Coprolalia

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Coprolalia is involuntary swearing or the involuntary utterance of obscene words or socially inappropriate and derogatory remarks. Coprolalia comes from the Greek κόπρος (kopros) meaning "feces" and λαλιά (lalia) from lalein, "to talk".[1] The term is often used as a clinomorphism, with "compulsive profanity" inaccurately referred to as being Tourette syndrome.

Related terms are copropraxia, performing obscene or forbidden gestures,[2] and coprographia, making obscene writings or drawings.[3]

Characteristics[edit]

Coprolalia encompasses 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.[4]

Coprolalia is an occasional characteristic of Tourette syndrome, although it is not required for a diagnosis of Tourette's. 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.[4]

Cases of deaf Tourette patients swearing in sign language have been described,[5][6] showing that coprolalia is not just a consequence of the short and sudden sound pattern of many swear words.[7]

Coprolalia is not unique to tic disorders; it is also a rare symptom of other neurological disorders.[8][9] It may occur after injuries to the brain such as stroke[9] and encephalitis;[9][10] in other neurological conditions such as choreoacanthocytosis,[11] seizures,[12] and Lesch–Nyhan syndrome;[13] and rarely in persons with dementia or obsessive–compulsive disorder in the absence of tics.[9]

Prevalence[edit]

Only about 10% of Tourette's patients exhibit any kind of verbal Tourettes,[14] but it tends to attract more attention than any other symptom.[15] There is a paucity of epidemiological studies of Tourette syndrome; ascertainment bias affects clinical studies. Studies on people with Tourette's often "came from tertiary referral samples, the sickest of the sick".[16] Further, the criteria for a diagnosis of Tourette's were changed in 2000, when the impairment criteria was removed from the DSM-IV-TR for all tic disorders,[17] resulting in increased diagnoses of milder cases. Further, many clinical studies suffer from small sample size. These factors combine to render older estimates of coprolalia—biased towards clinical populations of the more severe cases—outdated. An international, multi-site database of 3,500 individuals with Tourette syndrome drawn from clinical samples found 14% of patients 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: patients 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.[18] One study of a general pediatric practice found an 8% rate of coprolalia in children with Tourette syndrome, while another study found 60% in a tertiary referral center (where typically more severe cases are referred).[19] A more recent Brazilian study of 44 patients with Tourette syndrome found a 14% rate of coprolalia;[20] a Costa Rican study of 85 subjects found 20% had coprolalia;[21] a Chilean study of 70 patients found an 8.5% rate of coprolalia;[22] older studies in Japan reported a 4% incidence of coprolalia;[23] and a still older clinical study in Brazil found 28% of 32 patients had coprolalia.[24] Considering the methodological issues affecting all of these reports, the consensus of the Tourette Syndrome Association is that the actual number is below 15 percent.

Treatment[edit]

Some patients have been treated by injecting botulinum toxin (botox) near the vocal cords. This does not prevent the vocalizations, but the partial paralysis that results helps to control the volume of any outbursts.[25][26][27] Surprisingly, botox injections result in more generalized relief of tics than the vocal relief expected.[28]

The severity and frequency of outbursts can also be decreased by surgically disabling nuclei in the thalamus, the globus pallidus and the cingulate cortex.[7]

Perception[edit]

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. The coprolalic symptoms of Tourette's are also fodder for radio and television talk shows.[29]

References[edit]

