Involuntary Emotional Expression Disorder: Symptoms & Treatment

Instructor: Natalie Boyd

Natalie is a teacher and holds an MA in English Education and is in progress on her PhD in psychology.

Everyone feels emotions, and most people express them often, as well. But what happens when you can't control how you express your emotions? In this lesson, we'll explore the symptoms, diagnosis, and treatment of IEED.


Lorraine has a problem. She has Alzheimer's disease, which comes with all sorts of negative symptoms. But lately, a new and alarming symptom has popped up. Sometimes, for no reason, she will laugh or weep uncontrollably. What's going on?

Lorraine might have involuntary emotional expression disorder, which is also sometimes called pseudobulbar affect or emotional dysregulation. The main symptom of involuntary emotional expression disorder (or IEED) is uncontrollable emotional outbursts, such as laughing or crying when there's no reason to laugh or cry. For example, when Lorraine was having dinner with her sister the other day, she suddenly started laughing. Nothing funny had happened or been said; in fact, they were discussing a pretty serious topic. Nevertheless, Lorraine couldn't stop herself from laughing.

To help Lorraine understand what's happening to her, let's look closer at the cause, diagnosis, and treatment of IEED.

Cause & Diagnosis

It certainly seems like Lorraine has IEED. After all, she's laughing and crying uncontrollably in different situations. But what's causing it? And how can she know for sure whether or not she has IEED?

IEED probably has a neurological cause, but scientists have not discovered exactly what it is. In fact, one of its alternative names, pseudobulbar affect, comes from the fact that it seems a lot like what would happen if there was a tumor on the bulbar part of the brain, but the symptoms happen without the tumor.

One possible neurological explanation for IEED has to do with neurotransmitters, or hormones that are in the brain. One of these, glutamate, is a major excitatory neurotransmitter. That's just what it sounds like: glutamate and other excitatory neurotransmitters excite the brain, making it really active. Studies show that glutamate is likely involved in IEED, but scientists aren't really sure exactly what role it plays.

Regardless of what's causing it, Lorraine and others with uncontrollable emotional outbursts need to know whether or not they have it. Diagnosis of IEED is tricky. It isn't a stand-alone issue, but is usually secondary to a different neurological disorder. So, in other words, people don't solely get IEED, but only as a part of a larger neurological problem.

The neurological disorders that can cause IEED are very diverse. Lorraine has Alzheimer's disease, which can cause IEED. Other disorders include strokes, traumatic brain injuries, and even multiple sclerosis. If a patient has IEED and hasn't been diagnosed with a neurological disorder, doctors usually first try to find the primary neurological disorder that is causing IEED.

Another thing that can make diagnosis difficult is that it is a very rare disease. While estimates of how many people get it vary, fewer than 1% of the population have IEED.

It is sometimes misdiagnosed as other things. Depression, personality disorders, and even epilepsy are examples of diagnoses that are sometimes mistaken for IEED. For example, after hearing about a time that Lorraine started crying uncontrollably, her doctor diagnosed her with depression. It was only later that he realized that she had IEED.


Lorraine is glad to know more about the causes and diagnosis of IEED, but what now? What kind of treatment can she expect?

As of 2017, there are no drugs approved by the FDA specifically to treat IEED. However, some doctors prescribe drugs off-label, which involves prescribing a drug for something other than what it is approved to do. For example, many doctors give off-label prescriptions of antidepressant drugs to help treat IEED. So, even though there are no drugs specifically for IEED, Lorraine's doctor might give her an antidepressant to help.

The two main types of antidepressants that are often prescribed for IEED are selective serotonin reuptake inhibitors, or SSRIs, and tricyclic antidepressants. Both of these drugs impact the balance of neurotransmitters in the brain. Remember that neurotransmitters like glutamate are likely a cause of IEED, so it makes sense that a drug that changes the chemical balance of the brain would help with IEED. So, Lorraine's doctor might want to prescribe an SSRI to help control her IEED symptoms. In doing so, the neurotransmitters in her brain will change, which can therefore lead to fewer outbursts.

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