Coprolalia

{{Short description|Involuntary utterance of socially inappropriate words}} {{for|the EP|Coprolalia (EP){{!}}''Coprolalia'' (EP)}} '''Coprolalia''' ({{IPAc-en|ˌ|k|ɒ|p|r|ə|ˈ|l|eɪ|l|i|ə}} {{respell|KOP|rə|LAY|lee|ə}}) is involuntary swearing or the involuntary utterance of obscene words or socially inappropriate and derogatory remarks. The word comes from the Greek {{lang|grc|κόπρος}} ({{transliteration|grc|kópros}}), meaning "dung, feces", and {{lang|grc|λαλιά}} ({{transliteration|grc|laliā́}}) "speech", from {{lang|grc|λαλεῖν}} ({{transliteration|grc|laleîn}}) "to talk".<ref>[http://dictionary.reference.com/browse/coprolalia Coprolalia.] Dictionary.com, Accessed 30 October 2006.</ref>

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 individuals with Tourette's exhibit coprolalia.<ref name=SingerBehavior>{{cite journal |author=Singer HS |title=Tourette's syndrome: from behaviour to biology |journal=Lancet Neurol |volume=4 |issue=3 |pages=149–59 |date=March 2005 |pmid=15721825 |doi=10.1016/S1474-4422(05)01012-4|s2cid=20181150 }}</ref> It is not unique to tic disorders; it may also present itself as a neurological disorder.<ref>{{cite journal| author= Singer C |title= Tourette syndrome. Coprolalia and other coprophenomena |journal=Neurol Clin |date=May 1997 |volume= 15 |issue= 2 |pages= 299–308 |pmid= 9115463 |doi=10.1016/s0733-8619(05)70314-5|doi-access= free }}</ref><ref name=FreemanCopro>{{cite journal |vauthors=Freeman RD, Zinner SH, Müller-Vahl KR |title=Coprophenomena in Tourette syndrome |journal=Dev Med Child Neurol |volume=51 |issue=3 |pages=218–27 |date=March 2009 |pmid=19183216 |doi=10.1111/j.1469-8749.2008.03135.x |display-authors=etal|doi-access=free }}</ref>

Coprolalia is one type of coprophenomenon. Other coprophenomena include the related symptoms of copropraxia, involuntary actions such as performing obscene or forbidden gestures,<ref name=dude>{{cite journal |author=Schapiro NA |title='Dude, you don't have Tourette's:' Tourette's syndrome, beyond the tics |journal=Pediatr Nurs |volume=28 |issue=3 |pages=243–6, 249–53 |year=2002 |pmid=12087644 |url=http://www.medscape.com/viewarticle/442029}}</ref> and coprographia, making obscene writings or drawings.<ref>{{cite web| url= http://www.uwm.edu/Course/ling210/lectures/semantics-2.pdf | title=Linguistics 210 Semantics | work=Semantic features and Tourette's Syndrome | access-date=21 November 2006}} While this source defines coprographia, it makes misrepresentations about copro phenomena in relation to Tourette's: they are not common, and not required for diagnosis.</ref>

==Characteristics== Coprolalia encompasses the uncontrollable utterance of 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.<ref name=TSAbrochure>Tourette Association of America. [https://tourette.org/resource/understanding-coprolalia/ Understanding Coprolalia – A misunderstood symptom]. Accessed 12 October 2021.</ref>

Coprolalia is an occasional characteristic of Tourette syndrome, 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.<ref name=Singer1997/> 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.<ref name=Singer1997>{{Cite journal |last=Singer |first=Carlos |date=1997-05-01 |title=Coprolalia and Other Coprophenomena |journal=Neurologic Clinics |volume=15 |issue=2 |pages=299–308 |doi=10.1016/S0733-8619(05)70314-5 |pmid=9115463 |issn=0733-8619|doi-access=free }}</ref>

It may occur after traumatic brain injury such as stroke<ref name=FreemanCopro/> and encephalitis;<ref name=FreemanCopro/><ref>{{cite journal |vauthors=Dale RC, Webster R, Gill D |title=Contemporary encephalitis lethargica presenting with agitated catatonia, stereotypy, and dystonia-parkinsonism |journal=Mov. Disord. |volume=22 |issue=15 |pages=2281–4 |date=November 2007 |pmid=17914719 |doi=10.1002/mds.21664|s2cid=38995008 }}</ref> in other neurological conditions such as choreoacanthocytosis,<ref>{{cite journal |vauthors=Ruiz-Sandoval JL, García-Navarro V, Chiquete E |title=Choreoacanthocytosis in a Mexican family |journal=Arch. Neurol. |volume=64 |issue=11 |pages=1661–4 |date=November 2007 |pmid=17998451 |doi=10.1001/archneur.64.11.1661|display-authors=etal|doi-access=free |url= https://jamanetwork.com/journals/jamaneurology/fullarticle/794754 |url-access=subscription }}</ref> seizures,<ref>{{cite journal |vauthors=Caplan R, Comair Y, Shewmon DA, Jackson L, Chugani HT, Peacock WJ |title=Intractable seizures, compulsions, and coprolalia: a pediatric case study |journal=J Neuropsychiatry Clin Neurosci |volume=4 |issue=3 |pages=315–9 |year=1992 |pmid=1498584 |doi=10.1176/jnp.4.3.315}}</ref> and Lesch–Nyhan syndrome;<ref>Jinnah HA. [http://www.emedicine.com/neuro/topic630.htm Lesch-Nyhan Syndrome.] eMedicine.com (August 29, 2006). Accessed 28 October 2006.</ref> and rarely in persons with dementia or obsessive-compulsive disorder in the absence of tics.<ref name=FreemanCopro />