  1. ^ Coprolalia. Dictionary.com, Accessed 30 October 2006.
  2. ^ Schapiro NA (2002). ""Dude, you don't have Tourette's:" Tourette's syndrome, beyond the tics". Pediatr Nurs 28 (3): 243–6, 249–53. PMID 12087644. 
  3. ^ "Linguistics 210 Semantics" (pdf). Semantic features and Tourette’s Syndrome. Retrieved 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.
  4. ^ a b Cohen, J.E. and Levi-Pearl, S. Understanding Coprolalia - A misunderstood symptom. Available from the Tourette Syndrome Association, Accessed 30 October 2006.
  5. ^ Morris HR, Thacker AJ, Newman PK, Lees AJ (March 2000). "Sign language tics in a prelingually deaf man". Mov. Disord. 15 (2): 318–20. doi:10.1002/1531-8257(200003)15:2<318::AID-MDS1018>3.0.CO;2-H. PMID 10752584. 
  6. ^ Dalsgaard S, Damm D, Thomsen PH (December 2001). "Gilles de la Tourette syndrome in a child with congenital deafness". Eur Child Adolesc Psychiatry 10 (4): 256–9. doi:10.1007/s007870170015. PMID 11794551. 
  7. ^ a b Berger, Stephen (28 October 2005). "Scientists explore basis of swearing". The Johns Hopkins News-Letter. 
  8. ^ Singer C (May 1997). "Tourette syndrome. Coprolalia and other coprophenomena". Neurol Clin 15 (2): 299–308. PMID 9115463. 
  9. ^ a b c d Freeman RD, Zinner SH, Müller-Vahl KR, et al. (March 2009). "Coprophenomena in Tourette syndrome". Dev Med Child Neurol 51 (3): 218–27. doi:10.1111/j.1469-8749.2008.03135.x. PMID 19183216. 
  10. ^ Dale RC, Webster R, Gill D (November 2007). "Contemporary encephalitis lethargica presenting with agitated catatonia, stereotypy, and dystonia-parkinsonism". Mov. Disord. 22 (15): 2281–4. doi:10.1002/mds.21664. PMID 17914719. 
  11. ^ Ruiz-Sandoval JL, García-Navarro V, Chiquete E, et al. (November 2007). "Choreoacanthocytosis in a Mexican family". Arch. Neurol. 64 (11): 1661–4. doi:10.1001/archneur.64.11.1661. PMID 17998451. 
  12. ^ Caplan R, Comair Y, Shewmon DA, Jackson L, Chugani HT, Peacock WJ (1992). "Intractable seizures, compulsions, and coprolalia: a pediatric case study". J Neuropsychiatry Clin Neurosci 4 (3): 315–9. PMID 1498584. 
  13. ^ Jinnah, HA. Lesch-Nyhan Syndrome. eMedicine.com (August 29, 2006). Accessed 28 October 2006.
  14. ^ Singer HS (March 2005). "Tourette's syndrome: from behaviour to biology". Lancet Neurol 4 (3): 149–59. doi:10.1016/S1474-4422(05)01012-4. PMID 15721825. 
  15. ^ Tourette Syndrome FAQ. Tourette Syndrome Association. Accessed 6 October 2006.
  16. ^ Swerdlow NR (September 2005). "Tourette syndrome: current controversies and the battlefield landscape". Curr Neurol Neurosci Rep 5 (5): 329–31. doi:10.1007/s11910-005-0054-8. PMID 16131414. 
  17. ^ What is DSM-IV-TR? Psychnet-uk.com. Accessed 29 September 2006.
  18. ^ Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P (July 2000). "An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries". Dev Med Child Neurol 42 (7): 436–47. doi:10.1017/S0012162200000839. PMID 10972415. 
  19. ^ Singer C (May 1997). "Tourette syndrome. Coprolalia and other coprophenomena". Neurol Clin 15 (2): 299–308. PMID 9115463. 
  20. ^ Teive HA, Germiniani FM, Della Coletta MV, Werneck LC (September 2001). "Tics and Tourette syndrome: clinical evaluation of 44 cases". Arq Neuropsiquiatr 59 (3–B): 725–8. doi:10.1590/S0004-282X2001000500014. PMID 11593273. 
  21. ^ Mathews CA, Herrera Amighetti LD, Lowe TL, van de Wetering BJ, Freimer NB, Reus VI (April 2001). "Cultural influences on diagnosis and perception of Tourette syndrome in Costa Rica". J Am Acad Child Adolesc Psychiatry 40 (4): 456–63. doi:10.1097/00004583-200104000-00015. PMID 11314572. 
  22. ^ Miranda M, Menéndez P, David P, Troncoso M, Hernández M, Chaná P (December 1999). "[Tics disease (Gilles de la Tourette syndrome): clinical characteristics of 70 patients]". Rev Med Chil (in Spanish; Castilian) 127 (12): 1480–6. PMID 10835756. 
  23. ^ Kano Y, Ohta M, Nagai Y (August 1998). "Tourette syndrome in Japan: a nationwide questionnaire survey of psychiatrists and pediatricians". Psychiatry Clin. Neurosci. 52 (4): 407–11. doi:10.1046/j.1440-1819.1998.00412.x. PMID 9766689. 
  24. ^ Cardoso F, Veado CC, de Oliveira JT (February 1996). "A Brazilian cohort of patients with Tourette's syndrome". J. Neurol. Neurosurg. Psychiatr. 60 (2): 209–12. doi:10.1136/jnnp.60.2.209. PMC 1073809. PMID 8708658. 
  25. ^ Scott BL, Jankovic J, Donovan DT (July 1996). "Botulinum toxin injection into vocal cord in the treatment of malignant coprolalia associated with Tourette's syndrome". Mov. Disord. 11 (4): 431–3. doi:10.1002/mds.870110413. PMID 8813224. 
  26. ^ Jankovic J (May 1994). "Botulinum toxin in the treatment of dystonic tics". Mov. Disord. 9 (3): 347–9. doi:10.1002/mds.870090315. PMID 8041378. 
  27. ^ Kwak CH, Hanna PA, Jankovic J (August 2000). "Botulinum toxin in the treatment of tics". Arch. Neurol. 57 (8): 1190–3. doi:10.1001/archneur.57.8.1190. PMID 10927800. 
  28. ^ Stern JS, Burza S, Robertson MM (January 2005). "Gilles de la Tourette's syndrome and its impact in the UK". Postgrad Med J 81 (951): 12–9. doi:10.1136/pgmj.2004.023614. PMC 1743178. PMID 15640424. 
  29. ^ 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.
    * Letter of response to Dr. Phil. Tourette Syndrome Association. Accessed 8 May 2006.
    * Letter of response to Garrison Keillor radio show. Tourette Syndrome Association. Accessed 8 May 2006.
    * Born, Matt. Tourette's man 'exploited by Big Brother'. Dailymail.co.uk. Accessed 22 May 2006.