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In the United Kingdom, there are estimated to be between 199,000 and 331,000 people with Tourette’s syndrome according to the British Medical Journal. Of these, around 10% experience coprolalia. According to MedicineNet, coprolalia is “the excessive and uncontrollable use of foul or obscene language”. This means that there are somewhere between 19,900 and 33,100 individuals in the UK who have coprolalia.
What is coprolalia?
The National Library of Medicine gives origin to the word ‘coprolalia’. It comes from the Greek word “kopros”, meaning “faeces, dung” and “lalein” which means “babble”. Far from being intentional, coprolalia is involuntary and occurs like a tic in the same involuntary way that a twitch or an itch occurs.
Coprolalia most often coincides with Tourette’s syndrome (also known as Gilles de la Tourette Syndrome). Tourette’s involves compulsive grunting, facial tics, shouting and arm movements. It also occurs similarly with echolalia – the involuntary echoing or repetition of words or phrases that someone else has just spoken. One could say that parrots who learn to talk are echolalic.
Coprolalia is quite puzzling to most people in the UK and is often socially stigmatised. Whilst swearing and profanities are common vernacular these days, there remain occasions where such language is deemed entirely inappropriate and offensive. Coprolalia leaves no holes barred. Nothing is off limits for the coprolaliac brain. It is different from swearing in that these vocal outbursts do not often have any emotional or social context to them. They can be repeated loudly and compulsively in varying cadences and pitches compared to regular, purposeful and conversational speech. It is usually expressed in the person’s mother tongue but there have been cases where it has also occurred in a learned language.
Coprolalia can be embarrassing for the individual, especially if they are prone to ethnic or racial slurs in the presence of those who are of that ethnicity or race. However, what is often misunderstood is that the person with coprolalia does not necessarily have the thoughts or feelings that their profanities and outbursts reflect.
What causes coprolalia?
Whilst there is not one definite cause of coprolalia, it is thought to be the result of misfiring or “faulty wiring” within the brain’s inhibitory mechanisms. It is this part of the brain that causes tics and involuntary movements seen in those with Tourette’s syndrome.
As human beings, most of us have an innate ability to suppress unconscious thoughts and movements. It is thought that for those with Tourette’s syndrome, this ability is impaired in some way. Given the strong connection between Tourette’s and coprolalia, it can be presumed that coprolalia is the inability to suppress such thoughts verbally.
One hypothesis suggests that the development of tics in Tourette’s syndrome, including verbal, coprolaliac tics, involves the same regions of the brain that are equivalent to the brain areas involved in sex control and reproductive behaviour in primitive animals. These areas of the brain are the basal ganglia and limbic system. As a result, coprolalia could be a result of a dysfunction of these areas and therefore appears as a primitive vocal fragment.
A further hypothesis is that coprolalia is on the obsessive-compulsive spectrum, where a person’s brain suffers a failure in inhibiting a part of the cortico-striato-thalamo-cortical pathway (this forms part of the basal ganglia in the brain). The reason why such words and language are chosen rather than much more mundane, everyday language, is likely due to the person’s strong emotional reactions produced by the part of the brain that’s affected. These symptoms have been seen in people who have had a brain injury or stroke who have damaged the deep frontal region in the brain.
Aside from Tourette’s syndrome, there are a few other instances where coprolalia can manifest itself. It can also occur in some patients who have brain lesions, autoimmune disorders, neurodegenerative disorders and “senility”. However, according to The National Library of Medicine, there is very little research or information about coprolalia in the absence of Tourette’s syndrome.
Rare causes of coprolalia
As mentioned, there are a few other potential causes of coprolalia, aside from Tourette’s syndrome.
- Stroke. People who have experienced a stroke often develop aphasia. There are different kinds of aphasia depending on where in the brain the stroke occurred. According to Medic Journal, when gross afferent or efferent motor aphasia occurs, a “speech embolus” appears and this may result in profane or obscene vocabulary.
- Kleine-Levin-Critchley syndrome. With this syndrome, people experience polyphagia, hypersexuality and disinhibited behaviour, some of which may result in coprolalia.
- Lesch-Nyhan syndrome. This is an inherited disease that brings with it complex behavioural and neurological disorders including self-harming, mood swings, aggression towards others and dysarthria in speech, meaning coprolalia is also possible.
- Neuroinfections. Coprolalia can occur with brain infections such as encephalitis and meningoencephalitis due to psychomotor agitation. The person becomes more verbose and shouts profanities and obscene words and phrases.
What are the signs and symptoms of coprolalia?
Coprolalia is diagnosed clinically through observation and conversation. Those diagnosing the condition often do not diagnose it as a separate condition but as a part of Tourette’s syndrome, particularly if the person is under the age of 18 at the onset.
The signs and symptoms of coprolalia are pretty self-explanatory and include uttering or shouting profanities such as swear words, sexual comments, expletives, obscenities and sometimes racial slurs. However, the vocalised tics often have an unusual tone and inflection to them. They do not sound conversational and are more like outbursts of unusual pitch and cadence.
In the same way that those with Tourette’s feel the compulsion to “satisfy” their tics to experience relief, those with coprolalia feel similarly about their verbal outbursts. The pressure builds and the urge to “let out” the words that they are holding in becomes too much and is expressed so that the sufferer can feel relief momentarily. Often, the pressure to do so builds up frequently as the urge cannot be suppressed indefinitely and obscenities are uttered.
The signs and symptoms of coprolalia can vary over time. Those with the condition often suffer from more vocalisations during periods of extreme stress or tiredness. There is also some evidence that things such as caffeine, excitement, medications, and hormonal changes such as the menstrual cycle in females may exacerbate the condition. According to Medic Journal, coprolalia is more common in males than it is in females.