== 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 (PET) scans. The activity of the frontal operculum and Broca's area (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.<ref>{{Cite journal |last1=Stern |first1=Emily |last2=Silbersweig |first2=David A. |last3=Chee |first3=Kit-Yun |last4=Holmes |first4=Andrew |last5=Robertson |first5=Mary M. |last6=Trimble |first6=Michael |last7=Frith |first7=Christopher D. |last8=Frackowiak |first8=Richard S. J. |last9=Dolan |first9=Raymond J. |date=2000-08-01 |title=A Functional Neuroanatomy of Tics in Tourette Syndrome |url=http://archpsyc.jamanetwork.com/article.aspx?doi=10.1001/archpsyc.57.8.741 |journal=Archives of General Psychiatry |language=en |volume=57 |issue=8 |pages=741–748 |doi=10.1001/archpsyc.57.8.741 |pmid=10920461 |hdl=21.11116/0000-0001-A000-9 |s2cid=28185231 |issn=0003-990X|hdl-access=free|url-access=subscription }}</ref>

Limbic system structures such as the posterior cingulate cortex 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 aspect of the brain.<ref>{{Cite web |title=Basal Ganglia: What It Is, Function & Anatomy |url=https://my.clevelandclinic.org/health/body/23962-basal-ganglia |access-date=2023-12-09 |publisher=Cleveland Clinic |language=en}}</ref>

==Prevalence in Tourette syndrome==

Only about 10% of people with Tourette's exhibit coprolalia,<ref name=SingerBehavior/> but it tends to attract more attention than any other symptom.<ref>[https://web.archive.org/web/20050208082423/http://www.tsa-usa.org/what_is/Faqs.html Tourette Syndrome FAQ.] Tourette Syndrome Association. Accessed 6 October 2006.</ref>

[[File:Jean Itard.jpg|thumb|left|Jean Marc Gaspard Itard was credited with describing the first case of Tourette syndrome, including coprolalia, in the Marquise de Dampierre, a woman of nobility<ref name=Teive>{{cite journal |vauthors=Teive HA, Chien HF, Munhoz RP, Barbosa ER |title=Charcot's contribution to the study of Tourette's syndrome |journal=Arq Neuropsiquiatr |volume=66 |issue=4 |pages=918–21 |date=December 2008 |pmid=19099145 |doi= 10.1590/S0004-282X2008000600035|doi-access=free }}</ref>]]

There is a low number of epidemiological studies on Tourette syndrome due to ascertainment bias affecting clinical studies. Studies on people with Tourette's often "came from tertiary referral samples, the sickest of the sick".<ref name=Swerdlow>{{cite journal |author=Swerdlow NR |title=Tourette syndrome: current controversies and the battlefield landscape |journal=Curr Neurol Neurosci Rep |volume=5 |issue=5 |pages=329–31 |date=September 2005 |pmid=16131414 |doi=10.1007/s11910-005-0054-8|s2cid=26342334 }}</ref> Further, the criteria for Tourette's syndrome changed in 2000 when the impairment criterion was removed from the DSM-IV-TR for all tic disorders.<ref>{{cite web |url=http://www.psychnet-uk.com/x_new_site/DSM_IV/misc_pages/what_is_dsm_iv_tr.html |title=What is DSM-IV-TR? |author= |website=Psychnet-UK |access-date=21 June 2016 |quote=Tourette's Disorder and all of the Tic Disorders no longer require that symptoms cause distress or impair functioning.}}</ref> 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 people 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: individuals 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.<ref>{{cite journal |vauthors=Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P |title=An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries |journal=Dev Med Child Neurol |volume=42 |issue=7 |pages=436–47 |date=July 2000 |pmid=10972415 |doi=10.1017/S0012162200000839}}</ref>

