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Crying

Crying is the physiological process of producing tears from the lacrimal glands, usually accompanied by audible sobbing, facial muscle contractions, and other expressive behaviors, in response to emotional stimuli like sadness, joy, or frustration, physical pain, or environmental irritants.^[1] This response serves multiple functions, including emotional regulation, social signaling, and eye protection, and is generally considered a uniquely human trait when accompanied by vocalizations, though recent research has observed increased tear production in dogs during positive emotional contexts such as reunions with owners.^[2]^[3] Human tears are categorized into three main types based on their purpose and composition: basal tears, which continuously lubricate and protect the eyes from debris and bacteria; reflex tears, which flush out irritants such as smoke, dust, or onions; and emotional tears, which are produced during intense feelings and contain higher levels of stress hormones like adrenocorticotropic hormone (ACTH) and proteins compared to the other types.^[1]^[4] Emotional tears differ chemically, potentially aiding in the excretion of emotional toxins and contributing to mood recovery after distress.^[5] From a psychological perspective, crying acts as a form of emotional catharsis, helping individuals process overwhelming feelings and restore psychological balance by activating the parasympathetic nervous system, which promotes relaxation.^[6] It also fosters social bonds by eliciting empathy and support from others, as visible tears signal vulnerability and encourage prosocial responses.^[7] Research indicates gender differences in crying frequency, with women crying approximately 5.3 times per month on average compared to 1.3 times for men, influenced by both biological factors like testosterone levels and cultural norms.^[8] The benefits of crying extend to physical health, as it releases endorphins and oxytocin—hormones that reduce pain, lower stress, and enhance feelings of well-being—while also potentially improving immune function through the removal of stress-related chemicals via tears.^[9] Evolutionarily, emotional crying likely developed as a communication tool to signal distress and solicit care from social groups, enhancing survival by promoting cooperation and reducing aggression in interpersonal conflicts, though recent observations suggest analogous tear responses in dogs.^[2]^[3] Despite these advantages, cultural attitudes toward crying vary, with some societies viewing it as a sign of weakness, though scientific evidence underscores its adaptive value in human behavior.^[6]

Physiology and Biology

Types of Tears

Tears produced by the human eye are classified into three primary types based on their physiological roles and triggers: basal, reflex, and emotional tears. Each type originates primarily from the lacrimal glands located above the outer corner of each eye, though basal tears also involve accessory glands. These tears share a basic composition of approximately 98% water, along with electrolytes, lipids, metabolites, and proteins, but differ in volume, specific components, and production stimuli.^[4]^[5]^[10] Basal tears are continuously secreted at a low rate of about 0.5 to 2 microliters per minute to lubricate and protect the ocular surface, maintaining a stable tear film that nourishes the cornea and conjunctiva while preventing dehydration and infection. Their composition includes water, salts such as sodium and potassium, and antimicrobial proteins like lysozyme, which constitutes 20-30% of the total protein content and breaks down bacterial cell walls to provide innate immune defense. These tears form the foundational layer of the tear film, ensuring constant ocular health without conscious triggers.^[4]^[5]^[11] Reflex tears, in contrast, are produced in much higher volumes—up to 100-fold more than basal tears—by the main lacrimal glands in response to physical irritants such as smoke, dust, onions, or foreign bodies, serving to flush out these stimuli and protect the eye from harm. They contain similar electrolyte levels to basal tears, with osmolarities around 306-308 mOsm/L, aiding in rapid dilution and removal of irritants through increased flow rather than altered chemistry. This type of tearing is an involuntary reflex mediated by trigeminal nerve stimulation, distinct from emotional responses.^[4]^[1]^[12] Emotional tears arise specifically during crying induced by strong feelings like sadness, joy, or stress, and are unique in their biochemical profile compared to the other types. They contain elevated concentrations of stress-related hormones, including prolactin and adrenocorticotropic hormone (ACTH), as well as the endogenous opioid leucine enkephalin, which acts as a natural pain reliever by binding to opioid receptors. Chemical analyses, such as those conducted by biochemist William Frey, reveal that emotional tears have approximately 24% higher total protein content than reflex tears, contributing to their greater viscosity and supporting hypotheses that they facilitate the excretion of stress byproducts from the body.^[5]^[13]^[14] Regardless of type, all tears follow a common drainage pathway: after spreading across the eye surface, excess fluid enters small openings called puncta at the inner corners of the eyelids, travels through canaliculi to the lacrimal sac, and then down the nasolacrimal duct into the nasal cavity. This anatomical route explains the common accompaniment of a runny nose during crying, as the increased tear volume overwhelms the drainage system and stimulates nasal secretions.^[15]^[16]

