Coprolalia: Definition, Characteristics, Symptoms, Causes, Treatment and Recommendations

It comes from the Greek κόπρος (kopros) which means “feces” and λαλιά (lalia) from lalein, “to speak.”

The term coprolalia is used to describe involuntary vocalizations that are obscene or socially inappropriate.

Coprolalia includes swearing, but it also includes saying things that are culturally taboo, socially unacceptable, or inappropriate due to age or context.

For example, a child who uses any type of obscene language, or anyone who makes negative comments about another person’s ethnicity or physical appearance, or anyone who yells “bomb” or “fire” in a public place, are considered coprolalia. .

Coprolalia can also refer to these phrases or words that are said inside people’s heads or keep quiet to themselves, which can also cause intense internal distress. Copropraxia refers to gestures and actions of the same nature as coprolalia.

The obsession to perform (or not interpret) inappropriate behavior causes the need to move on with it, and vice versa.

The nature of coprolalia, being socially inappropriate, makes everyone involved uncomfortable – that is, until everyone understands what coprolalia is and why it occurs.

Education that coprolalia is an unintended symptom of a neurochemical disorder is essential to gain acceptance and understanding.

Coprolalia can be a lifelong struggle and the individual deserves understanding and acceptance. First, the family must accept coprolalia to provide a support system.

People with coprolalia may feel embarrassed and ashamed of their symptoms. There is no will or desire for the expression of coprolalia.

Often times, the response to coprolalia and the lack of understanding and acceptance of other people amplify the shame and shame of the person, leading to isolation.

The fear of performing the tic in public and being constantly examined and judged can also lead to isolation and depression. In addition, it prompts the person to constantly think about their coprolalia symptoms:

  • What’s that?
  • How will I handle it?
  • How can I delete it?
  • Who will laugh or watch?
  • Who will escape?

In turn, stress and hyper focus will make coprolalia occur more frequently and intensely.

In this way, the benign symptoms of coprolalia become malignant due to the stigmatization and judgment of bystanders. Coprolalia is a particularly distressing symptom for people with Tourette Syndrome.

Coprolalia can be a symptom of some neurological disorders as well as certain brain injuries and is a rare symptom in Tourette syndrome .

Although rare, it is often misunderstood and often glamorized by the media as a definition of Tourette Syndrome.

Coprolalia and Tourette syndrome

Coprolalia is an occasional feature of tic disorders, particularly Tourette syndrome, although it is not required for a Tourette diagnosis and only about 10% of Tourette patients have coprolalia.

It is not exclusive to tic disorders; it is also a rare symptom of other neurological disorders.

Related involuntary actions are copropraxia, making obscene or prohibited gestures, and coprography, making obscene writing or drawings.

Despite the misconception that Tourette syndrome is defined by uncontrollable and socially inappropriate name calling, only 10 percent of Tourette patients exhibit that symptom.

Most have milder tics such as rapid blinking, shrugging, and throat clearing. Coprolalia, the involuntary expression of obscenities, profanities, and derogatory comments, is an extreme example of a vocal tic experienced by some people with Tourettes.

When compulsion overcomes them, sufferers cannot help shouting inappropriate or culturally taboo comments or phrases.

A victim of coprolation may even blurt out ethnic insults, even if they are not racist, an embarrassing and distressing situation for everyone involved.

Understanding coprolalia within Tourette syndrome

Coprolalia is not necessary for a Tourette diagnosis, it does not have to be rude (in young children it can be something as simple as the word “poop”), and it occurs only in a portion of those with Tourette Syndrome.

Corolalia can be random, but it can also seem helpful and in context, especially when triggered or responded to a specific person, place, or situation.

Based on a variety of current research projects, Coprolalia is reported to occur in 4-60% of all Tourette Syndrome patients, although most seem to agree that the prevalence is likely to be around a little less than 30%.

These varying numbers may exist due to a number of factors, including cultural differences, variation in the ages of respondents, and a lack of detection of previous incidents of Coprolalia, rather than simply establishing whether they currently have it.

