Coprolalia ( ) is involuntary swearing or the involuntary utterance of obscene words or socially inappropriate and derogatory remarks. The word comes from the

Greek Greek may refer to: Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group *Greek language, a branch of the Indo-European language family **Proto-Greek language, the assumed last common ancestor of all kno ...

(), meaning "dung,

feces Feces (also known as faeces American and British English spelling differences#ae and oe, or fæces; : faex) are the solid or semi-solid remains of food that was not digested in the small intestine, and has been broken down by bacteria in the ...

", and () "speech", from () "to talk". Coprolalia is an occasional characteristic of

tic disorder Tic disorders are defined in the ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM) based on type (motor or phonic) and duration of tics (sudden, rapid, nonrhythmic movements). Tic disorders are defined similarly by the World Health ...

s, in particular

Tourette syndrome Tourette syndrome (TS), or simply Tourette's, is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinkin ...

, 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 may also present itself as a

neurological disorder Neurological disorders represent a complex array of medical conditions that fundamentally disrupt the functioning of the nervous system. These disorders affect the brain, spinal cord, and nerve networks, presenting unique diagnosis, treatment, and ...

Coprolalia is one type of coprophenomenon. Other coprophenomena include the related symptoms of

copropraxia Copropraxia is a tic consisting of involuntarily performing obscene or forbidden gestures, or inappropriate touching.Shimberg, Elaine Fantle (1995). ''Living with Tourette Syndrome''. New York: Simon & Schuster. p. 31. The word comes from the ...

, involuntary actions such as performing obscene or forbidden gestures, and

coprographia Coprographia is involuntarily making vulgar writings or drawings. The word comes from the Greek (), meaning "feces", and (), meaning "writing". Related terms are coprolalia Coprolalia ( ) is involuntary swearing or the involuntary utterance ...

, making obscene writings or drawings.

Characteristics

Coprolalia encompasses the uncontrollable utterance of words and phrases that are culturally

taboo A taboo is a social group's ban, prohibition or avoidance of something (usually an utterance or behavior) based on the group's sense that it is excessively repulsive, offensive, sacred or allowed only for certain people.''Encyclopædia Britannica ...

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.

Tourette Association of America Tourette syndrome (TS), or simply Tourette's, is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinkin ...

Understanding Coprolalia – A misunderstood symptom
Accessed 12 October 2021. Coprolalia is an occasional characteristic of

, although it is not required for a diagnosis of Tourette's. Typically, symptoms of coprolalia follow the development of phonic or motor tics by four to seven years. The severity of symptoms tends to peak during adolescence and subside during adulthood. 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 as they are unconsciously produced. Cases of deaf Tourette patients swearing in

sign language Sign languages (also known as signed languages) are languages that use the visual-manual modality to convey meaning, instead of spoken words. Sign languages are expressed through manual articulation in combination with #Non-manual elements, no ...

have been described. It may occur after

traumatic brain injury A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity ranging from mild traumatic brain injury (mTBI/concussion) to severe traumati ...

such as stroke and

encephalitis Encephalitis is inflammation of the Human brain, brain. The severity can be variable with symptoms including reduction or alteration in consciousness, aphasia, headache, fever, confusion, a stiff neck, and vomiting. Complications may include se ...

; in other neurological conditions such as choreoacanthocytosis, seizures, and Lesch–Nyhan syndrome; and rarely in persons with

dementia Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...

or obsessive-compulsive disorder in the absence of

tic A tic is a sudden and repetitive motor movement or vocalization that is not rhythmic and involves discrete muscle groups. Tics are typically brief and may resemble a normal behavioral characteristic or gesture. Tics can be invisible to the obs ...

Brain regions implicated

The neural mechanisms underlying the presence of coprolalia alone are poorly understood. Current research is designed to locate the brain regions that are active during an involuntary tic. Individuals with Tourette Syndrome (TS) exhibit the symptoms of coprolalia, so researchers can study subjects with TS to deduce an etiology for phonic tics. Patterns of neural activity were tracked by using

Positron Emission Tomography Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in metabolic processes, and in other physiological activities including blood flow, r ...

(PET) scans. The activity of the frontal operculum and

Broca's area Broca's area, or the Broca area (, also , ), is a region in the frontal lobe of the dominant Cerebral hemisphere, hemisphere, usually the left, of the Human brain, brain with functions linked to speech production. Language processing in the brai ...

(Brodmann’s area 44 and 45), may be responsible for the initiation of these vocal tics. Both of these brain areas are responsible for planning and producing speech, which are active during coprolalic vocal tic episodes.

Limbic system The limbic system, also known as the paleomammalian cortex, is a set of brain structures located on both sides of the thalamus, immediately beneath the medial temporal lobe of the cerebrum primarily in the forebrain.Schacter, Daniel L. 2012. ''P ...

structures such as the

posterior cingulate cortex The posterior cingulate cortex (PCC) is the caudal part of the cingulate cortex, located posterior to the anterior cingulate cortex. This is the upper part of the " limbic lobe". The cingulate cortex is made up of an area around the midline of ...

are also activated during coprolalic vocal tics. This region of the brain is responsible for emotional processing, so its increase in activation could reveal insights as to how taboo words may be organized differently than the

neurolinguistic Neurolinguistics is the study of neural mechanisms in the human brain that control the comprehension, production, and acquisition of language. As an interdisciplinary field, neurolinguistics draws methods and theories from fields such as neu ...

aspect of the brain.

Prevalence in Tourette syndrome

Only about 10% of people with Tourette's exhibit coprolalia, but it tends to attract more attention than any other symptom. There is a low number of

epidemiological studies Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population, and application of this knowledge to prevent diseases. It is a cornerstone ...

on Tourette syndrome due to

ascertainment bias In statistics, sampling bias is a bias (statistics), bias in which a sample is collected in such a way that some members of the intended statistical population, population have a lower or higher sampling probability than others. It results in a b ...

affecting

clinical studies Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, dietar ...