Biological Mechanisms

Crying involves coordinated activation of the facial nerve, cranial nerve VII, which innervates key facial muscles responsible for the characteristic expressions and movements. Specifically, contraction of the orbicularis oculi muscle closes the eyelids and facilitates tear overflow by compressing the lacrimal sac, while the zygomaticus major and minor muscles contribute to the downturned mouth and furrowed brow typical of sobbing.^[7] These muscular actions produce rhythmic facial contortions and audible sobs as the muscles alternate between contraction and relaxation.^[7] The autonomic nervous system plays a central role in the physiological cascade of crying, with parasympathetic activation via the facial nerve stimulating the lacrimal glands to secrete tears through acetylcholine-mediated release of electrolytes, water, and proteins.^[7] Concurrently, sympathetic nervous system responses during intense crying episodes elevate heart rate and respiratory rate, contributing to the overall arousal state and facilitating the expulsion of tears.^[17] Respiratory changes during crying include hyperventilation and irregular breathing patterns driven by spasms of the diaphragm and intercostal muscles, which generate the forceful inhalations and exhalations underlying vocalizations and sobbing.^[7] These spasms create a cycle of rapid air intake followed by partial glottal closure, producing the distinctive wail or cry sound while increasing overall ventilation to support the emotional intensity.^[7] Sensory feedback from the trigeminal nerve (cranial nerve V) is essential for initiating and modulating reflex cry responses to irritants, as its ophthalmic branch detects physical stimuli on the ocular surface and conveys afferent signals to trigger lacrimal secretion and facial reflexes.^[7] In emotional crying, central neural pathways integrate with autonomic systems to drive tearing, distinct from peripheral reflex mechanisms.^[7] Gender differences in crying physiology are evident, with women generally producing more emotional tears than men, linked to higher baseline prolactin levels that may lower the threshold for tear production and emotional expression.^[8] This hormonal disparity, where adult women exhibit serum prolactin concentrations approximately 60% higher than men, aligns with observed patterns of increased crying proneness in females.^[18]

Neural and Hormonal Responses

Crying involves a complex interplay of neural structures primarily within the limbic system, which orchestrates the emotional triggers and physiological expression of tears. The amygdala serves as a central hub for processing intense emotions such as sadness or pain, rapidly evaluating stimuli and initiating the cry response by signaling downstream structures.^[7] The anterior cingulate gyrus contributes to distress signaling, integrating sensory and emotional inputs to amplify the urge to cry, while the prefrontal cortex exerts regulatory control, modulating the onset, intensity, and cessation of crying episodes through inhibitory mechanisms.^[7] These regions form a networked circuit that distinguishes emotional crying from reflexive responses, with the insula playing a pivotal role in interoceptive awareness of bodily states associated with emotion.^[19] Neuroimaging studies, particularly functional magnetic resonance imaging (fMRI), provide evidence for differential activation during emotional versus reflex tears. Research has demonstrated heightened activity in the insula when individuals produce or observe emotional tears, reflecting its involvement in empathic and self-referential emotional processing, in contrast to minimal insula engagement during non-emotional tearing such as from irritants.^[7] For instance, fMRI scans of participants listening to infant cries reveal robust activation in the insula alongside the amygdala and cingulate cortex, underscoring the region's sensitivity to emotionally salient vocalizations.^[20] This activation pattern highlights the insula's contribution to the subjective experience of crying as a distress signal. At the neurotransmitter level, acetylcholine is released via parasympathetic innervation to stimulate lacrimal gland secretion, directly facilitating tear production during emotional episodes.^[7] Following the acute phase of crying, endorphins—endogenous opioids—are liberated, contributing to the characteristic post-cry relief and mood stabilization by binding to opioid receptors in the brain.^[9] Hormonally, stress-induced crying triggers a cortisol surge through activation of the hypothalamus-pituitary-adrenal (HPA) axis, which mobilizes the body's stress response; however, prolonged crying is associated with subsequent cortisol reduction, aiding recovery from emotional arousal.^[21] In social contexts, oxytocin release during or after crying enhances interpersonal bonding by dampening stress reactivity and fostering attachment, as evidenced in studies of emotional support interactions.^[22] These feedback loops via the HPA axis integrate neural signals with endocrine modulation, ensuring crying serves both cathartic and adaptive functions.

