Ken Shyminsky, a former vice president of the Greater Toronto Chapter of the Tourette Syndrome Foundation of Canada, draws upon his personal experiences as an teacher and student with Tourette Syndrome to help children with TS and related disorders. He also has Tourette himself and is the founder of the website Neurologically Gifted.
The term coprolalia is used to describe involuntary vocalizations that are obscene or socially inappropriate. Coprolalia includes swearing, but also includes saying things that are culturally taboo, socially unacceptable or inappropriate because of age or context.
For example, a child using any kind of obscene language, or anyone saying negative comments about another’s ethnicity or physical appearance. Coprolalia may also refer to these phrases or words being said inside the persons head or kept to themselves which also causes internal distress for the individual.
Coprolalia can be a symptom of some neurological disorders as well as certain brain injuries. Coprolalia occurs as a symptom in only about 10 percent of people with Tourette Syndrome. Copopraxia are gestures and actions of the same nature as coprolalia.
Coprolalia can occur in Obsessive Compulsive Disorder as well as Tourette Syndrome. People who have Obsessive Compulsive Disorder as well as Tourette Syndrome have a greater struggle as the two disorders may interact with and/or perpetuate coprolalia. The obsession with performing, (or not performing), the inappropriate behavior provokes the urge to perform the inappropriate behavior and vice versa.
Coprolalia is a particularly distressing symptom for people with Tourette Syndrome. The nature of coprolalia, being socially inappropriate, makes everyone involved uncomfortable, that is, until everyone understands what coprolalia is and why it occurs.
Education about coprolalia being involuntary and a symptom of a neurochemical disorder is essential to bring about acceptance and understanding. Coprolalia can be a lifelong struggle and the individual deserves understanding and acceptance. Coprolalia must be accepted by the family.
People with coprolalia feel embarrassed and ashamed of their symptoms. Often, the response to coprolalia and the lack of understanding and acceptance from other people amplifies the individual’s shame and embarrassment, leading to isolation. Fear of performing the tic in public and being constantly scrutinized and judged may also lead to isolation and depression. In addition, it drives the individual to constantly think about their coprolalia symptoms, in turn making the coprolalia occur more often. In this way, benign symptoms of coprolalia become malignant due to the stigmatization and judgment of the onlookers.
Difficulties in Understanding Coprolalia
Unfortunately, coprolalia may be expressed in complex and variable ways, further leading to the misunderstanding of the involuntary nature of the behavior.
A Misunderstanding of Provocation
Coprolalia, like other tics, is prompted by a premonitory urge. For example, racial slurs may be prompted by seeing a person of a particular race, sexual comments may be prompted by seeing a member of the opposite sex. Seeing these people reminds the brain of forbidden/unacceptable words. Coprolalia is somehow co-exists alongside the faulty autoinhibitory functions within the brain. When faced with a person of the opposite sex, the sufferer may quickly think “I’d better not say “_______”.
By thinking this thought, the individual has put the offensive phrase into their own mind. He/she will then be stuck with the phrase in their head. Coupled with poor impulsivity control, it can appear as if the person is willingly thinking the thought and then saying it without concern for the other person’s feelings.
In truth, coprolalia has no relationship or meaning to the observed person and is not a personal attack. There just happened to be something within the environment that prompted that particular urge. For the person with coprolalia, they struggle to prevent themselves from saying or doing the worst possible thing in the particular situation.
Imagine having to sit in a church or other place of worship. The mere sight of religious icons evokes meaning in our brains. This meaning cues the brain and conjures words (good and bad). A sufferer of coprolalia will focus on restraining themselves from shouting offensive words. This focus will bring these words to the tip of his/her tongue, and eventually out of the mouth.
The struggle is internal and far more painful for the individual than those who may overhear the utterance. Coprolalia is not directed at other people nor intended to cause harm or fear in others. Oddly enough, the more a sufferer wants to STOP saying an offensive word, the more likely they are to say it – because of their focus.
Incorporation into Speech
Another confusing aspect about the expression of coprolalia involves the incorporation of coprolalia into regular speech and actions. This phenomenon is more common in children. The urge to say the word may be strong enough that it will occur within the context of speech. The tic is somewhat satisfied for the child however, it very much appears as being a voluntary addition.
Consider the F_ word as a vocal tic that is coprolalia. The child may voluntarily slip it into speech in a fluent way, satisfying the tic but being unaware of how voluntary the tic appears to be to others. For example, “That f_ing dog just f_ing barked at me”. This is very difficult for others (especially parents and teachers) to understand.
I remember telling my child, when coprolalia began for him, to just pick one or two of the words and say them out of a sentence so people would more easily identify it as coprolalia! This strategy didn’t work because he doesn’t have the option to choose which tics he says, and because he never really understood why it would make a difference how or when it was expressed. To him, slipping it into speech was more “normal” than randomly shouting a bad word.
Intensity and Frequency Changes
Another difficult characteristic of coprolalia that further impedes understanding is that stress increases tic frequency and intensity. Parents of children with Tourette Syndrome are very familiar with this phenomena. Both negative or positive stress occupy mental attention. In these situations, a child has less mental energy to suppress his/her tic symptoms. As a result, more tics are expressed, to conserve mental energy for all the other things that are consuming the child’s mental resources. Consider that anger, disappointment and frustration are major stresses. When a child attends to these negative emotions, they do not expend energy on suppressing their tics or coprolalia.
In a situation that provokes strong feelings of anger in the child, tics and coprolalia escalate. In this type of situation, you will have a child who is angry, using inappropriate language, and louder because you have asked them to do something like “Come do your homework now, please.” What looks like a child reacting disrespectfully and aggressively may simply be a child reacting to a strong emotion, increasing tic expression due to the displacement of mental focus to the emotion.
This situation is extremely difficult to manage and creates intense stress on families living with neurological disorders. Education about the disorders, symptoms, and their expressions lay the groundwork to understanding, managing and accepting coprolalia.
In Coprolalia Part 2, strategies for understanding, accepting and managing coprolalia will be discussed. Understanding coprolalia and the nature of its expression will be essential when employing strategies and educating others about your or your child’s symptoms.