Is coprolalia linked with other conditions?
Given that coprolalia is often a sidekick to Tourette’s syndrome and other tic disorders, it would be worthwhile exploring Tourette’s syndrome further. For a person to be diagnosed with Tourette’s syndrome they must exhibit the following symptoms:
- Multiple motor tics (such as shoulder shrugging or blinking) and vocal tics (such as clearing the throat or yelling words or phrases).
- Tics for a minimum of one year. They can occur multiple times a day almost every day or more irregularly.
- Tics appeared before the age of 18.
- The symptoms must not be related to medications/drugs or linked with another medical condition such as epilepsy or post-viral encephalitis.
As mentioned previously, coprolalia occurs in about 10% of cases of Tourette’s syndrome. However, there are some other co-occurring conditions including:
How to manage coprolalia
Managing coprolalia is different for everyone. Many people with the condition are embarrassed by it and therefore become anxious in social situations which only heightens the condition, and the likelihood of outbursts increases.
Some suffers have come up with ways of masking their condition when in inappropriate situations such as when they are at work or in a social situation. They may manage to only shout the first sound of the word (such as “fffff” or “ssshh”). Others manage by mumbling inappropriate words quietly or whilst covering their mouths. This helps the sufferer to fulfil the urges somewhat as well as make it that bit more socially acceptable. Sometimes, some sufferers are able to substitute the word, but this does not have the same desired effect and leaves the urge unsatisfied. It’s a little like not being allowed to sneeze when you need to and being told you should try to cough instead. That need to sneeze does not really go away and is only relieved when you eventually sneeze.
Many children with coprolalia are unable to mask their condition or hide outbursts. Likewise, adults who are severely affected are unable to also. Managing in these circumstances is difficult because they may not get any warning that they’re about to have an outburst.
The difficulty in managing the condition often comes from the misunderstanding from others who view such behaviours as purposeful, hostile, weird and/or offensive. This is why raising awareness of the condition and the reasons or causes behind it is very important and helps those with coprolalia to lead full, positive lives.
How is coprolalia diagnosed?
As mentioned, coprolalia is often diagnosed alongside another condition such as Tourette’s syndrome. Usually, those who suffer from coprolalia will be examined by a neurologist and psychologist.
Often, many tests are carried out such as:
- Empirical and clinical tests such as interviews, symptoms descriptions, interviewing relatives (if the patient is unable to advocate for themselves) and observations.
- Instrumental diagnostics such as brain MRI scans, MR angiography and PET-CT scans to exclude other causes such as lesions. EEG/EMG and neuroimaging methods are also used to diagnose Tourette’s syndrome. With Kleine-Levin syndrome, there may be polysomnographic monitoring and with progressive paralysis, lumbar punctures are also often performed.
- Laboratory testing including tests for neurological infections and metabolic diseases, urine and blood tests, tests for syphilis, cerebrospinal fluid tests and genetic testing if necessary.
How is coprolalia treated?
Coprolalia cannot always be treated successfully but there are some methods of treatment that have been shown to work. The treatment depends on the severity of the condition and its developmental stage (i.e., new disease, an acute period or remission period).
The following are often tried and tested methods of treatment for coprolalia:
- Anticonvulsants: These drugs are prescribed for those who suffer from epilepsy and sometimes tics. They can also work to reduce irritability and aggressiveness.
- Neuroleptics: This is another name for antipsychotic drugs, and they are often used to treat Tourette’s syndrome, manic syndrome and schizophrenia. However, there is a risk with taking these drugs as often they can provoke coprolalia.
- Antidepressants: Antidepressant drugs such as SSRIs are often used to help minimise symptoms from obsessive states, depression and concentration disorders. The drugs also help to eliminate aggression and control impulsivity.
- Nootropics: These drugs have a range of uses including treatments for ischaemic stroke, neurological infections, dementia and hyperkinesis. They reduce neurological deficits as well as positively affect the brain’s metabolic processes and circulation.
- Etiopathogenetic therapy: Antiviral and antibacterial agents can be used to treat neurological infection and progressive paralysis. NSAIDs can also be used to disrupt uric acid production which helps treat Lesch-Nyhan syndrome, a rare cause of coprolalia. Tourette’s syndrome is also often treated with Botulinum therapy which helps eliminate the most severe vocal and motor tics, which include coprolalia.
Drug treatments are not always suitable for individuals with coprolalia, or they may be used in combination with other treatments.
Such treatments may include:
- Physical therapy.
- Speech therapy to help people overcome speech disorders after suffering from a stroke.
- Art therapy, reflexology and massage. These treatments can induce relaxation which can help reduce emotional tension, causing coprolalia to reduce or disappear.
- Cognitive Behavioural Therapy (CBT). This helps in cases of bipolar affective disorder and those with schizophrenia that is in remission. This can help them to learn to control anger and acquire improved communication strategies.
- Social rehabilitation. This is important if a person is withdrawing from social activities due to their coprolalia. Anxiety may therefore increase the presence of the outbursts, so they need to be socially rehabilitated to help their condition improve.
Many people have not heard of coprolalia as a condition in its own right. However, most people are familiar with it as a symptom or sign of the more commonly known condition of Tourette’s syndrome. Coprolalia, however, is a condition in itself and should be understood as such despite being closely related and linked to Tourette’s syndrome. Sufferers of coprolalia will experience improved quality of life and acceptance if there exists more understanding and awareness of their condition.