Functions and Purposes

Emotional Regulation

Crying serves as a key mechanism for emotional regulation by providing a cathartic release of built-up emotional tension, thereby reducing physiological arousal following intense emotional experiences. According to catharsis theory, as articulated in psychological literature, this process acts like a release valve, allowing individuals to discharge pent-up stress and return to a state of emotional equilibrium.^[23] Seminal work by researchers such as Thomas Scheff has framed crying within broader cathartic frameworks, emphasizing its role in alleviating internal pressure without the need for external intervention.^[23] Empirical studies indicate that crying often leads to mood improvement. Retrospective self-reports from surveys suggest that most individuals (around 70-90%) feel better afterward, though experimental studies show mixed results, with only about 30% reporting improvement and many showing no change.^[8]^[22] This is attributed in part to the release of endorphins and oxytocin during crying, which help ease physical tension and promote a sense of calm, counteracting the heightened arousal from negative emotions.^[9] Emotional tears contain higher levels of certain proteins compared to other types, and some researchers have hypothesized a role in expelling stress-related chemicals, though evidence for significant stress hormone content like cortisol is limited and debated.^[8] In the context of grief processing, crying facilitates the expression of sadness during mourning, enabling individuals to navigate emotional stages without suppression, which can otherwise prolong distress. This outward manifestation aligns with models of grief, such as those proposed by Elisabeth Kübler-Ross, where crying supports the acceptance and integration of loss by allowing unfiltered emotional discharge.^[9]^[24] Research highlights that such expression aids in emotional healing, preventing the buildup of unresolved sorrow.^[24] Crying also functions as a self-soothing behavior by activating the parasympathetic nervous system, shifting the body from sympathetic "fight-or-flight" arousal to a restorative "rest-and-digest" state. This autonomic response, involving slowed heart rate and deeper breathing during sobs, helps restore baseline emotional and physiological levels post-crying. A study by Gračanin et al. demonstrated this through measurements of mood and arousal, showing crying's potential to self-regulate intense feelings. Hormonal changes, including elevated oxytocin, briefly support this transition, though detailed mechanisms are explored elsewhere.^[9]^[22] However, the regulatory benefits are not universal; not all crying episodes result in relief, and prolonged crying can sometimes exacerbate anxiety or maintain elevated distress in vulnerable individuals. Laboratory studies reveal that while about one-third of crying instances show immediate mood enhancement, others lead to no change or worsening, particularly among those with depressive or anxiety symptoms.^[25] Factors such as the context of the cry and pre-existing mental health conditions influence outcomes, underscoring that crying's cathartic potential varies.^[22] Crying serves as a powerful non-verbal signal of vulnerability in human social interactions, often eliciting empathy and support from observers, which in turn strengthens interpersonal bonds. Research indicates that emotional tears act as a cue for distress, prompting others to offer comfort and assistance, thereby fostering cooperative behaviors and mutual pro-social responses.^[26] For instance, studies using vignettes of crying individuals have shown that observers report increased intentions to provide help and emotional support, viewing tears as a genuine plea for aid rather than a sign of weakness.^[27] Within the framework of attachment theory, crying plays a central role in prompting caregiving and building emotional intimacy across relationships. In parent-child dynamics, infant cries function as an adaptive signal to alert caregivers to the child's needs, facilitating proximity and protection, as originally proposed by Bowlby in his ethological model of attachment behaviors.^[28] This mechanism extends to adult relationships, where crying signals unmet social or emotional needs to attachment figures, such as romantic partners, promoting closeness and support. Empirical evidence links higher attachment anxiety to increased crying frequency and proneness, while attachment avoidance correlates with reduced crying, suggesting that tears help regulate relational distress by soliciting reassurance.^[29] Societal gender norms significantly influence the communicative roles of crying, with expectations often shaping how tears are expressed and received. Women are typically socialized to use crying as a signal of emotional need, eliciting comfort and sympathy from others, whereas men face pressure to suppress tears to conform to ideals of stoicism and emotional control.^[30] This disparity arises from cultural beliefs associating female crying with vulnerability that invites helping behaviors, while male crying may be perceived as incongruent with norms of strength, leading to less supportive responses.^[30] Cross-species parallels highlight crying's evolutionary roots in social signaling, with primate distress vocalizations serving similar functions for group cohesion. In non-human primates, separation calls and alarm cries signal social disconnection or threats, drawing group members closer to restore unity and provide aid, much like human tears facilitate bonding in social groups.^[31] Although primarily a signal for genuine support, crying can also be employed strategically in social contexts, such as negotiations, to influence outcomes, though this raises ethical concerns about authenticity. Perceived manipulative use of tears, often termed "crocodile tears," damages the crier's social image by evoking disgust and reduced empathy, particularly when intent is transparent. Gender moderates these reactions, with women facing greater backlash and harsher judgments for insincere crying compared to men.^[32]^[33]

