

ADHD is a common psychiatric disorder characterized by inattention, hyperactivity, and impulsivity. Research studies show that children with ADHD who have high levels of emotional lability also show low tolerance to frustration, increased irritability, and frequent crying spells or tantrums (Posner et al., 2014). 

Also, emotional lability in children with ADHD is associated with more severe ADHD symptoms, higher rates of substance use disorders, oppositional defiant disorder (defiant and disobedient behavior to authority figures), and affective symptoms (Sobanski et al., 2010).

Mood lability is not only a symptom of bipolar but also predicts Bipolar Disorder onset and is associated with psychological impairment (Hafeman et al., 2020). Although the standard treatment for Bipolar Disorder is medication, such as mood stabilizers and antidepressants, there are new and promising approaches to target mood lability—mindfulness. 

Mindfulness, or intentionally, non-judgementally paying attention to the present moment, has been shown to reduce emotional lability and anxiety (Hafeman et al., 2020).

Brain injury refers to brain dysfunction caused by a violent external blow to the head or body. For example, many American football players have severe brain injuries due to serious and frequent hits to the head or body (Morris et al., 2020). 

Emotional lability happens because of damage to the parts of the nervous system that control:

• Emotional awareness
• Ability to control emotional expression and
• Ability to inhibit strong emotional responses

​After a brain injury, one may lose emotional awareness and sensitivity, so the brain’s capacity to control emotional behavior may be impacted (Acquired Brain Injury Outreach Service, 2021). A reaction may be appropriate in a given situation, but the expression may be more intense. For example, after watching a movie where the dog dies at the end, a person with emotional lability can genuinely be sad and tearful, but once they start crying, it can become incredibly difficult to stop, and it can continue for hours without stopping. 

Being unable to control the intensity or the expression of your emotions can not only be frustrating but also impact your daily life. For example, if you struggle with emotional lability, you may avoid going to happy hour after work or hanging out with your friends because you are worried about what could happen. 

It is vital to know that you are not alone and treatment options exist.

• Medication. Your doctor could prescribe antidepressants, which can help with mood swings related to depression or borderline personality disorder (Iannaccone & Ferini-Strambi, 1996).
• Mindfulness. Mindfulness exercises, such as deep breathing or meditation, can have a positive impact on emotional lability and reduce overall stress.
• Therapy. Talking to a psychologist, social worker, or psychiatrist can be beneficial to help deal with feelings in a healthy way.

If you, or someone close to you, are experiencing emotional lability, there are a few things to do to better cope with it. Although it can be challenging to deal with emotional lability, there are a few ways to do so (Acquired Brain Injury Outreach Service, 2021).

• Be aware. It is very important to be aware of what triggers emotional lability and to try to avoid them whenever possible. Some of these triggers include extreme fatigue, stress, or anxiety, and certain social situations or environments.
• Take care of yourself. By taking care of yourself, both physically and mentally, you may reduce tension and relieve stress. Make sure that you get enough sleep every night, have a balanced diet, and exercise regularly. By doing something that makes you feel better, such as going on a stroll or spending quality time alone, you may increase your overall well-being.
• Take a break. If you witness lability happening to someone else, you can take a break from the situation, so the person regains control of the emotions. If you experience lability, it’s OK to take a step back for a few minutes to cope with the emotions. 
• Find a distraction. Sometimes it can be helpful to change the topic or to engage in a different activity to reduce stimulation and to regain control of the emotions.
• Acknowledge the feelings. It’s important to realize that sometimes you can’t control your emotions, and that’s OK. You just have to take care of yourself and practice self-compassion.
• Educate. Other people can be confused or frightened about what they can’t understand. If you feel comfortable, you can let people know what happened, similarly to how Joker did (e.g., “Since I had the stroke, I’m crying more often”).
• Ask for help. It is important to remember that you are not alone in this. You can talk to your friends or family members, or ask for help from a professional, such as a therapist or psychiatrist. ​

Want to learn more about emotional lability? Here are some more articles to read.​

• ​Acquired Brain Injury Outreach Service (2021). Understanding Emotional Lability. 
• Ahmed, A., & Simmons, Z. (2013). Pseudobulbar affect: prevalence and management. Therapeutics and Clinical Risk Management, 9, 483.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Hafeman, D. M., Ostroff, A. N., Feldman, J., Hickey, M. B., Phillips, M. L., Creswell, D., & Goldstein, T. R. (2020). Mindfulness-based intervention to decrease mood lability in at-risk youth: Preliminary evidence for changes in resting state functional connectivity. Journal of Affective Disorders, 276, 23-29.
• Iannaccone, S., & Ferini-Strambi, L. (1996). Pharmacologic treatment of emotional lability. Clinical neuropharmacology, 19(6), 532-535.
• Koenigsberg, H. W., Harvey, P. D., Mitropoulou, V., Schmeidler, J., New, A. S., Goodman, M., … & Siever, L. J. (2002). Characterizing affective instability in borderline personality disorder. American Journal of Psychiatry, 159(5), 784-788.
• Morris, W., Ganz, C., & Considine, A. (2020, January 30). The Super Bowl is problematic. why can’t we look away? The New York Times.
• Posner, J., Kass, E., & Hulvershorn, L. (2014). Using stimulants to treat ADHD-related emotional lability. Current psychiatry reports, 16(10), 478.
• Schoenleber, M., Berghoff, C. R., Tull, M. T., DiLillo, D., Messman-Moore, T., & Gratz, K. L. (2016). Emotional lability and affective synchrony in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 7(3), 211.
• Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., & Faraone, S. V. (2010). Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence. Journal of Child Psychology and Psychiatry, 51(8), 915-923.
• Stringaris, A., & Goodman, R. (2009). Mood lability and psychopathology in youth. Psychological medicine, 39(8), 1237-1245.
• Vicenty, S. ( 2020, Jan 6). The Joker’s laughing condition is based on a real disorder. Oprah Daily. 
• World of Dictionary. (n.d.). Labilis. Retrieved November 15, 2021.