. Studies on people with Tourette's often "came from tertiary referral samples, the sickest of the sick". Further, the criteria for

Tourette's syndrome Tourette syndrome (TS), or simply Tourette's, is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinki ...

changed in 2000 when the impairment criterion was removed from the

DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a c ...

for all tic disorders. This resulted in an increase of diagnoses in milder cases. Additionally, many clinical studies suffer from small sample size. These factors combine to render older estimates of coprolalia occurrences 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 study in

Brazil Brazil, officially the Federative Republic of Brazil, is the largest country in South America. It is the world's List of countries and dependencies by area, fifth-largest country by area and the List of countries and dependencies by population ...

had 44 patients with Tourette syndrome, and found a 14% rate of coprolalia; a study in

Costa Rica Costa Rica, officially the Republic of Costa Rica, is a country in Central America. It borders Nicaragua to the north, the Caribbean Sea to the northeast, Panama to the southeast, and the Pacific Ocean to the southwest, as well as Maritime bo ...

had 85 patients, and found that 20% had coprolalia; a study in

Chile Chile, officially the Republic of Chile, is a country in western South America. It is the southernmost country in the world and the closest to Antarctica, stretching along a narrow strip of land between the Andes, Andes Mountains and the Paci ...

had 70 patients, and found an 8.5% rate of coprolalia; older studies in

Japan Japan is an island country in East Asia. Located in the Pacific Ocean off the northeast coast of the Asia, Asian mainland, it is bordered on the west by the Sea of Japan and extends from the Sea of Okhotsk in the north to the East China Sea ...

reported a 4% incidence of coprolalia; a 1996

clinical trial Clinical trials are prospective biomedical or behavioral research studies on human subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...

, conducted in Brazil, found that only 9 of 32 patients (28%) 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. Specific treatment options for reliving motor and phonic tics (coprolalia) in Gilles de la Tourette syndrome include but are not limited to

Botulinum toxin Botulinum toxin, or botulinum neurotoxin (commonly called botox), is a neurotoxic protein produced by the bacterium ''Clostridium botulinum'' and related species. It prevents the release of the neurotransmitter acetylcholine from axon en ...

injections,

antipsychotics Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizo ...

or behavioral therapy depending on the individual's severity of symptoms.

Management

Botox Injections

Some patients have been treated by injecting

botulinum toxin Botulinum toxin, or botulinum neurotoxin (commonly called botox), is a neurotoxic protein produced by the bacterium ''Clostridium botulinum'' and related species. It prevents the release of the neurotransmitter acetylcholine from axon en ...

(botox) near the

vocal cords In humans, the vocal cords, also known as vocal folds, are folds of throat tissues that are key in creating sounds through Speech, vocalization. The length of the vocal cords affects the pitch of voice, similar to a violin string. Open when brea ...

. This does not prevent the vocalizations, but the partial

paralysis Paralysis (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...

that results helps to control the volume of any outbursts. Botox injections result in more generalized relief of tics than the vocal relief expected. Botulinum injections block neuromuscular transmission and decrease hyperactive muscle fibres thus reducing involuntary movement production.

Antipsychotic drugs

Aripiprazole Aripiprazole, sold under the brand name Abilify, among others, is an atypical antipsychotic primarily used in the treatment of schizophrenia, bipolar disorder, and irritability associated with autism spectrum disorder; other uses include as ...

is an FDA-approved antipsychotic drug that "acts as an antagonist at the

Dopamine receptor D2 Dopamine receptor D2, also known as D2R, is a protein that, in humans, is encoded by the ''DRD2'' gene. After work from Paul Greengard's lab had suggested that dopamine receptors were the site of action of antipsychotic drugs, several groups, ...

under hyperdopaminergic conditions and displays agonist properties under hypodopaminergic conditions." D₂ receptors (striatal dopamine receptors) play an essential role in motor output and the initiation of movements. The overproduction of dopamine exacerbates the production of tics. Aripiprazole works as a selective dopamine regulator controlling the release of dopamine in the brain, reducing the production of tics. Recent studies provide support for aripiprazole for symptom management. Aripiprazole oral dosages were approved in 2012 for the management of tics in children and adults.

Comprehensive Behavioral Intervention (CBI)

Habit reversal training is one of the most common CBI strategies used for patients with Tourettes syndrome. Patients work with a therapist to develop strategies to better anticipate the occurrence of potential tics and establish a designated response preventing the tics from occurring. Additionally, these therapies also support TS patients in implementing coping mechanisms following stress-inducing tics.

Coprolalia in deaf individuals

Coprolalia has also been documented in deaf individuals. Non-verbal phonic tics are referred to as "signing phonic tics" in deaf individuals. Coprolalia in signing individuals is characterized by uncontrollable fingerspelling of obscene and inappropriate words and phrases, the production of intercourse related signs, flicking middle fingers, or compulsive repetition of signs. TS is extremely understudied in the deaf community, often being misdiagnosed as schizophrenia. Researchers are still studying the relationship between deafness and Tourette's syndrome to combat misdiagnosis.

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.Oprah and Dr. Laura – Conflicting Messages on Tourette Syndrome. Oprah Educates; Dr. Laura Fosters Myth of TS as "Cursing Disorder".
Tourette Syndrome Association (May 31, 2001). Accessed 6 October 2001.

Tourette Syndrome Association. Accessed 8 May 2006.

Tourette Syndrome Association. Accessed 8 May 2006.

References

{{Topics related to Tourette syndrome Profanity Symptoms and signs: Nervous system Tourette syndrome Symptoms or signs involving appearance or behaviour