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.

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