In addition to Tourette’s, brain injuries, strokes, dementia, seizures, and many other forms of neurological damage can mark the onset of coprolalia as well.

Coprolalia can occur in obsessive compulsive disorder and Tourette syndrome. People who have obsessive compulsive disorder and Tourette syndrome have a greater difficulty as the two disorders can interact with each other and can perpetuate coprolalia.

features

Coprolalia encompasses words and phrases that are culturally taboo or generally inappropriate for acceptable social use, when used out of context. The term is not used to describe contextual insults.

It is usually expressed outside of the social or emotional context, and can be spoken in a louder tone or in a different cadence or tone than normal conversation. It can be a single word or complex phrases.

A person with coprolalia may repeat the word mentally instead of saying it out loud; these subvocalizations can be very distressing.

Coprolalia is an occasional feature of Tourette syndrome, although it is not necessary for the diagnosis of Tourette.

In Tourette syndrome, compulsive swearing can be uncontrollable and unwanted by the person speaking the sentences.

Involuntary comments, such as racial or ethnic slurs in the company of those who are offended by such comments, can be particularly embarrassing. The phrases uttered by a person with coprolalia do not necessarily reflect the person’s thoughts or opinions.

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

Coprolalia is not exclusive to tic disorders; it is also a rare symptom of other neurological disorders.

It can occur after injuries to the brain, such as stroke and encephalitis; in other neurological conditions such as choreoacanthocytosis, seizures and Lesch-Nyhan syndrome; and rarely in people with dementia or obsessive compulsive disorder in the absence of tics.

While little research has been done to understand coprolalia, data now indicates that less than a third of all people with Tourette Syndrome experience this symptom at some point in their lives.

How is coprolalia manifested (symptoms)?

While obscenities and profanity may be common in everyday conversations in our culture, coprolalia is different from simply cursing or using bad language.

These vocal tics are generally not expressed in social or emotional contexts, and are often compulsively expressed or repeated in a higher pitch or in a cadence or pitch different from normal colloquial speech.

A young man with Tourette syndrome has been known to yell, “Help me, my underwear is on fire!” Some people with Tourette Syndrome don’t actually say inappropriate words out loud, but they can repeat them mentally.

Words are usually expressed in a person’s native language, but it is not uncommon for someone with Tourette syndrome to swear in a language they have learned.

Common difficulties in understanding coprolalia

Coprolalia is generally expressed in complex and variable ways, leading to a misunderstanding of the involuntary nature of the behavior. It rarely presents itself as a dry, cutting symptom that always defies everyone’s understanding and acceptance.

The three examples below demonstrate how, by the complex nature of the symptom, parents, teachers, individuals themselves, and bystanders can be constantly challenged to consistently accept coprolalia as an unwanted and uncontrollable symptom of Tourette Syndrome.

A misunderstanding of provocation

Coprolalia, like other tics, is triggered by a premonitory impulse. For example, racial slurs can be prompted by seeing a person of a particular race; Sexual comments can be prompted by seeing a member of the opposite sex.

Seeing these people reminds the brain of forbidden / unacceptable words.

Coprolalia coexists alongside faulty autoinhibitory functions within the brain. When confronted, for example, with a person of the opposite sex, the person may quickly think “You better not say” _______ “.

By thinking of this thought, the individual has put the offensive phrase in his own mind.

He / she will get stuck with the phrase in his / her head. Along with poor control of impulsivity, it can appear as if the person is voluntarily thinking about the thought and then saying it without caring about the other person’s feelings.

In truth, coprolalia has no relation or meaning to the person being observed and is not a personal attack. It just so happened that there was something within the environment that triggered that particular impulse.

For the person with coprolalia, they struggle to avoid saying or doing their worst in a particular situation. Imagine having to sit in a church or other place of worship. The mere sight of religious icons conjures up meaning in our brains. This meaning indicates the brain and evokes words (good and bad).

A coprolalia patient will focus on avoiding yelling offensive words. This approach will bring these words to the tip of your tongue, and finally out of your mouth.

