Emotional Lability and Communicating

I ran across an article of this topic which is one I am still learning more about.  The one thing that I do know for sure is that this is one of those things that is hard not to notice sometimes especially with anger.  That seems to be the problematic one that everyone can see including us (ADHD'ers) when that happens.  But as I have now come to understand better....this is directly related to executive functioning and the ability to control your emotions.  As it is stated very well in this article...the emotional responses may be appropriate to the situation....but the response or how they are expressed or come out are bigger, louder and longer than what would be considered normal. 

So it seems.....it's not only anger we're talking about....it's all strong emotions and even weaker less noticeable ones.  Less noticeable for you that is if you don't have this.  We notice them for sure even if you aren't aware of them in a more self aware mindful way meaning......a lot of our (my) behavior is geared towards dealing with this and this is learned over your entire lifetime with ADHD.  Without realizing it and not knowing anything different.....how we learn to manage this and how other people react to us will definitely become a pattern of behavior that is specifically designed in dealing with this phenomenon to the point....that it is part of our personality as much as the rest of things that come into play.  Again.....this was really telling.

I know I made a post a while ago stating that we (ADHD'ers) are use to being this way.  It's all we know.  Everyone else however.....not so much! lol  This really is where we have trouble seeing ourselves compared to others sometimes and why other people are left scratching their heads going......what the...huh???????

When I read this I went....wait a minute.  This was me when I was a kid growing up but I learned how to dampen it down after enough criticism and embarrassment with enough time and practice.  It occurred to me in context to this article for professionals to use with patients having suffered a brain injury....that they are talking about a person who went from not being this way and all of a sudden...finding themselves in the same boat with people with ADHD.  The big difference is that we have been this way all of our lives and have had a lot of time and practice in getting use to it and adjusting to it even though....it's still there and we still run into the same problems just less often and in more extreme situations when we have more difficulty controlling it.

I went....mmmmmmm. Fascinating?  In context to this article and explaining it in terms of a head injury out of the blue and this being the follow up to those in this situation....as read through the suggestions for others to follow and the reasons why...........

I went (again).....wait a minute?  I learned to do this on my own a long time ago but it is the exact same things I do already to the letter under the same exact circumstances. 

And again.....I do this and don't expect other people to do this for me because when I don't.....I'm back to square one when I was a kid and I know that one all too well!! lol

Anyway...for what it is worth.  This really is what it is like having ADHD from the inside looking out and vise versa.  I thought this would be useful for others to use for the same reason....to simply understand what the hell is going on sometimes with us! lol


Understanding Emotional Lability

Acquired brain injury can change parts of the brain that regulate or control emotional behaviour and feelings.

What is emotional lability? Emotional lability refers to rapid, often exaggerated changes in mood, where strong emotions or feelings (uncontrollable laughing or crying, or heightened irritability or temper) occur. These very strong emotions are sometimes expressed in a way that is not related to the person’s emotional state.

What causes emotional lability?

Emotional 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.  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 just 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 orperson.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 behaviour may also be reduced. They may overreact to people or events around them – 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 behaviours can be confusing, embarrassing, and difficult to understand for the person with brain injury and for others. 


Emotional responses after an injury.  

Emotional reactions may be appropriate in the situation, but the behaviour or expression maybe stronger, louder or last longer than would be usual for that person.

side note:  I can't tell you how many times someone has asked me if I was really upset or angry about something.   It was simply because the volume level of my voice goes up at times even when it's not a big deal or I am feeling even remotely upset at something.  Maybe only slightly annoyed or irritated.... but simply because the volume goes up is why people ask me about this or are confused?  And in turn.....I'm even more confused why they ask me in the first place?   More like...."No?....Why?....are YOU really upset about something? I figured you'd have to be or you wouldn't be asking me? " I'm sooooo confused! lol

For example, a person may be genuinely happy, but once the laughter has started they may be unable to stop or regulate the behaviour, laughing too loud, too much, or for too long.  After brain injury an individual may also show extreme but genuine emotional responses,including sadness and grief, despair, frustration and irritability, anger, anxiety and depression,and even joy, happiness, and pleasure. These may be appropriate and normal emotional responses but more out of scale.

Coping with Emotional Lability

Become aware of triggers.  Be 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 behaviour.

Try to ignore the emotional lability as much as is possible.

Try to get others to ignore it too and continue on with the conversation or task.Focussing on the 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 behaviour. 

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.

Provide simple explanations or information to other people about the lability, for example, “I cry a lot since I had my stroke ...don’t worry about it” or “Sometimes when Iam nervous I get the giggles”.

Tell people what they should do, for example “Just ignore me 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

ƒUsing distractions – thinking of something else, imagining a peaceful image or picture, counting
Doing an activity (going for a walk)

Cognitive and behavioural strategies such as thought stopping could be discussed with a Psychologist.Counselling and support.

Sometimes a person has had many losses and changes to cope with after the brain injury – loss of work, ability to drive, independence, changes in relationships or finances, changes in the quality of their life.

All these changes happen quite suddenly with little chance to prepare or get ready.

These feelings of sadness, grief, anger,frustration, disappointment, jealousy, or depression after an injury are common and  maybe very difficult to cope with.


If there are other emotional adjustment and coping issues, referral to a counsellor such as a Psychologist, Social Worker or Psychiatrist maybe helpful. Families (parents, siblings, children),friends or carers may also benefit from support and care to help them understand and to cope with these changes