Coprolalia Part 2: Coping With Coprolalia

Coprolalia Part 2: Coping With Coprolalia

Coprolalia can be a particularly distressing symptom and a lifelong struggle for an individual with Tourette Syndrome.  Stigmatization, shame and isolation must be reduced by the efforts of the individual, their families, their community and society.

Strategies to  manage coprolalia will target improving the acceptance and understanding of this difficult symptom which will in turn reduce the frequency and intensity of it’s expression.

Understanding the nature of coprolalia is essential to understanding strategies for the management of coprolalia.

Be aware that coprolalia, a symptom of a neurological disorder, will not go away.  If the symptom is not being expressed, the individual is either effectively managing or suppressing it’s expression.  Suppression is NOT a desired response.  Suppression requires the individual to constantly focus on the symptom reinforcing coprolalia and exhausting the person’s mental capacity to do anything other than suppress.  Obsession with suppression may lead to a constant internal struggle.  Effective management will serve to increase everyone’s understanding about coprolalia, reduce stress and prevent hyper focussing on the symptoms.  In a sense,  just by changing how we think about and react to coprolalia we can reduce it’s incidence and negative impact

Promote Understanding

In order for the individual with coprolalia to be accepted, education about coprolalia must happen.  Education is essential to the individual and their families as well as all others who will, or should, become the support network essential for healthy living.  This will include the individual’s school, their peers, their medical professionals, clubs they are involved with, their community and society in general.

There are numerous internet sources aimed at the promotion of awareness and understanding of Tourette Syndrome all of which can be useful sources for information and support.  Coprolalia is a rare symptom of Tourette Syndrome and there are few comprehensive sources for information specific to this symptom. Many sources about Tourette Syndrome define coprolalia generally but few offer more than a definition.   We recommend Neurologically Gifted’s article, Coprolalia Part 1:  The Nature of Coprolalia, which is a comprehensive look at what coprolalia is and how it may manifest.  This article provides a deeper understanding  of coprolalia, how it may be expressed and how it feels for the individual. We also recommend using other sources of information about Tourette Syndrome, particularly explanations about tics and the nature of tics, to further understand coprolalia.  Coprolalia, however complex, is a vocal tic.  If one understands how tics work they can understand how coprolalia works.   Use your knowledge of tics and coprolalia to share information with the key people in your own or your child’s lives.

If your child has Tourette Syndrome educate them also and use them as source for information.  They are experts about how their brain works but will need adult coaching to gain insight into their symptoms.  Teach them the language needed to explain their symptoms to others.  Include them when you are speaking to others about their disorder.  Advocate for your child, with your child present whenever possible, and teach them how to advocate for themselves.  The gift of self advocacy will provide them with security and strength and serve them throughout their lives.  Practice at home having your child educate others about Tourette Syndrome and coprolalia to improve confidence and self acceptance.

Always consider that not everyone you or your child meets will understand or care to understand about your own or your child’s symptoms.  Be aware and let your child know about this possibility.  I often tell my child that others may never understand him or care that he can not control his symptoms.  They may “just never get it”.  I let him know that we have done our part by sharing information with them and that it is their choice to make an effort to understand or not.  I let him know that we can feel good and satisfied by our efforts knowing we have done what we can do and move forward in a positive way.

 

Reduce Stress From Coprolalia

Tension can often get out of control in a home where coprolalia occurs.  There are not many people whose anxiety doesn’t rise exponentially when faced with loud, sometimes aggressive shouting of obscenities or unkind words.  Education, as above, will allow members of the family and those around the individual to understand coprolalia as a symptom of a neurological disorder and not a threat.  With this understanding there becomes a different perspective on the behaviour and acceptance and understanding of the individual will follow.  Reducing stress in the home will reduce stress to all members of the family.  Family members will no longer react with anger or fear.  The individual will no longer hyper focus on suppressing their symptoms, thus breaking a powerful positive reinforcement cycle.

Ignore symptoms of coprolalia

The individual with coprolalia already knows that their behaviour is unacceptable and not the social norm.  In fact, the more unacceptable the behaviour the more driven the individual is to perform it.  Everyone in the family should know that the individual cannot help doing the behaviour and that it is a symptom of a neurological disorder.  Planned ignoring helps to relieve stress on the individual and within the family.  The individual deserves a break and a comfortable place to relax and let their guard down.  It is very likely that the individual is exhausted from expending mental energy to suppress some or all of their symptoms while in public.  In school or in the workplace they are driven to be accepted and to fit in as best they can.   Give them a break at home for working so hard outside the home.

Here is an example of Planned Ignoring of Coprolalia Caution:  Clip contains Coprolalia

Planned ignoring provides an environment where the behaviour is acceptable, reducing the urge to perform it which is driven by the auto inhibitory mechanism that tells them “Do it!”  By allowing coprolalia, the tic is not reinforced and the person does not hyper-focus on the behaviour.  For the family, stress is also reduced.  Parents are no longer torn between accepting and punishing the behaviour.  Siblings are no longer fearful that their sibling is in trouble, and that mom and dad are going to be angry again.