The struggle is internal and much more painful for the individual than those who can overhear it. Coprolalia is not directed at other people nor is it intended to cause harm or fear in others.

Oddly enough, the more a patient wants to stop saying an offensive word, the more likely they are to say it, due to their focus.

Incorporation into speech

Another confusing aspect about the expression of coprolalia involves the incorporation of coprolalia into speech and regular actions. This phenomenon is more common in children.

The urge to say the word may be strong enough to occur within the context of speech. However, the tic is somewhat satisfied for the child; appears very much like a voluntary addition. Consider the word M_ as a vowel tic that is coprolalia.

The child may voluntarily slide it into speech in a fluent way, satisfying the tic but not realizing how voluntary the tic appears to be to others. For example, “that F ** k dog that just F ** ked at me.” This is very difficult for others to understand (especially parents and teachers).

I remember telling my son, when coprolalia started for him, to just pick one or two of the words and say them in a sentence so that people would more easily identify it as coprolalia.

This strategy didn’t work because you don’t have the option to choose which tics you say and because you never understood why how or when it was expressed would make a difference.

For him, slipping it into speech was more “normal” than randomly shouting a bad word. And doing it my way didn’t satisfy her urge, of course.

Intensity and frequency changes

Another difficult feature of coprolalia that makes understanding even more difficult is that stress increases the frequency and intensity of tics. Parents of children with Tourette Syndrome are very familiar with this phenomenon.

Both negative and positive stress occupy significant mental attention. In these situations, a child has less mental energy to suppress his tic symptoms.

As a result, more tics are expressed, to conserve mental energy for all the other things that consume the child’s mental resources.

View anger, disappointment, and frustration as major stresses. When a child attends to these negative emotions, they do not spend energy suppressing their tics or coprolalia.

In a situation that provokes strong feelings of anger in the child, the tics and coprolalia intensify. In this type of situation, you will have a child who is angry, using inappropriate language and louder because you have asked him to do something like “Do your homework now, please.”

What appears to be a disrespectful and aggressive child reacting may simply be a child reacting to a strong emotion, increasing tic expression due to the shift from mental focus to emotion.

This situation is extremely difficult to handle and creates intense stress for families living with neurological disorders.

Education about the disorders, symptoms, and their expressions lays the foundation for understanding, managing, and accepting coprolalia.

Causes of coprolalia

It is known to be caused by brain dysfunction, but the details are, so far, hazy. One hypothesis, described by psychologist Timothy Jay in his book “Why We Curse” (John Benjamins Pub Co. 2000), suggests that it is caused by damage to the amygdala, a region of the brain that normally mitigates anger and aggression.

Because cursing is a form of verbal aggression, damage to the amygdala could result in the inability to control aggression, including verbal aggression or cursing.

It seems that the innate ability that we all have to suppress unwanted movements and unconscious thoughts is somewhat impaired in people with Tourette Syndrome.

Just as people with Tourette Syndrome must satisfy the overwhelming urge to contract, they must also “let out” the sounds and words that accumulate and must be expressed before momentary relief is felt.

Depending on the severity of the symptom, the pressure to express those symptoms will reoccur, because the irresistible and unbearable urge to contract, curse, or scream cannot be indefinitely inhibited.

Such symptoms have been observed in individuals after a stroke or other brain injury in the deep frontal regions of the brain.

As with all tics, there may be an increase in symptoms with increased emotional stress, pleasant arousal, or even fatigue. The emotional state does not cause the tic symptoms, but can increase them.

Predominance

Only about 10% of Tourette patients have coprolalia, but it tends to attract more attention than any other symptom. There is a paucity of epidemiological studies of Tourette syndrome; determination bias affects clinical studies.

Studies in people with Tourette often “come from samples of tertiary bypass, the sickest of the sick.”

Additionally, the criteria for a Tourette diagnosis were changed in 2000, when the impairment criterion was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) for all tic disorders, resulting in an increase of the diagnosis of milder cases.

Also, many clinical studies suffer from a small sample size. These factors combine to make older estimates of coprolalia bias toward more severe clinical populations out of date.

