Pathological crying is a frequent consequence of traumatic brain injury, and can easily be misconstrued as a symptom of major depressive disorder or an adjustment problem. First, this article discusses the neurobiological bases of pathological crying. The multiplicity of pathological entities and lesion locations that can produce this pathological affect are highlighted. The literature is reviewed with respect to the occurrence of pathological crying, specifically in traumatic brain injury. Consideration is then given to the clinical assessment of patients where crying is the chief complaint, and the traditional differential diagnostic approach is emphasized. Finally, psychological and somatic treatment considerations are addressed. Although psychopharmacological intervention can often provide significant relief, patient and family education about this clinical phenomenon is essential.