Coprolalia

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Coprolalia is involuntary swearing or the involuntary utterance of obscene words or socially inappropriate and derogatory remarks. Coprolalia comes from the Greek ?????? (kopros) meaning "feces" and ????? (lalia) from lalein, "to talk".

Coprolalia is an occasional characteristic of tic disorders, in particular Tourette syndrome, although it is not required for a diagnosis of Tourette's, and only about 10% of Tourette's patients exhibit coprolalia. It is not unique to tic disorders; it is also a rare symptom of other neurological disorders.

Related involuntary actions are copropraxia, performing obscene or forbidden gestures, and coprographia, making obscene writings or drawings.

Video Coprolalia

Background and causes

Coprolalia is a manifestation that may come from or may be a part of many different underlying causes. Most commonly, however, people seem to associate coprolalia with Tourette syndrome. When it comes to Tourette syndrome, the pathology of what causes this type of tic is not well pinpointed, but there are several correlations.

First of all, some research has pinpointed decreased grey matter thickness within the insula and sensorimotor cortex as the cause of some cases. Research notes that behavioral and functional brain imaging evidence indicates that the premonitory sensory phenomena (PSP) is associated with brain activity in the insular cortex, which is linked to interoceptive awareness. In the results of this research, it is noted that increased tic severity scores are associated with premonitory urges. Along with this, there is also evidence for the involvement of the insular cortex in the perception of urges. When conducting the research, the researchers of this report found that there was a relationship between grey matter thickness and PSP and that premonitory urges in Tourette syndrome are inversely associated with grey matter thickness in the sensorimotor and insular cortices. [30]

Another possibility when it comes to Tourette syndrome is genetics. In a study conducted in 2017, researchers found that there was a possible genetic and neurobiological relationship of the disinhibition phenotype in Tourette syndrome patients. However, it is noted that more research would be needed to determine a direct relationship. [31]

Coprolalia is not unique to tic disorders; it is also a rare symptom of other neurological disorders.[9][10] It may occur after injuries to the brain such as stroke[10] and encephalitis;[10][11] in other neurological conditions such as choreoacanthocytosis,[12] seizures,[13] and Lesch-Nyhan syndrome;[14] and rarely in persons with dementia or obsessive- compulsive disorder in the absence of tics.[10]

Maps Coprolalia

Characteristics

Coprolalia encompasses words and phrases that are culturally taboo or generally unsuitable for acceptable social use, when used out of context. The term is not used to describe contextual swearing. It is usually expressed out of social or emotional context, and may be spoken in a louder tone or different cadence or pitch than normal conversation. It can be a single word, or complex phrases. A person with coprolalia may repeat the word mentally rather than saying it out loud; these subvocalizations can be very distressing.

Coprolalia is an occasional characteristic of Tourette syndrome, although it is not required for a diagnosis of Tourette's. In Tourette syndrome, compulsive swearing can be uncontrollable and undesired by the person uttering the phrases. Involuntary outbursts, such as racial or ethnic slurs in the company of those most offended by such remarks, can be particularly embarrassing. The phrases uttered by a person with coprolalia do not necessarily reflect the thoughts or opinions of the person.

Cases of deaf Tourette patients swearing in sign language have been described, showing that coprolalia is not just a consequence of the short and sudden sound pattern of many swear words.

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Why swear words?

While the reason for choosing words that are commonly thought of as inappropriate is widely unknown, Doctor Timothy Jay suggests that it is caused by damage to the amygdala. The amygdala is a region of the brain that normally oversees emotions such as anger and aggression. Because of this, it is thought that the use of inappropriate words is a verbal manifestation of the inability to control aggression, including verbal aggression. [32]

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Prevalence

Only about 10% of Tourette's patients exhibit coprolalia, but it tends to attract more attention than any other symptom. There is a paucity of epidemiological studies of Tourette syndrome; ascertainment bias affects clinical studies. Studies on people with Tourette's often "came from tertiary referral samples, the sickest of the sick". Further, the criteria for a diagnosis of Tourette's were changed in 2000, when the impairment criterion was removed from the DSM-IV-TR for all tic disorders, resulting in increased diagnoses of milder cases. Further, many clinical studies suffer from small sample size. These factors combine to render older estimates of coprolalia--biased towards clinical populations of the more severe cases--outdated. An international, multi-site database of 3,500 individuals with Tourette syndrome drawn from clinical samples found 14% of patients with Tourette's accompanied by comorbid conditions had coprolalia, while only 6% of those with uncomplicated ("pure") Tourette's had coprolalia. The same study found that the chance of having coprolalia increased linearly with the number of comorbid conditions: patients with four or five other conditions--in addition to tics--were four to six times more likely to have coprolalia than persons with only Tourette's. One study of a general pediatric practice found an 8% rate of coprolalia in children with Tourette syndrome, while another study found 60% in a tertiary referral center (where typically more severe cases are referred). A more recent Brazilian study of 44 patients with Tourette syndrome found a 14% rate of coprolalia; a Costa Rican study of 85 subjects found 20% had coprolalia; a Chilean study of 70 patients found an 8.5% rate of coprolalia; older studies in Japan reported a 4% incidence of coprolalia; and a still older clinical study in Brazil found 28% of 32 patients had coprolalia. Considering the methodological issues affecting all of these reports, the consensus of the Tourette Syndrome Association is that the actual number is below 15 percent.