An international multi-site database of 3,500 individuals with Tourette syndrome drawn from clinical samples found that 14% of Tourette patients accompanied by comorbid conditions had coprolalia, while only 6% of those with uncomplicated Tourette had coprolalia .

The same study found that the likelihood 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 people with Tourette alone .

One study from a general pediatric practice found a coprolalia rate of 8% in children with Tourette syndrome, while another study found 60% in a tertiary referral center (where more severe cases are usually 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 that 20% had coprolalia.

A Chilean study of 70 patients found a coprolalia rate of 8.5%; Older studies in Japan reported a 4% incidence of coprolalia; and an even older clinical study in Brazil found that 28% of 32 patients had coprolalia.

Given the methodological issues affecting all of these reports, the consensus of the Tourette Syndrome Association is that the actual number is less than 15 percent.

Regardless of the actual percentages, for those who suffer from Coprolalia as part of their Tourette it can be an isolating and stigmatizing symptom that needs more knowledge, acceptance and understanding.

Treatment

Some patients have been treated by injecting botulinum toxin (botox) near the vocal cords. This does not prevent vocalizations, but the partial paralysis that results helps control the volume of any outbursts.

Surprisingly, botox injections result in more widespread relief from tics than expected vocal relief.

The severity and frequency of the outbursts can also be reduced by surgical deactivation of nuclei in the thalamus, globus pallidus, and cingulate cortex.

Treatments like Habit Reversal Therapy (HRT) and Comprehensive Behavior Intervention Therapy (CBIT) are known to help some patients as well.

Additionally, deep brain stimulation (DBS) using electrodes, which has been used to treat Parkinson’s, has been used in some Tourette patients, but the efficacy of this treatment is not widely accepted.

Reduces the stress of coprolalia

Stress can often get out of hand in a home where coprolalia occurs. There are not many people whose anxiety does not increase exponentially when faced with loud, sometimes aggressive shouts of obscenities or unpleasant words.

Education, as indicated above, will allow family members and those around the person to understand coprolalia as a symptom of a neurological disorder and not as a threat.

With this understanding, a different perspective on behavior becomes and the acceptance and understanding of the individual will follow.

Reducing stress at home will reduce stress for all family members. Family members will no longer react with anger or fear. The individual will no longer focus on suppressing their symptoms, thus breaking a powerful cycle of positive reinforcement.

Ignoring the symptoms of coprolalia

The individual with coprolalia already knows that their behavior is unacceptable and not the social norm.

In fact, the more unacceptable the behavior, the more driven the individual will be to do it. Everyone in the family should know that the person cannot avoid the behavior and that it is a symptom of a neurological disorder.

Planned ignoring helps relieve stress on the individual and within the family. The individual deserves a rest and a comfortable place to relax and let his guard down.

The individual is most likely exhausted from expending mental energy to suppress some or all of his symptoms while in public. At school or in the workplace, it encourages them to be accepted and fit in as best they can. Give them a break at home to work so hard outside the home.

Planned ignoring provides an environment where the behavior is acceptable, reducing the need to perform it, which is driven by the automatic inhibitory mechanism that tells them “do it!” By allowing coprolalia, the tic is not reinforced and the person does not focus on the behavior.

For the family, stress is also reduced. Parents are no longer torn between accepting and punishing behavior. Siblings are no longer afraid that their brother is in trouble, and that Mom and Dad are going to get angry again.

This is not to say that you should ignore every curse or assault in your home. Every action, wanted or unwanted, uncontrollable or under control will have a consequence. Your child must be responsible for all behaviors. It is still unacceptable for another child without Tourette Syndrome to swear or copy the behavior.

Tourette syndrome is not contagious and neither is coprolalia. If a child without Tourette’s parrots tries to justify with “But Johnny says so,” his response should be a negative consequence if it is within that child’s ability to follow appropriate behavior.

It also does not mean that your child with Tourette Syndrome can simply continue to swear at will if the voluntary oath is not a symptom of their disorder.

