You Got Your Coprolalia in My Tourette’s Syndrome

Coprolalia is one of those wacky symptoms of Tourette’s syndrome plus (TS+) that can be described easily enough, but the reality is hard to grasp. In my book, Tiger Trails, I define coprolalia as “unmotivated outbursts of inappropriate words”. Coprolalia is such a weird symptom, even doctors get confused about what it is and how it fits into the discussion of Tourette’s syndrome (TS).

For example, during my childhood, coprolalia was mandatory for a diagnosis of TS. Now it is a fringe problem, occurring in less than 3% of the TS population. I know many older Touretters with vocal tics but no coprolalia, who did not get treatment in childhood, who are relieved to hear this, especially if they have children. However, more work must be done to fully understand coprolalia, and to describe it accurately.

Coprolalia has been classified as a ‘vocal’ tic, as opposed to a ‘motor’ tic. Keep in mind, tics are defined as muscle contractions. Swallowing, coughing, sniffling, and throat-clearing are common vocal tics. You can see how someone might call these ‘vocal’ tics: they come with noises. I believe they are merely complicated tics which involve the diaphragm, throat, mouth, etc. I have always said: all vocal tics are motor tics.

The classification of tics, especially coprolalia, is currently the subject of debate. I came up with a theory and, once I started talking about it, found out others, including some doctors, had a similar idea. Coprolalia is not a tic, but a compulsion: a symptom of obsessive-compulsive disorder (OCD), which is highly comorbid with TS.

Coprolalia should not be part of the spectrum of ‘vocal’ tics. The only common feature between the simpler noises and the intrusive outbursts is the genes that give us TS+. Vocal tics are complicated and unpleasant muscle processes, involving no language at all. Coprolalia is a completely different beast in its construction, the way it feels, and how it affects the world. Saying that a tic can include language makes things overly complicated.

In order for coprolalia to be ‘just’ a tic, the mechanism in the crocodile (lower) brain that creates tics has to reach up into your left temporal lobe, and hit the Wernicke (language) and Broca (speech) areas. Then the tic ‘signal’ has to grab some inappropriate language, in context, and push it out your mouth.

Compare this with coprolalia being a symptom of OCD. OCD already makes us think and feel things against our will. Compulsions already include contextual clues. When you compulsively touch a hot stove, the OCD understands temperature and injury. This understanding might be as simple as, “Big metal thing = Ouch!” but this is still orders of magnitude more complicated than, “Contract muscle.”

This is a large pill to swallow, even if you have coprolalia. To help you chew (ewww) on that pill, in the next post, I will present stories from the conferences about some special Touretters I like to call “The Coprolalia Avengers”.

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Questions? Suggestions? Yell at me, or to me, in an email to The Tourette Tiger. For definitions and clarifications, please see my book, Tiger Trails.

Comments

  1. Chris says

    Hi Darin !

    I couldn’t agree more… Coprolalia is definitely a compulsion and has a totaly different pattern, even with other vocal tics.
    I have severe TS (including coprolalia) and thought the process leading to inappropriate outbursts is very different from my other vocal tics, like shouting, barking or spitting.
    My brain brings up the inappropriate words or phrases and they become so overwhelmingly present (just like obsessions) that the only way to get rid of that thought is to actually say it out loud.
    In my book, that whole process is identical to the one that forces me to touch things 3 times before it feels right or perform my rituals in the same specific order.
    Chris.

  2. Roger D. Freeman, M.D. says

    You are presenting some interesting ideas, however, you’re wrong about the prevalence of coprophenomena. We published the data last year (Freeman et al., Coprophenomena in Tourette syndrome. (2009) Developmental Medicine & Child Neurology 51: 218-227), and it’s not 3% but about 15%, because about half of coprophenomena are intermittent or temporary, and many are muffled (coprolalia) or hidden (copropraxia). I completely agree that these phenomena are associated with OCD-like symptoms, and they are quite complex and not always impairing. For some people with TS they are just like you describe, but not for everyone all the time. It’s a shame that so little research has gone into understanding better the varieties of experience.

    • The Tourette Tiger says

      Dr. Freeman! My first comment from a medical doctor. I’m honored that you took the time to read my blog. My mother, Sherry Pruitt, told me to say hello for her, when I mentioned your comment.

      As for that, I am pleased to see that you and your colleagues are doing research in this area. I have no problem ‘ticcing corrected’. It is exciting to see some evidence to back up my nutty theories. You are correct: we need more research on coprophenomenon. (New Word!) I was going to expand on this posting, approach the topic slowly, but that post is not ready. Since the cat is out of the bag, I might as well say: I believe that in 10 or 15 years we will not even have a distinction between TS and OCD. I truly believe TS is a subset / manifestation / subtype / whatever of OCD, not the other way around. I think that our definitions of coprophenomenon need to be updated to include the symptoms you describef: those not as “…complex and not always impairing”. I know Touretters who report the urge of corprolalia, although they don’t have the outward symptoms. If we include the subtle and the internal coprophenomenon, we not only undermine the ‘just a complex tic’ silliness, we easily justify a jump in frequency from 3% to 15%.

      Whether I’m right or wrong, I am looking forward to see what happens next. Please keep up the good work, and keep us posted!

Trackbacks

  1. […] The funniest incidents involving the Coprolalia Avengers fall into the “Everyone was thinking that” category.  After a couple of days of heckling by the Avengers, speakers become acutely aware of their effect on the audience, and our reactions.  The Avengers opened up discussions, as many Touretters do, about our mutually assumed rules of social conduct.  One speaker in particular got caught between hammer and anvil: between bad scheduling and the social bluntness of coprolalia.  This is another story that makes me wonder why we cling to calling coprolalia “merely a tic”. […]

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