A characteristic symptom of Gilles de la Tourette’s tics disease, coprolalia indicates a more or less irresistible tendency to use particularly coarse and foul language. Very disabling on a daily basis, people who are affected can be victims of a feeling of intense anxiety in social situations. What are the causes of these vocal tics? How can we help people who have it?

The term coprolalia comes from the Greek words kopros which means excrement and lalein which means to speak. It designates the tendency to inappropriately use, voluntary or not, and frequent strings of reprehensible, taboo, obscene, abusive and filthy words of a sexual, religious or scatological nature, that is to say in relation to excrement. .

This neologism was formed in 1885 by the doctor Gilles de La Tourette who observed it frequently in subjects suffering from the disease to which his name was given. In fact, these vocal tics, which manifest themselves in the form of impulsive verbalizations or even howls, are in fact only found in 20% of patients with Gilles de la Tourette syndrome.

Coprolalia, which is one of the most disabling sound tics, affects children as well as adults and is only reserved for people with Gilles de la Tourette syndrome.

Formerly called “blasphemous mania”, it is indeed observed in:

• children in the phase of anal preoccupations, with the value of provocation or transgression;
• shy adolescents who want to assert themselves by shocking those around them;
• rare subjects who are anxious, inhibited or timid, as a release, with acting value compensating for a feeling of inferiority;
• sexual perverts using certain coprolalic practices as an artifice to try to reach orgasm;
• people with mania, obsessive neurotics, dementia or schizophrenia.

In emotionally frustrated young children, coprolalia can invade the entire sphere of language and express their hostility towards the world perceived as threatening. It disappears when the child regains emotional security.

In the neurotic, in particular during obsessive-compulsive disorders, it can constitute an obsessive temptation such as the urge to launch swear words during a religious ceremony or an official meeting for example. According to psychoanalysts, coprolalia is a regression towards pleasure in the anal and oral stages.

The causes of coprolalia remain unclear. Its genetic origin is assumed, as are environmental and / or toxic factors.

Coprolalia is socially very debilitating. It is characterized by:

• a lack of control: the person with coprolalia cannot help producing these strings of filthy words or insults. If he sometimes resists uttering them at the cost of great efforts, he cannot avoid them completely and can only postpone them. He then seeks to isolate himself to let himself go to the landfill;
• the shameful or shocking character does nothing, quite the contrary. Insults can be uttered against people loved and appreciated, or even spoken when there is no recipient;
• an emotional character: the difficulty of control is particularly due to the fact that these manifestations appear in an emotional context or that they have an important cathartic dynamic, that is to say a purifying dynamic;
• a loss of linguistic significance: a fleeting anesthesia of the intellect appears during symptomatic execution. Thought is then completely monopolized, in an obsessive way: obsession with production, with irrepressible and uncontrollable enunciation, and obsession with the spoken word;
• an alteration in language functioning: caught in an exchange that fascinates him, the subject cannot help interrupting his interlocutor repeatedly and brutally. This violence is one of the major causes of the situation of social disruption in which the subject finds himself;
• an alteration of the discourse: this rupture of the co-construction of the exchange is the consequence of the deconstruction of the discourse of the subject who no longer responds to the usual language rules;
• an appearance of vocal phenomena: throat clearing, screaming, belching, productions resembling interjections but not functioning like these;
• an appearance of verbal phenomena: a loss of the meaning of the terms used is observed.

In all cases, these manifestations are characterized by an irrepressible takeover of the body over reason, of the sensitive over the intellect, leading to a need for expression in the most literal sense of the term: the tension must be “pressed in. outside ”, expelled by the action of the symptom.

People with coprolalia may have an environmental maladjustment with a feeling of intense anxiety in social situations. In the past, these people were avoided, isolated, they were even believed to be possessed by the devil. They can become impulsive and aggressive, or even engage in self-destructive behaviors.

To combat coprolalia, people who have it may have different options.

Medical treatment

Medicines to stop vocal tics are only recommended if they persist and interfere with activities or self-image. The lowest dose needed to make the tics tolerable is used, and the doses are lowered as the tics decrease.

Thus, depending on the severity of the tics and their repercussions on the personal and social life of the person, it may be prescribed:

• agonists of certain neurotransmitters such as alpha-2 adrenergic agonists (clonidine, guanfacine) or dopaminergic agonists (pergolide, ropinirole) in the event of mild tics;
• neuroleptics (haloperidol, risperidone, pimozide, tiapride, olanzapine, aripiprazole, tetrabenazine), capable of blocking the dopamine circuit in order to treat moderate to severe tics;
• antidepressants or anxiolytics depending on the case.

Cognitive-behavioral therapies

Behavioral therapy approaches can improve vocal tics. These include:

• relaxation techniques;
• tic education which aims to help identify situations in which tics occur or worsen;
• a habit reversal technique, i.e. learning a new behavior to replace the tic

 Social support

The entourage plays an essential role in providing psychological support to the patient and helping him to integrate despite his illness and tics. Also, precisely informing the patient and his entourage, often in distress, is a crucial step which often makes it possible to expose suffering, frustrations, guilt and incomprehension.

Neurosurgical treatments

For severe forms resistant to drug treatment, high-frequency deep brain stimulation of the associative-limbic zone within the thalamus or pallidum can reduce tics.