Crying behavior and psychiatric disorder in adults: A review

doi:10.1016/0010-440X(93)90049-A

Comprehensive Psychiatry

Volume 34, Issue 3, May–June 1993, Pages 206-211

https://doi.org/10.1016/0010-440X(93)90049-A Get rights and content

Abstract

Crying is a common human behavior that is encountered in varied clinical settings. However, its relationship to mood and psychiatric disorders remains unclear. In this report, the relevant literature on the relationship of crying behavior and psychiatric disorders is reviewed. Two clinically distinct types of crying behavior are identified. The relationship of “functional” crying with mood is inconsistent, but some trends suggest an apparent reduction in the behavior with worsening depression. “Organic” crying has attracted relatively more attention recently and is associated with a wide variety of neurological lesions, but neither the cerebral localization of the behavior nor its relationship to coexisting mood is clear. The clinical typologies, possible functional roles, and etiology of the behavior are discussed, and suggestions are made for future research.

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Reflex tearing occurs in response to external stimulation, resulting in increased tear production of up to 100 μL/min [256,299]. Emotional tears arise from a complex secretomotor response that occurs without ocular irritation and results in a rise in tear production, up to 400 μL/min [269,298,300]. Newly produced tears flow into the conjunctival sac and, due to negative hydrostatic pressure, are drawn into the superior and inferior menisci [301,302] (see Section 5.2.2).
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Emission of 22 kHz vocalizations in rats as an evolutionary equivalent of human crying: Relationship to depression
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Crying often develops into long bouts of crying vocalizations and sobbing in response to a single event, however, it is also dependent on other environmental stimuli [87,89]. Sobbing, which is a form of convulsive inhaling and exhaling air with spasmatic contractions of the respiratory and trunk muscle [2], is not present in rats. Crying and sobbing is aggravated by additional pathological conditions as brain damage, stroke, or other psychiatric conditions, in which long uncontrolled crying spells could be precipitated almost by any stimulus and they could last for a long time (e.g. [90,91]).
There is no clear relationship between crying and depression based on human neuropsychiatric observations. This situation originates from lack of suitable animal models of human crying. In the present article, an attempt will be made to answer the question whether emission of rat aversive vocalizations (22 kHz calls) may be regarded as an evolutionary equivalent of adult human crying. Using this comparison, the symptom of crying in depressed human patients will be reanalyzed. Numerous features and characteristics of rat 22 kHz aversive vocalizations and human crying vocalizations are equivalent. Comparing evolutionary, biological, physiological, neurophysiological, social, pharmacological, and pathological aspects have shown vast majority of common features. It is concluded that emission of rat 22 kHz vocalizations may be treated as an evolutionary vocal homolog of human crying, although emission of 22 kHz calls is not exactly the same phenomenon because of significant differences in cognitive processes between these species. It is further concluded that rat 22 kHz vocalizations and human crying vocalizations are both expressing anxiety and not depression. Analysis of the relationship between anxiety and depression reported in clinical studies supports this conclusion regardless of the nature and extent of comorbidity between these pathological states.
Crying in borderline personality disorder patients
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Below, we first discuss in more detail what is currently known about human emotional crying. Human emotional crying can be described as the shedding of tears from the lacrimal apparatus in the absence of any irritation of the eyes, which is often accompanied by vocalizations, sobbing, and increased activity in some facial muscles (Patel, 1993). Only humans cry with tears in response to both positive and negative emotional events (Gračanin et al., 2018; Trimble, 2012; Vingerhoets, 2013).
Emotion dysregulation and hyperreactivity are considered central features of Borderline Personality Disorder (BPD). We assumed that such emotion dysregulation is also reflected in increased crying behavior of these patients and, consequently, hypothesized that BPD patients (N = 62), compared to Cluster C personality disorder patients (Cluster C-PD; N = 25) and non-patients (N = 54), would show higher scores on crying measures. To evaluate crying behavior, we used a set of specially designed tools. Compared to non-patients, BPD patients showed the anticipated higher crying frequency despite a similar crying proneness and ways of dealing with tears. They also reported less awareness of the influence of crying on others. However, Cluster C-PD patients showed a very similar pattern of findings. Overall, our results suggest that the increased crying of BPD patients likely results from environmental factors or the misperception of situations, rather than from stable traits. Remarkable is that the observed discrepancies in crying behavior compared to non-patients seem to be similar for Cluster-C PDs and BPD.
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Excessive tearfulness with tears dropping off the face may be observed as a distinct sign of cessation of prolonged cocaine use (16). In contrast, crying was no more likely in patients with major depression than healthy controls and crying decreases with worsening depression (17–20). Although other autonomic signs are found in major depression, including constipation and lower salivation rate, respiratory sinus dysrhythmia is a pure measure of parasympathetic tone and is decreased in major depression and acute cocaine intoxication (21–26).
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Although crying spells and increased tearfulness are considered to be signs of depression, crying was no more likely in depressed subjects than in healthy controls in multiple studies [10,11]. Furthermore, in other studies, crying behavior decreases with worsening depression [12,13], consistent with the decreased parasympathetic tone in this disorder. Acute cocaine intoxication is also associated with signs of decreased parasympathetic tone including mydriasis [14], increased heart rate, and decreased RSA [15,16].
This study aims to investigate excessive tearfulness as a sign to help determine the etiology of depressive symptoms.
Clinicians were instructed to document the occurrence of excessive tearfulness in all patients seen in the Psychiatric Emergency Service. Excessive tearfulness was defined as crying to the severity that at least 1 tear drops off the face. A comparison group was formed from the general population of the Psychiatric Emergency Service.
Excessive tearfulness was documented in 36 different patients. The prevalence of the sign in the general population was 1.9%. Patients with excessive tearfulness were more likely to have cocaine in their urine (P < .0001, χ² test), receive a substance-related primary diagnosis (P < .0001, χ² test), and be admitted for psychiatric hospitalization (P < .001 χ² test). Patients with excessive tearfulness had significantly shorter voluntary hospital stays (P < .05, t test).
Excessive tearfulness could be a useful clinical sign of cocaine-induced depression.
Crying: Is it beneficial for one's well-being?
2002, International Congress Series
This paper summarises the current knowledge with respect to the intrapersonal and interpersonal effects of crying. It has been hypothesised that crying may have an impact on psychobiological processes in the crying individual himself facilitating the physiological and psychological recovery after distress (intrapersonal effects). At the same time, crying may elicit positive or negative reactions from the social environment (interpersonal effects). However, until now no compelling evidence has been found that either the intrapersonal effects or the interpersonal effects of crying are beneficial for the crying person. A possible explanation is that crying may only have a positive effect on well-being when it induces positive effects from the social environment. This would imply that crying does not by definition lead to tension and/or emotional relief. Rather, the sociocultural context in which the crying occurs is expected to be important. Future research should compare the psychobiological processes in the crying individual in situations in which crying has positive interpersonal effects with situations in which crying has no or negative interpersonal effects.

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Crying behavior and psychiatric disorder in adults: A review

Abstract

Behav Res Ther

Changes in behaviour in dementia: a neglected research area

Br J Psychiatry

Crying behaviour in the human adult

Integr Psychiatry

Crying and depression among older adults

Gerontologist

Weeping: a problem of many facets

Bull Br Psychol Soc

Crying and laughing after brain damage

J Neurosurg Neurol Psychiatry

Emotionalism: clinical features and management

Geriatr Med

Why grown-ups cry: a two-factor theory and evidence from the Miracle Worker

Motiv Emotion