Evolutionary Perspectives

Crying in human infants serves as a critical survival mechanism by signaling needs for protection, feeding, and care, eliciting rapid responses from caregivers to ensure the vulnerable offspring's well-being. This function traces back to evolutionary adaptations where infant cries act as distress signals, analogous to those in other mammals, promoting parental investment and reducing mortality risks in early human environments.^[34] Such signaling likely evolved to maximize reproductive success in ancestral populations facing high infant mortality rates.^[7] Beyond infancy, emotional crying in adults fosters group cohesion by promoting altruism and cooperation, particularly in small-scale societies like those of hunter-gatherers, where shared distress signals strengthened social bonds and collective resource sharing. This prosocial role enhances trustworthiness and elicits supportive behaviors from others, providing selective advantages in cooperative survival strategies.^[2] In these contexts, crying acted as an honest signal of vulnerability, reinforcing interpersonal ties essential for group-level success.^[35] The detoxification hypothesis posits that emotional tears remove stress-related chemicals from the body, offering a physiological benefit that could have provided a selective edge in high-stress ancestral environments by aiding recovery and maintaining homeostasis. William Frey's research suggested that emotional tears contain higher concentrations of proteins and possibly stress-related chemicals compared to basal or reflex tears, supporting the idea of a cleansing function, though this remains debated due to limited direct evidence.^[36]^[8] However, while this mechanism may contribute to mood regulation, its evolutionary primacy remains debated due to limited direct evidence of adaptive outcomes.^[37] Comparative ethology reveals crying's deep roots in mammalian evolution, spanning approximately 200 million years since the divergence of mammals, with distress vocalizations in species like elephants serving similar functions to human cries by alerting group members to threats and soliciting aid. For instance, Asian elephants produce vocalizations paired with physical comforts during conspecific distress, mirroring the consolatory aspects of human emotional crying and underscoring conserved signaling pathways across taxa.^[38] These parallels suggest that human crying elaborated on ancient mammalian distress calls for enhanced social communication.^[7] Recent neurobiological research as of 2023 highlights emotional crying's uniqueness in humans, potentially linked to advanced prefrontal cortex functions for social emotion signaling, though further studies are needed.^[7] In modern contexts, cultural norms that suppress crying, such as those emphasizing stoicism in certain societies, may create an evolutionary mismatch by inhibiting a behavior adapted for stress relief and social bonding, potentially leading to heightened emotional dysregulation. This conflict arises because human crying evolved in environments where open expression facilitated group support, yet contemporary suppression can undermine these innate benefits.^[39]

Patterns and Variations

Frequency and Triggers

Adults cry on average between 1 and 5 times per month, with significant individual variation influenced by factors such as gender and context.^[8] Women typically cry more frequently than men, reporting 30 to 64 episodes per year compared to 6 to 17 for men, a pattern observed across multiple studies in Western populations.^[8]^[26] The primary triggers for crying in adults are predominantly negative emotions, accounting for 80 to 90 percent of episodes, including sadness, anger, frustration, and helplessness.^[40] Positive emotions such as joy or overwhelming happiness elicit crying in 10 to 20 percent of cases, often in response to reunions, achievements, or aesthetic experiences.^[40] Physical pain serves as a reflex trigger, distinct from emotional crying, by activating basal tear production to protect the eyes and lubricate tissues.^[41] Crying frequency exhibits age-related patterns, peaking during adolescence due to hormonal shifts and emotional intensity, before declining steadily in older adulthood as emotional regulation improves and physical factors like drier eyes reduce tear production.^[42]^[43] Gender differences in crying intensify during this period, with adolescent girls reporting higher proneness linked to pubertal changes.^[44] In women, estrogen fluctuations contribute to variations in crying frequency, with elevated levels during the menstrual cycle's luteal phase or surges in pregnancy heightening emotional sensitivity and proneness to tears.^[8]^[45] These hormonal influences interact with prolactin, which promotes crying and rises under estrogen's effect, explaining increased episodes during reproductive transitions.^[8] Environmental and cultural factors also modulate crying rates, with higher frequencies reported in individualistic societies—such as those in Western Europe and North America—compared to collectivist ones in Asia or Africa, where emotional restraint is more valued.^[46] This disparity correlates with societal emphases on personal expression versus group harmony, affecting both self-reported proneness and observed behaviors.^[46]