This is not to say you must ignore all swearing or aggression in your home.  Every action, wanted or unwanted, uncontrollable or within control will have a consequence.  Your child should be held accountable for all behaviours.  (see: Be Accountable and Responsible below)

It remains unacceptable for another child without Tourette Syndrome to swear or copy the behaviour.  Tourette Syndrome is not contagious and neither is coprolalia.  If a child without Tourette parrots and then tries to justify with “But Johnny says it”, your response should be a negative consequence if it is within that child’s abilities to follow appropriate behaviour.  It also isn’t to say your child with Tourette Syndrome can just carry on swearing at will if the swearing voluntary it is not a symptom of their disorder.

If an individual has coprolalia it is their reality and will be a lifelong struggle.  How well they manage the symptom and how well they succeed will be determined on how empowered they feel about themselves.  Unconditional love and acceptance is paramount in nurturing a healthy human being.  In the home, ignore benign displays of coprolalia and nurture self-esteem while dealing with this problematic behaviour.  Less stress and less focus on the coprolalia will serve to give them more energy to apply other strategies to manage coprolalia.  Planned ignoring is not easy but keep in mind the benefits and energy you can use towards other useful strategies.

Now visit Coprolalia Part 3:  Taking Action on Coprolalia  to see what you can do, besides sharing awareness, to lessen the impact of coprolalia.

WHERE TICS AND COMPULSIONS MEET: TS PLUS OCD

Coprolalia 1 Neurologically Gifted

WHERE TICS AND COMPULSIONS MEET: TS PLUS OCD

Tourette Syndrome and Obsessive Compulsive Disorder often occur together.  In fact, the Centers of Disease Control and Prevention states that more than one third of persons with Tourette Syndrome also have Obsessive Compulsive Disorder.  Often tics and compulsions can look similar and be difficult to distinguish.  Actually, to an observer it may be impossible to determine whether a behaviour is a compulsion or a tic without asking the person performing the behaviour, and even then it may remain a mystery.

The key to distinguishing a tic from a compulsion is the motivation behind the act.  As an example, lets break down a simple motor tic which could very well be a simple compulsive behaviour .

The behaviour is blowing on the back of the right hand.

If the behaviour is a tic the person may feel a premonitory urge to perform the tic.  The premonitory urge could be a tickle on the hand, a sensation in the elbow joint prompting the movement, a sensation in the lips to purse, a feeling in the chest prompting a need to exhale a breath.  Premonitory sensations may be any feeling or urge that prompts the tic, creating the itch that needs to be scratched.  The person scratches that itch and the tic is performed.

If the behaviour is a compulsion, the person is prompted by a different mechanism to perform the exact same behaviour.  The person may have an obsession that there may be dust on the back of the hand, a thought that they may need to blow on the back of the hand to prevent something bad from happening, a feeling of anxiety or emotional unease unless they blow on the back of their right hand.  The person then performs the action, (not a tic), and temporarily relieves the uneasiness or anxiety.

As you see from this scenario, the behaviour from the outside observer is identical.  To the person, the behaviour may be triggered from and performed for very different reasons.  It could also be that the person themselves may be unaware of the difference as well.  Distinguishing the “why” the behaviour occurs requires some cognitive awareness, maturity and insight.  A child, for example, may not be able to determine the “why” and just know that they have to do the act.  A person with many tics and compulsions may have a low reserve of mental energy to distinguish the “why” of the behaviour.  A person who has little understanding or insight about their differences may also be unable to articulate whether they are compelled due to anxiety to perform the act or if the act is a sudden, intermittent, unpredictable, repetitive, non-rhythmic movement that is classified as a tic.

Coprolalia 1 Neurologically Gifted

Now let’s throw more uncertainty into the simple blowing on the back of the right hand.  Perhaps this tic or compulsion is linked with another behaviour.

For example, the person has established that the blowing on the back of the right hand is a tic but immediately after performing the tic they are compelled to do it over until it feels just right.  Now the behaviour may be motivated by anxiety and the following act is a compulsion.  So the person blows on the back of the hand twice, once performing a tic, the second time due to a compulsion but both times in the exact same way. Alternatively, it may be the opposite, where the initial act is a compulsion which then triggers the tic.

To make it more confusing, it may not be the exact same behaviour, it may be any other tic or compulsion. For example, the person may be compelled to jiggle the door handle to make sure it is locked and then perform a tic by knocking on the door. The combinations may be endless and the compulsions and tics may interact in very intricate ways.

So why may it important to distinguish a tic from a compulsion?

Sometimes it may not be. If the tic or compulsion is not intrusive, disruptive or bothersome to the person performing it, then knowing the motivation for the behaviour may not be important to them.  If the person is bothered by the act, motivation is important in terms of modifying or extinguishing the behaviour.

Obsessive compulsive disorder may be treated using Exposure and Response Prevention, (ERP) and Cognitive Behavioural Therapy, (CBT).

Tics may be treated or modified using Cognitive Behavioural Intervention for Tics, (CBIT).

Both of these therapies require gaining insight about the motivation that drives the behaviour and thus determining whether it is a tic or a compulsion.  The insight lays the groundwork for the appropriate behavioural intervention. But, not only is knowledge and understanding important for therapy, it helps us to better understand who we are, how our brains work and why we do what we do which will contribute to our overall self-awareness and emotional well-being.

Here is a short example of tics and compulsions interacting….

For information how Tics and Compulsions manifest in Coprolalia see:  Coprolalia Part 1:  The Nature of Coprolalia