If an individual has coprolalia, it is their reality and it will be a fight for life. How well they handle the symptom and how well they succeed will depend on how powerful they feel about themselves.

Unconditional love and acceptance are critical to nurturing a healthy human being. At home, ignore benign signs of coprolalia and nurture self-esteem as you deal with this troublesome behavior.

Less stress and less focus on coprolalia will give you more energy to apply other strategies to manage coprolalia. Ignoring planned is not easy, but consider the benefits and energy you can use towards other helpful strategies.

Society and culture

The entertainment industry often portrays those with Tourette syndrome as social misfits whose only tic is coprolalia, which has fostered stigmatization and public misunderstanding of those with Tourettes.

Tourette’s coprolalic symptoms are also fodder for radio and television talk shows.

Celebrities who have suffered from Tourette include David Beckham (who also has a bad obsessive-compulsive disorder) and Ghostbusters star Dan Ackroyd, who claims that therapy helped him beat the disease in his late teens.

Shame, outrage, and misunderstandings

Coprolalia can be a particularly distressing symptom and a lifelong struggle for a person with Tourette Syndrome. Stigmatization, shame, and isolation must be reduced by the efforts of the individual, their families, their community, and society.

Keep in mind that coprolalia, a symptom of a neurological disorder, will not go away. If the symptom is not expressed, the individual is effectively managing or suppressing its expression.

Suppression is NOT a desired response. Suppression requires the individual to constantly focus on the symptom that reinforces coprolalia and depletes the person’s mental capacity to do anything other than suppress.

The obsession with suppression can lead to constant internal struggle. Effective management will serve to increase everyone’s understanding of coprolalia, reduce stress, and focus on symptoms.

In a sense, simply by changing the way we think and react to coprolalia, we can reduce its incidence and negative impact.

“It is extremely embarrassing to try to get out or find a job when you have Corprolalia. Therefore, people only see you as an unpleasant, disrespectful and threatening person. Joel L.

Nobody wants to give you a chance. If they did, they would discover that I am a normal person who loves others and wants to be accepted as a respectful and cooperative member of society.

This level of understanding is not always available to those with coprolalia. An example of this can be found by examining a post by a mother on the popular Circle of Moms website, in which the anonymous father shared this statement about his son:

“My 9-year-old son was diagnosed with Tourette Syndrome for about a year, quite severe Tourette Syndrome.”

“I just started a few months ago becoming vulgar and socially inappropriate (he proclaimed very loudly in the vitamin store that a woman had interrupted the sentence and” that’s OUR right place in line !! “

He also calls his younger sisters “retarded” “crazy,” and so on. and “garbage.” Any advice? It is very humiliating to be in social situations when there is a lack of information about Tourette. He’s a very, very sweet and kind guy and he gets very embarrassed afterwards.

Another forceful description can be found in this comment made to a Reddit member during a Q&A related to his coprolalia.

The author was obviously judging those with Tourette, assigning blame through perceived purpose in the inappropriate words they yelled:

I’ve seen so many articles and documentaries about tourettes, and a common line I hear over and over again about vocal tourettes is that you don’t mean what you say. However, I have noticed that many times the tics come out when you seem to think about it.

It’s true that they don’t want to say it, but don’t you mean it when you say it? And by goodwill you can’t control what you want to say? “

Kathy Giordano and Margo Edelman of the Tourette Association of America addressed this very issue when they wrote about the perceptions surrounding coprolalia:

  • “A common misunderstanding is that for ‘inappropriate words or sounds’ to be a symptom of Tourette Syndrome, they must be said ‘out of nowhere’ and must be repetitive in nature.”
  • “This leads to the mistaken belief that if a student swears once and / or at an ‘appropriate’ time, then it is not due to Tourette syndrome and therefore deserves punishment.”
  • “Coprolalia can be a word, a chain of words or a phrase, said many times or said once but repeated over time.”
  • “However, the symptoms of Tourette Syndrome, including coprolalia, are different for each person, are inconsistent, change periodically, increase and decrease with stress .”

