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J Neuropsychiatry Clin Neurosci. 2016 Summer;28(3):162-7. doi: 10.1176/appi.neuropsych.15090238. Epub 2016 Feb 22.

Pathological Joking or Witzelsucht Revisited.

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From the Depts. of Neurology (EG, MFM) and Psychiatry and Behavioral Sciences (MFM), David Geffen School of Medicine, University of California, Los Angeles; and the Neurology Service (MFM), Neurobehavior Unit (EG), VA Greater Los Angeles Healthcare System, Los Angeles, CA.


Humor, or the perception or elicitation of mirth and funniness, is distinguishable from laughter and can be differentially disturbed by neuropsychiatric disease. The authors describe two patients with constant joking, or Witzelsucht, in the absence of pseudobulbar affect and review the literature on pathological humor. These patients had involvement of frontal structures, impaired appreciation of nonsimple humor, and a compulsion for disinhibited joking. Current neuroscience suggests that impaired humor integration from right lateral frontal injury and disinhibition from orbitofrontal damage results in disinhibited humor, preferentially activating limbic and subcortical reward centers. Additional frontal-subcortical circuit dysfunction may promote pathological joking as a compulsion.

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