Crying in Infants

Newborns typically emit their first cry immediately after birth, which helps clear amniotic fluid from the lungs and initiates the transition to air breathing by expanding the alveoli and facilitating gas exchange.^[47] This initial cry is a critical physiological response that signals the onset of independent respiration and alerts caregivers to the infant's arrival. In the ensuing weeks, crying becomes a primary mode of communication, with healthy infants crying for an average of 2 to 3 hours per day during the first three months, reaching a peak around 6 weeks of age before gradually declining.^[48] Infant cries vary acoustically to convey specific needs, enabling parents to interpret and respond effectively. Hunger cries are often rhythmic and repetitive, characterized by a steady pattern of phonation and pauses, while pain elicits high-pitched, intense bursts with rapid rises in fundamental frequency and longer durations. Tiredness or discomfort may produce whinier, lower-intensity cries with irregular rhythms and shorter phonation periods.^[49]^[50] These acoustic differences allow caregivers to distinguish between distress types through auditory cues, such as pitch, duration, and melody, fostering appropriate interventions.^[51] As infants develop, crying patterns evolve alongside emerging communication skills. After the peak at 6 weeks, total crying time typically decreases significantly by 3 to 4 months, coinciding with the onset of cooing, babbling, and other pre-linguistic vocalizations that supplement or replace crying as expressive tools.^[52] This shift reflects neurological maturation and the infant's growing ability to self-soothe or signal needs verbally. Excessive crying, known as colic, affects up to 20% of infants and is defined by episodes lasting more than 3 hours per day, occurring on more than 3 days per week, for at least 3 weeks, often without an identifiable medical cause.^[53] Effective soothing techniques can substantially mitigate infant crying. Methods such as swaddling, which provides a sense of security by restricting startle reflexes, and gentle rocking, which mimics intrauterine motion, have been shown to reduce crying durations in fussy infants compared to unswaddled states. Responsive parenting—promptly attending to cries with holding, feeding, or environmental adjustments—further enhances calming, with studies indicating that consistent responsiveness can decrease overall cry time and promote self-regulation.^[54]^[55] Persistent unsoothed crying in early infancy is associated with potential long-term attachment challenges, as outlined in John Bowlby's attachment theory, which posits that consistent caregiver responsiveness to cries builds secure internal working models of relationships, whereas neglectful responses may foster insecure attachments marked by anxiety or avoidance.^[56] This evolutionary adaptation underscores crying's role in soliciting proximity and care from adults, ensuring infant survival through bonded interactions.^[57]

Crying Across Cultures

Cultural norms significantly shape the expression, acceptance, and perceived meaning of crying, varying between collectivist and individualistic societies. In individualistic cultures such as the United States, crying is frequently regarded as a personal emotional outlet, often kept private to prevent being seen as a sign of vulnerability or weakness, aligning with values emphasizing self-reliance and emotional control in public.^[46] Conversely, in collectivist cultures like Japan, crying can be more socially accepted within group contexts, where it serves to foster harmony and emotional connection among members, as evidenced by practices like "rui-katsu" (tear-seeking activities) that encourage collective crying sessions to relieve stress and build communal bonds.^[58] By 2025, this Japanese practice has inspired the global emergence of crying clubs, with examples including the opening of such venues in Mumbai, India, promoting emotional release as a wellness trend.^[59]^[60] These differences reflect broader patterns where crying frequency is higher in individualistic nations, but its social utility in collectivist settings promotes relational maintenance over individual catharsis.^[46] Gender roles further influence crying norms across regions, with Mediterranean cultures exhibiting greater tolerance for male crying compared to Northern European ones. In Mediterranean societies, such as those in Italy and Greece, men may express grief more openly without severe stigma, rooted in expressive emotional traditions that view tears as a natural response to loss or joy, contrasting with the more restrained expectations in Northern European cultures like Germany or the Netherlands, where male crying is often associated with diminished stoicism.^[61] This tolerance in Mediterranean contexts stems from cultural emphases on passionate interpersonal bonds, leading to smaller gender disparities in crying proneness than in less expressive Northern regions. Funeral rituals highlight these cultural variances in crying's public role. In Mediterranean traditions, such as Southern Italian lamenting, public wailing serves as a communal expression of grief, where women (and sometimes men) vocalize sorrow through improvised songs and cries to honor the deceased and affirm social ties, transforming personal loss into a shared cultural performance.^[62] In contrast, East Asian mourning practices, particularly in China and Japan, favor restrained expressions, prioritizing ritualistic composure and ancestor veneration over overt emotional displays to maintain familial harmony and avoid burdening others, with public crying often viewed as disruptive to collective equilibrium.^[63] Media portrayals, especially from Hollywood, have amplified the view of crying as a therapeutic and empowering act, influencing global perceptions of emotional release. Films and television often depict crying as a pathway to personal growth and resolution, normalizing intense emotional displays in narratives that resonate worldwide and encouraging viewers to see tears as a sign of strength rather than frailty.^[64] Globalization, driven by Western media exposure, is prompting shifts in traditional societies, where younger generations increasingly embrace open crying influenced by individualistic ideals. In East Asian contexts, access to Hollywood content and global pop culture has led youth to express emotions more freely, challenging historical restraints and blending local harmony-focused norms with Western therapeutic views of tears.^[65] This evolution subtly enhances social bonding by making emotional vulnerability a shared, cross-cultural experience.^[66]

