Coprolalia

Coprolalia is the involuntary utterance of obscene, profane, or socially inappropriate words or phrases, most often as a vocal tic in Tourette syndrome. It is one manifestation of tic disorders and is not under conscious control. Like other tics, coprolalia typically follows a premonitory urge and may be temporarily suppressed with effort.

Prevalence varies; coprolalia occurs in a minority of people with Tourette syndrome, with commonly cited estimates around 10–20%. It can also appear in other tic disorders but less commonly. The behavior can be distressing and stigmatizing and is not a sign of intention or moral failing. Individuals may experience social or educational difficulties as a result, and experiences can range from mild to severely disruptive.

Neurobiologically, coprolalia involves dysfunction in cortico-basal ganglia-thalamo-cortical circuits and dopaminergic signaling. The exact causes are not fully understood and likely involve genetic and environmental factors. Coprolalia is considered a symptom within a broader spectrum of tic disorders rather than a distinct disease.

Management focuses on reducing tics and mitigating psychosocial impact. Behavioral therapies such as comprehensive behavioral intervention for tics (CBIT) or habit reversal can be effective. Pharmacologic options include atypical antipsychotics (for example, risperidone or aripiprazole) and alpha-2 adrenergic agonists (guanfacine, clonidine). In focal cases, botulinum toxin injections may help, and deep brain stimulation is considered for severe, refractory tic syndromes. Many individuals experience a reduction of tics, including coprolalia, with age.