==Management== Botulinum toxin (botox) may be injected near the vocal cords. This does not prevent the vocalizations, but the partial paralysis that results may help control the volume of any outbursts.<ref>{{cite journal |vauthors=Scott BL, Jankovic J, Donovan DT |title=Botulinum toxin injection into vocal cord in the treatment of malignant coprolalia associated with Tourette's syndrome |journal=Mov. Disord. |volume=11 |issue=4 |pages=431–3 |date=July 1996 |pmid=8813224 |doi=10.1002/mds.870110413|s2cid=10339547 }}</ref><ref>{{cite journal |author=Jankovic J |title=Botulinum toxin in the treatment of dystonic tics |journal=Mov. Disord. |volume=9 |issue=3 |pages=347–9 |date=May 1994 |pmid=8041378 |doi=10.1002/mds.870090315|s2cid=19270507 }}</ref><ref>{{cite journal |vauthors=Kwak CH, Hanna PA, Jankovic J |title=Botulinum toxin in the treatment of tics |journal=Arch. Neurol. |volume=57 |issue=8 |pages=1190–3 |date=August 2000 |pmid=10927800 |doi=10.1001/archneur.57.8.1190|doi-access=free}}</ref> Botox injections result in more generalized relief of tics than the vocal relief expected.<ref name=Robertson2005PMJ>{{cite journal |vauthors=Stern JS, Burza S, Robertson MM |title=Gilles de la Tourette's syndrome and its impact in the UK |journal=Postgrad Med J |volume=81 |issue=951 |pages=12–9 |date=January 2005 |pmid=15640424 |pmc=1743178 |doi=10.1136/pgmj.2004.023614}}</ref>

== 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.<ref>{{Cite journal |last1=Robertson |first1=M. M. |last2=Roberts |first2=S. |last3=Pillai |first3=S. |last4=Eapen |first4=V. |date=2015-10-01 |title=Gilles de la Tourette syndrome in a cohort of deaf people |url=https://www.sciencedirect.com/science/article/pii/S1876201815001562 |journal=Asian Journal of Psychiatry |volume=17 |pages=65–70 |doi=10.1016/j.ajp.2015.06.017 |pmid=26216703 |issn=1876-2018|url-access=subscription }}</ref> 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.<ref>{{Cite journal |last=Burd |first=Larry |date=2014-08-27 |title=Language and Speech in Tourette Syndrome: Phenotype and Phenomenology |journal=Current Developmental Disorders Reports |volume=1 |issue=4 |pages=229–235 |doi=10.1007/s40474-014-0027-1 |s2cid=143272775 |issn=2196-2987|doi-access=free }}</ref>

==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.<ref>{{cite journal|title= Tourette syndrome in film and television |vauthors= Calder-Sprackman S, Sutherland S, Doja A |journal= The Canadian Journal of Neurological Sciences |volume= 41 |issue= 2 |date= March 2014 |pages= 226–32|doi= 10.1017/S0317167100016620 |doi-access=free|pmid= 24534035 |s2cid= 39288755}}</ref><ref>{{cite journal |title= Public perception of Tourette syndrome on YouTube |vauthors= Lim Fat MJ, Sell E, Barrowman N, Doja A | journal= Journal of Child Neurology |volume= 27 |issue= 8 |date= 2012 |pages= 1011–16|citeseerx = 10.1.1.997.9069|doi = 10.1177/0883073811432294|pmid = 22821136|s2cid= 21648806 }}</ref><ref name="Holtgren">{{cite news |author= Holtgren B |title= Truth about Tourette's not what you think |work=The Cincinnati Enquirer |date= January 11, 2006 |quote=As medical problems go, Tourette's is, except in the most severe cases, about the most minor imaginable thing to have. ... the freak-show image, unfortunately, still prevails overwhelmingly. The blame for the warped perceptions lies overwhelmingly with the video media—the Internet, movies and TV. If you search for 'Tourette' on Google or YouTube, you'll get a gazillion hits that almost invariably show the most outrageously extreme examples of motor and vocal tics. Television, with notable exceptions such as Oprah, has sensationalized Tourette's so badly, for so long, that it seems beyond hope that most people will ever know the more prosaic truth.}}</ref> The coprolalic symptoms of Tourette's are also fodder for radio and television talk shows.<ref>[https://web.archive.org/web/20011006192716/http://tsa-usa.org/drlaura.html 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.<br />* [http://www.tsa-usa.org/news/DrPhil.htm Letter of response to Dr. Phil.] {{webarchive |url=https://web.archive.org/web/20080831055605/http://www.tsa-usa.org/news/DrPhil.htm |date=August 31, 2008}} Tourette Syndrome Association. Accessed 8 May 2006.<br />* [http://tsa-usa.org/news/Garrison-Keillor.htm Letter of response to Garrison Keillor radio show.] Tourette Syndrome Association. Accessed 8 May 2006.</ref>

== See also == * List of language disorders

== References == {{Reflist|30em}}

Category:Profanity Category:Symptoms and signs: Nervous system Category:Tourette syndrome Category:Symptoms or signs involving appearance or behaviour