Psychological and Pathological Aspects

Categorizing Dimensions

Crying episodes vary in intensity, typically classified on a spectrum from mild manifestations, such as tearing up or moist eyes without overt sobbing, to severe forms involving uncontrollable sobbing, vocalizations, and physical distress.^[43] This gradation is commonly assessed through self-report questionnaires or observational methods that quantify emotional and behavioral components, including tools like the Crying Proneness Scale, which evaluates the frequency, duration, and perceived intensity of crying responses across situations.^[67] Contextually, crying is categorized as situational or chronic based on its triggers and persistence. Situational crying arises from acute events, such as personal loss or overwhelming experiences, and tends to resolve once the stimulus subsides.^[68] In contrast, chronic crying persists over time and is often linked to underlying psychological states, like those in major depressive disorder, where it manifests as frequent, intense episodes without clear external prompts.^[69] From a psychological perspective, crying dimensions include the primary emotion driving the response—most commonly sadness, but also anger, frustration, or even joy—and secondary traits reflecting individual styles, such as repressed (inhibited or suppressed expression) versus expressive (open and uninhibited release).^[70]^[43] Repressed traits may correlate with higher emotional restraint due to personality factors like attachment avoidance, while expressive styles facilitate quicker mood recovery through uninhibited catharsis.^[43] Vingerhoets' model offers a structured framework for categorizing and analyzing adult crying, incorporating four interrelated factors: the situation (external context eliciting the response), antecedents (personal predispositions and emotional appraisals leading to distress), the crying behavior itself (intensity, duration, and accompaniments like tears or vocalizations), and consequences (post-crying effects on mood, social interactions, or physiology).^[71] This biopsychosocial approach emphasizes how these factors interact dynamically, enabling researchers to dissect crying's multifaceted nature beyond simple emotional triggers. Recent datasets, such as the Emotional Crying Behavior Dataset (ECBD) released in 2025, further support this by providing resources for studying crying signals in emotional contexts.^[72] To distinguish pathological from typical crying, research employs diagnostic tools that differentiate involuntary outbursts, as seen in pseudobulbar affect (PBA)—a neurological condition involving sudden, disproportionate laughing or crying unrelated to emotional state—from voluntary, emotion-driven crying.^[73] PBA is identified through clinical assessments focusing on episode uncontrollability and incongruence with context, often using scales like the Center for Neurologic Study-Lability Scale to quantify frequency and impact.^[74] Pseudobulbar affect (PBA) is a neurological condition characterized by sudden, involuntary episodes of crying or laughing that are disproportionate to the individual's emotional state and often occur in response to minimal or no stimuli.^[73] It arises from damage to neural pathways, including those in the brainstem and corticopontocerebellar tracts, which disrupt the regulation of emotional expression.^[75] PBA is commonly associated with neurological disorders such as amyotrophic lateral sclerosis (ALS), stroke, multiple sclerosis, and traumatic brain injury, where it manifests as uncontrollable outbursts that can significantly impair social functioning and quality of life. As of 2025, emerging treatments like MTS-004, an experimental tablet, have shown safety and reduction in PBA symptoms in phase 2 trials for patients with MS and ALS.^[76] These episodes are distinct from voluntary emotional responses, as they are reflexive and not reflective of the person's internal feelings.^[77] Dry eye syndrome, also known as dry eye disease (DED), involves insufficient production of basal tears or poor tear quality, leading to ocular surface instability and discomfort.^[78] This reduction in tear volume can make attempts at emotional crying painful, as the lack of lubrication exacerbates irritation, burning, and foreign body sensations on the eye surface.^[78] Often linked to autoimmune conditions like Sjögren's syndrome, DED affects tear homeostasis and can hinder the physical expression of emotions, complicating emotional regulation for affected individuals.^[79] Symptoms may include reflex tearing in response to irritation, but true emotional tearing remains challenging and distressing.^[80] In depression, crying patterns can vary widely; anhedonia, a core symptom involving diminished ability to experience pleasure or emotions, frequently leads to an inability to cry despite overwhelming sadness.^[81] Conversely, excessive or hyper-crying may occur as a prominent symptom, with frequent crying spells interfering with daily activities and reflecting heightened emotional distress.^[82] Anxiety disorders can also involve excessive crying triggered by apprehension or worry, where crying spells may accompany physical tension and hypervigilance. These patterns underscore how mood disorders disrupt normal crying as a cathartic or communicative function. Individuals with autism spectrum disorder (ASD) exhibit atypical crying patterns, including differences in the production and triggers of emotional versus distress cries.^[83] Emotional tears in response to social or affective stimuli may be reduced, reflecting challenges in emotional expression and regulation.^[84] However, cries triggered by sensory overload—such as overwhelming auditory, visual, or tactile inputs—are often heightened, manifesting as intense meltdowns that serve as a physical release from sensory distress.^[85] Recent research as of 2025 indicates that atypical cry characteristics, such as fundamental frequency and duration, may serve as early biomarkers for ASD identification in infants.^[86] These variations stem from atypical sensory processing and emotion regulation, affecting up to 97% of individuals with ASD.^[87] Certain treatments for related conditions, such as selective serotonin reuptake inhibitors (SSRIs) used in depression and anxiety, can influence crying through side effects like emotional blunting, which may result in an inability to cry or reduced emotional reactivity.^[88] In some cases, particularly during initial treatment phases or in vulnerable populations like newborns exposed prenatally, SSRIs have been associated with increased crying or excessive emotional expression.^[89] These effects highlight the need for monitoring emotional responses during pharmacotherapy.^[90]

