What is Coprolalia?
Coprolalia is a term derived from the Greek words “kopros,” meaning “dung, feces,” and “lalein,” meaning “to babble.” It refers to a type of tic where a person unintentionally uses obscene or socially inappropriate language. This happens in about 10-33% of cases associated with tic disorders, especially Tourette syndrome. Worldwide, Tourette syndrome is estimated to affect approximately 1% of the population, with rates varying between 0.4% to 3.8%.
Instances of coprolalia have also been observed in people with brain lesions, aging-related cognitive decline, and those suffering from neurodegenerative and autoimmune conditions. It can also be seen in relation to seizures, during or after the episode.
Other vocal tic behaviors, like palilalia (repeating one’s own words), echolalia (repeating someone else’s words without purpose), and klazomania (uncontrollable shouting), are sometimes seen alongside coprolalia.
Among similar conditions, collectively known as coprophenomena, coprolalia is the most common. Others include copropraxia (uncontrolled obscene gestures), mental coprolalia (persistent obscene thoughts), and coprographia (compulsion to write obscenities).
There isn’t much known about coprolalia when it doesn’t appear alongside Tourette syndrome. Thus, current knowledge about coprolalia is mostly based on its presence in Tourette’s or occasionally other tic disorders.
What Causes Coprolalia?
The exact causes of coprolalia, a symptom often seen in conditions like Tourettes where people use obscenities or inappropriate language, are not yet fully understood. Some theories suggest that it might be down to certain parts of the brain, called the limbic circuit, that could be going wrong.
There are several other theories as well. One such theory suggests how little movements or sounds, termed as ‘tics’, and coprolalia might develop in Tourettes. It says that the same parts of the brain that deal with impulsiveness and basic bodily functions in very simple animals might cause these symptoms if they’re not working right.
Another theory relates coprolalia to obsessive-compulsive disorder. This theory posits that coprolalia could result from a failure to regulate a certain brain pathway, which includes a region called the basal ganglia. This pathway is involved in habit formation and reward-based learning.
Risk Factors and Frequency for Coprolalia
The exact number of people who have coprolalia, a condition marked by the involuntary use of inappropriate language, is hard to pinpoint as it can vary widely. It’s been observed that it occurs more in males than in females, and this pattern is also seen in individuals with Tourette’s syndrome, where coprolalia is a distinctive symptom. In Japan, reported coprolalia cases in large university hospitals range between 27% to 39%, while in primary care clinics, it’s around 8%.
Coprolalia is a type of tic, which typically starts to appear between the ages of 4 to 6 and tends to worsen as a child approaches pre-adolescence (10 to 12 years old). It’s detected more among white individuals than in Hispanics and African-Americans.
- Coprolalia is a condition characterized by involuntary inappropriate language use.
- More males have it than females, a pattern also seen in Tourette’s syndrome patients.
- In Japan, coprolalia cases in major university hospitals run between 27% to 39%, but in primary care clinics, it’s about 8%.
- Coprolalia is a type of tic, usually first appearing between ages 4 to 6 and worsening around age 10 to 12.
- It’s more commonly found in white individuals than in Hispanics and African-Americans.
Signs and Symptoms of Coprolalia
Doctors usually evaluate patients primarily through a thorough discussion of their medical history.
Testing for Coprolalia
To evaluate a patient for tic disorders, a doctor will typically perform a detailed interview and clinical history check. It’s during this interview that uncontrollable speaking or noises (tics) might be noticeable.
For a diagnosis of Tourette syndrome to be made, there are certain criteria that must be met, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include:
- The presence of multiple motor (movement) tics and vocal (sound-making) tics. These don’t have to occur simultaneously.
- The tics must have been present for a minimum of one year, happening multiple times a day and almost every day.
- The tics must have started before the person turned 18 years old.
- The symptoms can’t be due to drugs or other medical conditions.