Imagine for a moment living a life in which your very existence embarrasses your family and convinces people that you are lying to them on a regular basis.

Add to this mix the concept of always being the butt of joke, both to your peers and to society at large. Now match all those mental burdens with a stress-exacerbated disorder. How well do you think you would do in that life?

How do people manage?

Some people with coprolalia have discovered ingenious ways to hide or mask their outbursts when they are in social or work situations. They can pronounce only the first few letters of a four-letter word, (for example, “mm” or “shhh”).

Others may silently mumble unacceptable words or cover their mouths to muffle obscenities. These masking techniques help alleviate the overwhelming urge to manifest involuntary symptoms, while silencing unacceptable and disturbing outbursts.

It is possible to cough instead of sneeze, but the urge to sneeze persists, and we eventually have to sneeze.

Because children are less socially sophisticated, young people may not try or even be able to mask or hide their outbursts. Severely affected adults with ongoing vocal tics may not be able to suppress or mask these symptoms.

Unfortunately, some have no warning when coprolalia is about to occur. The public often views these behaviors as strange or offensive and hostile.

Somehow, there are people with coprolalia who develop an exceptional ability to cope with Tourette Syndrome and its ramifications.

Understanding and accepting the symptoms of Tourette Syndrome is a key element in helping people with Tourette Syndrome lead full and productive lives.

Coping with coprolalia

Strategies for managing coprolalia will focus on improving acceptance and understanding of this difficult symptom, which in turn will reduce the frequency and intensity of its expression.

Understanding the nature of coprolalia is essential to understanding coprolalia management strategies.

“Finally, my son taught himself coping methods (such as saying the words without sound, in a low voice or on a pillow or jacket) and became almost imperceptible.”

These days, Ccoprolalia only manifests itself in times of extreme stress; however, given the presentation, I’m sure you can understand how it may sound useful at this point to anyone who is unfamiliar with the complexities of Tourette Syndrome and the tics that accompany the disorder.

Promote understanding

For the person with coprolalia to be accepted, there must be education about coprolalia.

Education is essential for the individual and their families, as well as for all others who will become or become the essential support network for healthy living.

This will include the individual’s school, their peers, their medical professionals, the clubs they are involved with, their community, and society at large.

There are numerous Internet sources intended to promote knowledge and understanding of Tourette syndrome, which can be useful sources of information and support.

Coprolalia is a rare symptom of Tourette syndrome and there are few comprehensive sources of information specific to this symptom. Many sources on Tourette Syndrome define coprolalia in general, but few offer more than one definition.

We recommend the Neurologically Gifted article, Coprolalia Part 1: The Nature of Coprolalia, which is a comprehensive look at what coprolalia is and how it can manifest itself.

This article provides a deeper understanding of coprolalia, how it can be expressed, and how it feels to the individual.

We also recommend using other sources of information about Tourette Syndrome, particularly explanations about tics and the nature of tics, to better understand coprolalia.

Coprolalia, complex as it may be, is a vocal tic. If you understand how tics work, you can understand how coprolalia works. Use your knowledge of tics and coprolalia to share information with the key people in your own or your child’s life.

If your child has Tourette Syndrome, educate them too and use them as a source of information. They are experts on how your brain works, but will need adult training to gain insight into your symptoms.

Teach them the language necessary to explain their symptoms to others. Include them when you talk to others about your disorder.

Advocate for your child, with your child present whenever possible, and teach him how to stand up for himself. The gift of self-defense will provide them with security and strength and will serve them throughout their lives.

Practice at home with your child educating others about Tourette syndrome and coprolalia to improve confidence and self-acceptance.

Always keep in mind that not everyone you or your child knows will understand or care to understand their own or your child’s symptoms. Please be aware and let your child know about this possibility.

I often tell my child that others may never understand or care because he cannot control his symptoms. It is possible that “I never get it.”

I let you know that we have done our part by sharing information with them and that it is your choice to make an effort to understand or not. I let him know that we can feel good and satisfied with our efforts knowing that we have done what we can and move forward in a positive way.