Therapeutic Interventions

Therapeutic interventions for crying focus on leveraging or regulating this behavior to alleviate distress in mental health and medical settings. In psychotherapeutic approaches, such as Gestalt therapy, encouraged crying serves as a cathartic mechanism for emotional release, allowing individuals to process suppressed feelings and achieve greater self-awareness. Research on crying episodes during psychotherapy indicates that these moments often align with pivotal therapeutic events, promoting emotional insight and transient mood improvements immediately following the release. ^[91] A clinical review of crying research further supports the role of catharsis in therapy, noting short-term positive effects on mood from emotional expression, though sustained benefits depend on integrated therapeutic support. ^[92] Pharmacological treatments target crying modulation through neurochemical pathways, particularly serotonin. Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, effectively diminish excessive or pathological crying in depressive disorders by elevating serotonin levels, which stabilizes emotional responses and reduces involuntary outbursts. ^[93] In neurological conditions like pseudobulbar affect, where uncontrollable crying occurs due to brain lesions, botulinum toxin (Botox) injections into facial muscles can interrupt hyperactive neural signals, decreasing the frequency and intensity of episodes. ^[94] However, SSRIs may also induce emotional blunting as a side effect, leading to reduced ability to cry even in appropriate emotional contexts. ^[95] Cognitive-behavioral therapy (CBT) and mindfulness-based interventions provide behavioral strategies to manage crying triggers, emphasizing identification and reframing of emotional cues. These techniques have demonstrated efficacy in anxiety disorders, with studies showing reductions in emotional distress post-treatment through enhanced regulation skills. ^[96] For instance, mindfulness practices foster non-judgmental awareness of crying impulses, while CBT challenges maladaptive thought patterns that exacerbate them, leading to fewer episodes over time. ^[97] In pediatric contexts, interventions for infant crying balance sleep training with attachment needs. The "cry-it-out" method, which involves allowing infants to self-soothe without immediate response, contrasts with attachment parenting's responsive soothing approach. Longitudinal studies indicate that consistent nighttime responsiveness to cries predicts secure mother-infant attachment at one year, supporting emotional security and reduced stress reactivity in responsive care models over extinction-based techniques. ^[98] Emerging therapies incorporate virtual reality (VR) simulations to facilitate safe crying practice in trauma treatment, particularly for post-traumatic stress disorder (PTSD). VR exposure therapy immerses patients in controlled environments that evoke traumatic memories, enabling gradual emotional release—including crying—without real-world risks, with preliminary trials showing symptom reductions through this immersive processing. ^[99]

Historical and Religious Contexts

Historical Views

In ancient Greek philosophy and medicine, crying was understood through the lens of humoral theory, where tears were seen as a mechanism for expelling excess bodily fluids to restore balance. Hippocrates, in his foundational works on temperament, associated melancholy—a state characterized by persistent sorrow—with an overabundance of black bile.^[100] Aristotle extended humoral views in his discussions of physiology and emotions, linking bodily fluids to the regulation of inner equilibrium.^[101] During the medieval and Renaissance periods, perspectives on crying shifted toward greater emphasis on restraint, influenced by revived classical philosophies. While earlier medieval thought often valorized emotional displays as markers of depth, Renaissance humanists drew on Stoic principles to advocate for emotional control, viewing unrestrained crying as a sign of weakness or lack of rational mastery over passions. Stoic thinkers like Seneca and Epictetus, whose works gained prominence in this era, argued that true virtue lay in assenting only to rational judgments, thereby tempering emotional outbursts such as weeping to prevent them from disrupting one's equanimity.^[102]^[103] The 19th century marked a turn toward embracing crying as a genuine emotional release, aligned with Romantic ideals of authenticity and individualism. Romantic philosophers and writers, reacting against Enlightenment rationalism, celebrated tears as a profound expression of the inner self, evident in literary works where weeping symbolized unfiltered sentiment and connection to nature's sublime forces. Charles Darwin's seminal 1872 publication, The Expression of the Emotions in Man and Animals, further advanced this by observing emotional tears as an innate human response, distinct from reflexive ones, serving adaptive purposes in social bonding and grief processing.^[104]^[105] In the 20th century, psychoanalytic theory reframed crying as a therapeutic catharsis, while post-World War II research highlighted the harms of its suppression in trauma contexts. Sigmund Freud, in collaboration with Josef Breuer, described in Studies on Hysteria (1895) how evoking and expressing repressed emotions through weeping could discharge psychic energy, leading to symptom relief in neurotic patients. Following the war, studies on survivors revealed that inhibited emotional expression, including suppressed crying, contributed to chronic post-traumatic stress, with longitudinal analyses of veterans showing that unprocessed grief exacerbated long-term psychological distress.^[106]^[107]

