Emotionalism
- Aoife Hickey, Senior Clinical Psychologist
- 4 minute read
- Last updated: November 2023
Emotionalism involves sudden, uncontrollable episodes of crying or laughing which don’t fit with how you really feel, or may be an exaggerated expression of how you feel. It affects around one in five people during the acute stage, and one in eight in the longer term.
What is emotionalism?
Emotionalism is a common but poorly understood neurological effect of stroke. It involves episodes of crying or laughing which happen with little or no warning. It’s a problem with how you express emotion, rather than how you experience emotion. Emotional outbursts happen in situations in which you would not have cried before the stroke, or following something mildly emotionally moving. Triggers can be internal (for example, thoughts or memories) or external (for example, watching something on TV, hearing about something sad, or talking about emotive topics, which can include your stroke).
Uncontrolled crying is more common than uncontrolled laughing. Emotionalism is more common in younger people. The loss of the control over emotions can cause embarrassment and distress, and can lead to avoidance of social situations.
Emotionalism happens due to damage to areas or circuits in the brain which are involved in control and coordination of expressing emotions. Emotionalism can be mistaken as a psychological or psychiatric problem. Crying is often regarded as a normal part of adjustment, and this means it can be easily missed, especially in the early stage after a stroke.
Emotionalism is sometimes called pseudobulbar affect or emotional lability.
What can help?
Research on emotionalism after stroke is limited. Antidepressant medications can be useful, but their effect tends to be small. There have been no trials of psychological treatments yet.
People often develop various ways of coping with emotionalism over time. These include distraction, humour, or accepting emotionalism and allowing it to happen.
Understanding emotionalism and knowing that it’s a neurological consequence of stroke, rather than a psychological or psychiatric consequence, seems helpful. Family support also seem useful. If embarrassment is an issue, it can be helpful to explain emotionalism to others, and explain to others how best to respond.
What can get in the way?
Some people experience embarrassment or shame due to episodes of emotionalism, which can lead to avoidance of activity or social situations. Avoidance can lead to a loss of enjoyment, achievement and connection to others, which may make low mood more likely. Avoidance can also mean anxiety about social situations keeps going, as you don’t learn that you can get used to or cope with emotionalism in social contexts.
How are emotionalism and depression different?
Emotionalism can be mistaken for depression. Depression and emotionalism can both be present, which can make diagnosis a challenge, but there are important differences. Emotionalism episodes are usually brief, they’re typically caused by an emotional trigger, and they don’t accurately reflect how you really feel. In depression, crying is likely to be more prolonged, it reflects how you really feel, and there are usually beliefs present about hopelessness, worthlessness and guilt.
Other information
Top tips
Learn about emotionalism and find what works for you
Explain emotionalism to your family, and how you would prefer your family to respond during episodes of emotion. This varies from person to person. Some people value reassurance or support from others. Others find that people’s reassurance can unintentionally increase emotionalism in the moment, and so you may prefer to ask people to ignore it.
Aoife Hickey | Senior clinical psychologist |
Try to accept emotionalism
This might mean just letting episodes of emotionalism happen, and seeing these episodes as a neurological consequence of the stroke. When episodes of emotionalism happen, try to see them in a neutral way, without negative beliefs about yourself. “There’s emotionalism again. It’s just an effect of my stroke.”
Aoife Hickey | Senior clinical psychologist |
Slowing your breathing can help
In the moment, if you prefer to try to control your emotionalism episodes, it can be helpful to slow down your breathing, change your body position, or try to focus your attention on something else. Often people learn their own triggers for emotionalism over time, and how best to manage these.
Aoife Hickey | Senior clinical psychologist |
Useful links
Information and advice about your mental health and wellbeing from the HSE
