Mood lability

Labile mood or emotional lability, is a medical term to describe people who experience irregular emotional responses (uncontrollable laughing or crying, or heightened irritability or temper). Labile mood is associated with severe mood swings and with intense emotional reactions. Often the emotions will be particularly strong and disproportionate to the situation the person is in. Labile mood indicates that there is little control around emotional responses. It indicates a low ability to handle and process frustration.

Someone who experiences labile mood may find it difficult to understand emotions and will quickly move to an extreme response and reaction which would appear to be out of proportion to the experience.

A labile mood can be related to conditions such as borderline personality disorder. Labile mood may appear as part of a presentation that would include manic and hyper manic episodes.

Left unchecked, the experience of labile mood can have a profound impact on your life. You may find yourself trapped in feelings and find it hard to develop any insight into what they relate to.

Labile mood causes

Labile mood may develop suddenly as a reaction to a head or brain injury.

Mood lability occurs because of damage to parts of the brain that control:

• Awareness of emotions (ours and others)
• Ability to control how emotions are expressed – so ability to inhibit or stop emotions coming out.

Mood lability may also develop as part of a response to growing up in an environment in which there was poor emotional or affect regulation.

• If as a small child you were exposed to sudden and unpredictable changes in a parents’ mood
• If the environment you were in suddenly became dominated by a parents’ difficult mood swings, then it is likely that you will struggle to learn how to regulate your own emotional responses.

Ideally a parent helps their child learn about the moods and emotions they experience

If a child gets into an emotional state then the parent helps them out of it. All being well, this leads to the child learning how to move around their emotions. A child in this situation would grow up knowing their emotions are part of them. But if it did not work like this, and if the parent was themselves someone who would have sudden powerful and possibly very frightening mood changes, then the child has very limited opportunities to learn about mood regulation. As a consequence, emotions are likely to provoke anxiety and stress.

Stress leads to the over production of hormones like cortisol and noradrenaline which have a powerful effect on our brain chemistry which in a small child can easily lead to embedding states of anxiety and stress.

As the child grows and matures their emotional response system is set to hyper vigilance rather than a more ordinary manageable and constructive setting.

Labile mood symptoms

Labile mood is a medical term to describe people who experience irregular emotional responses. Labile mood is associated with severe mood swings and with intense emotional reactions.

When a person is emotionally labile, emotions can be out of proportion to the situation or environment the person is in. For example, a person may cry, even when they are not unhappy – they may cry in response to strong emotions or feelings, or it may happen “out of the blue” without warning. A person may have little control over the expression of these strong emotions, and they may not be connected to any specific event or person.

Following brain injury an individual may also lose emotional awareness and sensitivity to their own and other’s emotions, and therefore their capacity to control their emotional behavior may also be reduced. They may overreact to people or events around them, for example, conversations about particular topics, sad or funny movies or stories. Weaker emotional control and lower frustration tolerance, particularly with fatigue and stress can also result in more extreme changes in emotional responses.

The person may express their emotions in situations where previously they would have been able to been restrained or in control (in quiet situations, in church, listening to a concert). These behaviors can be confusing, embarrassing, and difficult to understand for the person with brain injury and for others.

Labile mood symptoms include:

• it will make relationships very difficult
• it is likely that you will find it hard to trust,
• will see the worst in a situation,
• become very anxious over the smallest thing.

Left untreated it may lead to isolation, loneliness and in an extreme form, paranoia. It will make it very hard to concentrate and do well at school and make it very hard for you to develop your potential.

Labile mood treatment

If you are coming to the question of your own labile mood as an adult there are probably two support systems that you will need to try to put in place to help you.

1. Medical therapy. It may well be helpful to see your doctor to discuss this. It may be possible to be referred for a psychiatric assessment. There are drugs and medicines available that can help balance the extreme range of emotional swings. These drugs will have side effects and you would need to work with your doctor and psychiatrist to check on the way the medication is effecting you.
2. Psychotherapy. Psychotherapy or talk therapy would give you the chance to build up a greater understanding of the mood swings you go through. Psychotherapy can help you develop insight and understanding into yourself and into where these mood swings started. It also works through the development of the therapeutic relationship. In psychotherapy there is a possibility of developing the sense of trust in someone and this can go a long way into helping to give you greater confidence with your emotions. If you can start to develop a sense of trust in the psychotherapy relationship you may well be able to build upon that and start to develop other areas of your life as well.

Coping with mood lability

Become aware of triggers for emotional lability and try to avoid these when you can.

Triggers can include:

• excessive fatigue or tiredness
• stress, worry or anxiety
• high stimulation (too demanding, too noisy, too many people) – too much pressure
• strong emotions or demands from others
• very sad or funny situation (such as jokes, movies, certain stories or books)
• discussing certain topics e.g. driving, loss of job, relationships, death of a family member
• speaking on the telephone or in front of a group or where a person feels under pressure

Have a break

Have a short break away from the situation so the person can regain control of emotions, and to give the opportunity for emotions to settle.

Sometimes a break of a few minutes or a longer period is enough to regain control of emotions – taking a short walk, doing a different activity all can help to cope with these strong emotions.

Ignore the behavior

Try to ignore the emotional lability (but not the person) as much as is possible. Try to get others to ignore it too and continue on with the conversation or task.

Focusing on the mood lability or giving the person too much attention when it is happening can reinforce and increase the problem. It is important that other people don’t laugh too, as this will also reinforce and increase the behavior.

Change the topic or task

Changing the topic or activity (redirection and distraction) can reduce stimulation or stress (particularly if the topic was a trigger). Try to distract or divert the person’s attention by engaging them in a different activity or task.

Provide information and education

Uncontrolled crying or laughing can be upsetting, frightening or confusing for other people if they don’t understand.

• Providing simple explanations or information to other people about the lability, for example, “They cry a lot since they had the stroke … don’t worry about it” or “Sometimes when they are nervous they get the giggles”.
• Tell people what they should do, for example “Just ignore it and it will stop”.

Plan ahead

When there is severe emotional lability, one-to-one, brief and fun activities in a quiet environment will be better.

• Try to avoid putting the person in stressful situations or environments e.g. noisy, busy, high levels of activity or that are too demanding.
• Plan activities that are within the person’s ability.
• Plan more demanding activities or appointments after rests, or when the person has the most energy.
• Plan for rests between activities.

Use cognitive techniques

Some simple cognitive strategies can also assist in managing emotional lability:

• Relaxation and breathing exercises to reduce tension and stress
• Using distractions – thinking of something else, imagining a peaceful image or picture, counting
• Doing an activity (going for a walk)
• Cognitive and behavioral strategies such as thought stopping could be discussed with a psychologist.