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Comorbidities

Attention-Deficit Hyperactivity Disorder (ADHD)[33][34]

Obsessive-Compulsive Disorder (OCD)[33][34]

Anxiety [33][34]

Lower Quality of Life [33][34]

Depression [33][34]

Aggression [34]

Emotional Dysregulation [34]

Physical consequences such as pain and discomfort of the repetitive movements [33]

Low Self-Esteem [33]

Autism Spectrum Disorder [33]

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Treatment

Some patients have been treated by injecting botulinum toxin (botox) near the vocal cords. This does not prevent the vocalizations, but the partial paralysis that results helps to control the volume of any outbursts. Surprisingly, botox injections result in more generalized relief of tics than the vocal relief expected.

The severity and frequency of outbursts can also be decreased by surgically disabling nuclei in the thalamus, the globus pallidus and the cingulate cortex.

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Living with Coprolalia

Because Coprolalia is such a severe form of Tourette Syndrome due to the type of tic involved, the social and societal aspects of a Coprolalia patient's life can be very difficult. Oftentimes, the stigma and social maladjustment in Coprolalia can lead to social exclusion, bullying, and discrimination, which cause patients with severe symptoms to experience a negative impact on their health and wellbeing.[33]

According to Comorbidities, Social Impact, and Quality of Life in Tourette Syndrome, about one-third of Tourette Syndrome patients have been reported to have social problems, especially when they have Coprolalia. In agreement with this report, a study of Tourette Syndrome patients reported that the patients had problems with family relationships (29%), difficulties in making friends (27%), social life (20%), and being self-conscious (15%). One theory behind these statistics is that Tourette Syndrome patients have higher rates of insecure peer attachments, problems in peer relationships, difficulty making friends, stigmatization, and lower levels of social functioning than their control counterparts. Along with this, a study including parents of Tourette Syndrome patients resulted in 70% of parents reporting at least one problem area when considering school, home, or social activities due to experiencing symptoms of isolation and trouble when encountering new people. [33]

At a more personal level, these patients have also expressed difficulty with self care, which tends to be heightened by the presence of a comorbidity such as ADHD and OCD. Along with this, those who also have ADHD exhibit an increase in behavioral problems and a poorer quality of life in relationship to their healthy counterparts along with their counterparts who have isolated Coprolalia. It is important to note however, that many of these social aspects of the life of a person with Coprolalia manifest more in younger patients and patients who also experience comorbidities.[34]

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Society and culture

The entertainment industry often depicts those with Tourette syndrome as being social misfits whose only tic is coprolalia, which has furthered stigmatization and the public's misunderstanding of those with Tourette's. The coprolalic symptoms of Tourette's are also fodder for radio and television talk shows.

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See also

• Lists of language disorders

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References

30. Draper, A., Jackson, G. M., Morgan, P. S., & Jackson, S. R. (2016).

        Premonitory urges are associated with decreased grey matter              thickness within the insula and sensorimotor cortex in young         people with Tourette syndrome. Journal of Neuropsychology, 10(1),         143-153. http://doi.org/10.1111/jnp.12089  

31. Darrow, S. M., Hirschtritt, M. E., Davis, L. K., Illmann, C.,

        Osiecki, L., Grados, M., ... the Tourette Syndrome Association.            International Consortium for Genetics. (2017). Identification of         two heritable cross-disorder endophenotypes for Tourette Syndrome.         The American Journal of Psychiatry, 174(4), 387-396.         http://doi.org/10.1176/appi.ajp.2016.16020240  

32. Jay, T. (2000). Why we curse: A neuro-psycho-social theory of speech.

        Philadelphia: J. Benjamins Pub. Co.  

33. Eapen, V., Cavanna, A. E., & Robertson, M. M. (2016). Comorbidities,

        Social Impact, and Quality of Life in Tourette Syndrome. Frontiers         in Psychiatry, 7, 97. http://doi.org/10.3389/fpsyt.2016.00097  

34. 30. Rizzo R., Gulisano M., Pellico A., Cali P.V., Curatolo P.

        Tourette Syndrome and Comorbid Conditions: A Spectrum of Differen         Severities and Complexities. J. Child Neurol. 2014;29:1383-1389.          doi: 10.1177/0883073814534317.  

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