Treatment Options for Coprolalia
Choosing to treat vocal tics or coprolalia (involuntary swearing or saying inappropriate things), largely depends on how much it’s impacting the child and how it affects the family. Sometimes, rather than treating it right away, doctors may choose to keep an eye on the situation. When treatment is needed, it can be either non-drug related or involve medication.
Non-drug treatments
Behavioral therapy has been proven to help patients manage their compulsions, and can be particularly effective for those with coprolalia.
One method with strong evidence backing its success is habit reversal therapy (HRT). Here, the patient learns to sense when they feel the urge to tic coming and develops a response or an alternative behavior to manage it. Other therapies like comprehensive behavioral intervention for tics (CBIT), and exposure-response prevention (ERP) have also shown success in clinical trials.
Medication treatments
Medications for treating coprolalia are rarely discussed in medical literature. Instead, literature often covers treatments for conditions linked to coprolalia, like tic disorders, impulsivity, obsessive-compulsive disorder, and Tourette syndrome.
Pimozide and Haloperidol are two medications found to reduce symptoms. However, they often come with side effects that limit their first-line use, with Pimozide reducing symptoms by 90% after a year of treatment in a group where 50% had coprolalia.
Clonidine and clomipramine have been shown to influence behavioral symptoms but were not specifically mentioned for combatting coprolalia. Risperidone and aripiprazole are now often preferred options due to safer profiles and fewer side effects. They are FDA-approved for treating tics. If OCD, anxiety, or depressive disorders are also present, selective serotonin reuptake inhibitors (SSRIs) can also be beneficial.
Attempts have been made to treat vocal tic disorders with botulinum toxin injections in the vocal cords, but it’s still unclear how effective this method is.
What else can Coprolalia be?
Coprolalia, or the involuntary use of inappropriate or offensive language, is most commonly tied to tic disorders, especially Tourette’s syndrome. Therefore, healthcare professionals should look for signs of these conditions when evaluating a patient.
However, other disorders can also cause coprolalia, such as Sydenham chorea and hemiballismus, conditions characterized by uncontrolled movements. While these disorders can include coprolalia, the motor tics or swift, erratic movements often give them away.
Epilepsy can also lead to coprolalia. Specifically, coprolalia can happen during the ictal phase (or the ‘actual’ seizure) in cases of temporal or orbitofrontal epilepsy.
Startle syndromes, including latah and miryachit, should also be considered. These conditions, more likely in women and often triggered by sudden shocks, can cause sudden muscle jerks, repetition of other people’s words (echolalia), and coprolalia. These individuals may also repeat actions they witness or are overwhelmingly compliant.
Moreover, klazomania, characterized by obsessive shouting, can present with coprolalia as well. Therefore, all these possibilities should be explored when diagnosing a patient with coprolalia.
What to expect with Coprolalia
Coprolalia symptoms can increase and decrease for no apparent reason. Factors such as emotional or physical stress, tiredness, caffeine, excitement (both positive or negative), certain medications, and hormonal changes (like menstrual cycles) could potentially make coprolalia and tics worse. However, relaxation tends to lessen the symptoms.
A small number of people may see their symptoms become more severe and continue into adulthood.
Possible Complications When Diagnosed with Coprolalia
There are several potential impacts on a child due to various circumstances, these impacts include:
- Difficulty in studying and paying attention, affecting school performance
- Inability to attend school
- Social isolation due to bullying and rejection from the community
- Conflicts between family members and interpersonal relationships
- Victimization by peers
Preventing Coprolalia
When discussing coprolalia with families, it’s important to explain what it typically looks like, its common associated conditions, what the future might hold, as well as the possible courses of treatment, including the option of doing nothing but watching. Factors that can make coprolalia worse or better also need to be discussed with the person who has the condition. The healthcare provider can also recommend helpful websites where the individual or family can learn more information and connect with support groups.
Some of these websites include the Tourette Syndrome Association and Tourette Syndrome “Plus”. These resources offer more in-depth information and a platform to connect with others facing the same challenges.
