Coprolalia and Tourette Syndrome
cop·ro·la·li·a
- cursing, uttering obscenities, the explosive utterance of
foul or "dirty" words or more elaborate sexual, aggressive
or insulting statements (e.g., racial slurs). Literally, “dung
talking”, because of a compulsion to do so. The speech is
not always swearing words, is neither intentional nor
purposeful, and is not necessarily directed towards anyone. Pronunciation
Also
see: Copropraxia,
Coprographia
Coprolalia
is considered a complex vocal tic and is undoubtedly
the most striking, socially distressing, and dramatic symptom
of Tourette Syndrome. However, coprolalia is not, as many people
once thought, prerequisite to the diagnosis of Tourette Syndrome.
Coprolalia is only evident among a minority of Tourette
Syndrome patients, regardless it is the most popular
Tourette symptom, primarily because, in the media, this rare behavior
is emphasized for its sensational effect. Contrary to popular
perceptions, the majority of Tourette patients do not
ever exhibit this symptom.
Although Coprolalia is the most widely known symptom, coprolalia
occurs in as low as 5-15% of patients and 5-30% in some
clinical series. Prevalence of coprolalia varies because, not
everyone with Tourette Syndrome is seen for treatment and recorded
for clinical research. So there may be evidence by some reports
of 8% in primary pediatric practices to over 60% in tertiary referral
centers. Those figures are factored in with presumed minor cases
of Tourette’s that are never seen; for this reason some
figures now show prevalence of coprolalia in Tourette Syndrome
as low as 5-15%.
How
it works…
The
coprolalia type outburst usually disrupts communication, speech,
or something that a patient is involved in. Following the
disruption, the patient continues about their communication, speech,
or project normally. These disruptions will usually continue to
enter in and out of a patients normal behaviors and events.
For
example. A patient with coprolalia could be talking with someone
who mentions the word “duck”. The word “duck”
trips a vocal tic in the coprolalia patient of which follows three
quick vocal burst of, “fuck a duck, fuck a duck, fuck a
duck”. The conversation keeps flowing as it was prior to
the vocal disruption.
An
observer, who is not familiar with coprolalia nor understands
it, may believe the outburst is the result of a conscious and
voluntary decision to swear. However the outburst are neither
intentional nor purposeful.
“While
obscenities and profanities may be common in everyday conversation
in our culture, coprolalia is different from simply swearing
or using bad language. These vocal tics usually are not uttered
within social or emotional contexts, and are often spoken or
repeated compulsively in a louder tone or different cadence
or pitch than normal conversational speech. Particularly embarrassing
for some individuals with coprolalia are involuntary outbursts
within social contexts, such as racial or ethnic slurs in the
company of the very people who would be most offended by such
remarks.” - Understanding Coprolalia, by Sue Levi Pearl
and Joanne E. Cohen
Treatment
Treatment
for coprolalia is primarily pharmacologic with dopamine-blocking
agents and other medications.
Course
and Pathogenesis
Coprolalia
tends to peak in severity during adolescence and to diminish during
adulthood.
The
pathogenesis may be related to dysfunction of basal ganglionic
and limbic mini-circuits.
Associated
Coprophenomena Conditions
Copropraxia
- obscene behavior and has many variations in its expression
(e.g., giving the middle finger, grabbing crotch and public sexual
expressions.).
Coprographia - obscene writing or drawings
(e.g., writing curse words on walls, paper, etc. for display and
drawing pornographic pictures with obscenities).
In
summary
Coprolalia has been a recognized symptom of Tourette syndrome
from the first description of the syndrome. Coprolalia is considered
a complex vocal tic and seen in a variety of neurologic disorders.
The majority of Tourette patients do not ever exhibit coprolalia
which only occurs in as low as 5-15% of Tourette Syndrome patients.
Edited
by:
Paul
Marshall
editor@tourettes-disorder.com
Neurol
Clin. 1997 May;15(2):299-308.
Tourette
syndrome. Coprolalia and other coprophenomena., Singer C.
Movement
Disorders Clinic, Department of Neurology, University of Miami
School of Medicine, Miami, Florida 33136, USA.
Psychology
Today Magazine, Sussex Publishers
New York, NY 10010
http://cms.psychologytoday.com/conditions/tourettes.html
Tourette
Syndrome Association TSA
http://www.tsa-usa.org/research/guidetodiagnosis.html
The
Facts About Tourette Syndrome
http://members.tripod.com/~tourette13/FAQ/01-1.html
The
Tourette Syndrome Phenomenon
http://members.tripod.com/~Mark_Kozlowski/s3.html