Religious Interpretations

In Christianity, tears are often interpreted as a profound expression of repentance, compassion, and spiritual intimacy with God. The shortest verse in the Bible, "Jesus wept" (John 11:35), depicts Jesus shedding tears at the death of his friend Lazarus, symbolizing divine empathy and the humanity of Christ, which serves as a model for believers to express genuine sorrow and solidarity in grief. This act underscores tears as a sacred response to loss, aligning with broader New Testament themes where weeping accompanies calls for repentance, as in Jesus' lament over Jerusalem (Luke 19:41). In monastic traditions, particularly within Eastern Orthodox and Catholic spirituality, the "gift of tears" (charisma dakryon) is revered as a divine grace granted during prayer or contemplation, signifying contrition, purification of the soul, and deeper union with God; early Desert Fathers like Abba Poemen described it as a "second baptism" that washes away sins and fosters humility.^[108] This practice was emphasized in communities such as those founded by Pachomius in the fourth century, where incessant weeping during devotion was seen as total surrender to divine love.^[109] In Islam, crying is viewed as a manifestation of humility (tawadu') and emotional piety (zukhraf), particularly during supplicatory prayer known as du'a, where tears demonstrate sincere dependence on Allah and soften the heart against arrogance. The Prophet Muhammad exemplified this through his own tears, such as when he wept upon hearing recitations of the Quran or contemplating the afterlife, modeling for Muslims that such expressions strengthen faith and invite divine mercy; a hadith narrates him crying while praying for his community, stating that his tears stemmed from overwhelming compassion.^[110] Another tradition records the Prophet advising believers to cry out of fear of Allah if unable, or even feign it to cultivate genuine remorse, as tears in du'a repel anger and affirm submission.^[111] This aligns with Quranic encouragement of soft-heartedness, where the Prophet's emotional displays during night prayers (tahajjud) highlight crying as a pathway to spiritual elevation and forgiveness.^[112] Judaism regards crying as an integral element of mourning rituals and a vehicle for expressing raw grief toward God, often intertwined with practices that acknowledge human vulnerability and divine comfort. The ritual of kriah, or tearing one's garments upon hearing of a death, immediately precedes or accompanies weeping as a physical and emotional rupture symbolizing the brokenness of loss, performed by close relatives during funerals and shiva observance to externalize inner pain.^[113] This act draws from biblical precedents, such as Jacob tearing his clothes upon learning of Joseph's supposed death (Genesis 37:34), and is complemented by communal crying during eulogies or Kaddish recitations. The Psalms further elevate tears as a nocturnal offering to God, with Psalm 6:6 portraying the psalmist flooding his bed with weeping every night as a plea for deliverance, emphasizing tears as sustenance in spiritual distress and a precursor to morning joy (Psalm 30:5). Such passages, recited in liturgies, frame crying as a righteous response that God collects in a bottle (Psalm 56:8), transforming personal sorrow into covenantal dialogue. In Hinduism and Buddhism, crying is symbolically linked to the release of karmic burdens and attachments, serving as a cathartic mechanism for emotional and spiritual purification within contemplative or tantric frameworks. In Hindu tantric traditions, such as those outlined in kriya yoga practices, tears facilitate the dissolution of deep-seated emotional blockages and karmic patterns, allowing practitioners to transcend ego-driven attachments through intensified sadhana (spiritual discipline) that includes weeping as a sign of inner alchemy.^[114] This aligns with bhakti paths where devotional crying, as seen in saints like Mirabai, purifies the soul by surrendering worldly bonds to the divine. In Buddhism, particularly Vajrayana and Theravada contexts, tears symbolize the impermanence (anicca) of phenomena and aid in detaching from samsaric illusions; texts describe them as bodily manifestations of insight into suffering, enabling purification by releasing clinging and fostering compassion.^[115] Tantric Buddhist rituals may invoke tears during visualization or deity yoga to cleanse obscurations, viewing them as a natural outflow of realizing emptiness and non-attachment. Indigenous traditions worldwide incorporate crying into shamanic ceremonies as a communal rite for healing trauma, restoring balance, and facilitating spirit communication. In various Native American and Siberian practices, crying rituals—often part of vision quests or healing circles—allow participants to vocalize grief through wailing or keening, which shamans interpret as invoking ancestral spirits to absorb pain and guide resolution, thereby mending social and cosmic harmonies.^[116] For instance, among the Ju/'hoan people of southern Africa, healing dances encourage collective weeping to channel supernatural energy (n/ang), where tears bridge the human and spirit realms, promoting communal catharsis and spiritual insight.^[117] These ceremonies emphasize crying not as isolation but as a shared invocation, enabling dialogue with unseen forces for personal and collective renewal.

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