Other mood and behaviour changes
More rarely, some people with MS experience changes to their emotions or behaviour that don’t seem to make sense, or that they aren’t able to control.
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Uncontrollable or out of control displays of emotion are often grouped together under the heading of ‘emotional lability’ or ‘emotionalism’.
If you’re experiencing emotionalism, you may find that you have very sudden, intense periods of emotion that seem out of proportion or unrelated to whatever triggered them.
You may easily burst into tears, or suddenly get very angry. These emotions may build up very quickly, and you may have no control over them.
Sometimes, these emotions are related to what you’re actually feeling. At other times, the emotions you show may not reflect how you’re feeling inside: you may react to hearing some bad news by laughing hysterically, or you may start crying when you’re feeling happy. Sometimes, you may swing from one to the other with no warning.
Why is this happening?
Emotionalism is often caused by MS-related nerve damage in the areas of your brain that control your emotions. However, as with any emotional symptom of MS, there may be a number of different factors involved.
Are there any treatments for it?
There are some drug treatments that may help.
The NICE guideline for MS, which outlines how MS should be treated on the NHS in England and Wales, recommends prescribing amitryptiline, an antidepressant. Other antidepressants, such as such as fluoxetine or citalopram, may also help.
A drug called Nuedexta has been licensed specifically for treating one aspect of emotionalism. In studies, people taking Nuedexta had 50 per cent fewer episodes of uncontrollable laughing or crying than those taking a placebo. However, it has not been assessed for use on the NHS so it is not widely available.
Talking therapies can also help, either in combination with medication or on their own. There’s more on talking therapies in our booklet Living with the effects of MS
How can I help myself?
As well as medication and talking therapies, there are things you can do to help yourself. These include tips for when you find yourself becoming overly emotional, as well as suggestions for things your friends and family can do.
- Taking a break from a conversation may help when your emotions get out of control
- You can also tell your friends and family how you would like them to react if you do start becoming overly emotional
- Talking to the people around you and explaining it as a symptom can help to make both you and them feel less embarrassed when it happens.
- If there are situations that you know are likely to make you overly emotional you may find it helps to tell others how you’re likely to react so it’s not a surprise for them.
- It can help if people around you know that it’s not something you can control – simply telling you to stop crying or shouting won’t work.
- Remind people that not all emotional outbursts are emotionalism. If you are genuinely feeling upset about something, make sure that the people around you know, so you get the support you need from them.
There are various behavioural symptoms associated with MS that are very rare and little researched.
These symptoms overlap with cognitive difficulties that can cause problems with the way thoughts are processed, concentration, or the way plans are made.
Euphoria is characterised by persistently cheerful mood, particularly at times of difficulty. People may seem strangely unconcerned about their ongoing physical deterioration, and may have a sense of optimism that appears out of place, given their situation.
In some people, both their mood and the way they express their feelings is euphoric. In others, their outward expression of optimism fails to give the true impression of their inner feelings of despair.
Disinhibition is one of the rarest behavioural symptoms of MS and only a very small percentage of people are affected. It is linked to MS-related damage in the brain.
People experiencing disinhibition lose control over their impulses, leading to inappropriate behaviour and a loss of their sense of social rules. They may have little or no awareness of others' feelings regarding their actions.
For example, someone may make a hurtful or inappropriate comment, break into a rage, or behave in a sexually disinhibited manner – all of which they would have considered outrageous previously. It is important to recognise that people experiencing this symptom cannot control their behaviour.
Lack of insight
In certain situations, some people are unable to understand what is happening to them or around them.
Their judgement of safety may not be as good as it was, or they may have no insight into the way their behaviour affects others.
Again, this only affects a small percentage of people with MS and may be linked to nerve damage in the brain.
Lack of initiative
Initiating actions, for example, getting dressed, doing housework and getting involved in social or leisure activities, is controlled by a part of the brain called the frontal lobe.
If someone has extensive nerve damage in this area, they may experience a lack of initiative.
They may be fine to carry on doing something once they have begun, but unable to take the first steps towards doing it alone.