Dear Alice,

What do doctors call this illness when people just blurt out foul language for no reason?

Dear Reader,

It sounds like you are referring to Tourette’s syndrome (TS). Named after the French neuropsychiatrist Dr. Georges Gilles de la Tourette, TS is a neurological condition that affects up to one in 100 individuals. Individuals with TS usually experience repetitive involuntary or compulsive movements and vocalizations referred to as tics. What you are referring to specifically is the most widely recognized symptom, coprolalia, or the blurting of socially inappropriate words such as swear words. It’s important to note that this symptom isn’t the most common and only occurs in ten to fifteen percent of people with TS.  

Tics usually develop in childhood between the ages of three and nine, and are three to four times more common among boys than girls. Up to 18% of all children experience symptoms. Tics characteristic of TS are classified into two groups. Simple tics are sudden, brief, repetitive movements that only involve a few muscle groups. They usually manifest before complex tics. Examples include:

  • Rapid eye blinking.
  • Shoulder shrugging.
  • Grimacing.
  • Yelping or other vocalizations.
  • Sniffing, grunting, or throat clearing.
  • Head jerking.
  • Neck stretching.

Complex tics are more involved activity patterns that require the coordinated effort of several muscle groups. They include:

  • The simultaneous combination of two or more simple tics.
  • Jumping, hopping, bending, twisting, or kicking.
  • Echolalia — repeating what other people say or do.
  • Coprolalia — using foul language, curses, or ethnic slurs.
  • Self-injurious behaviors, such as lip and cheek biting, head banging, or hitting oneself. These extremely rare symptoms are associated with the most severe forms of TS, which affects approximately 200,000 Americans.

Tics are often difficult to control. Some people with TS are able to suppress tics for a short time (similar to holding back a cough), but eventually tension mounts and the tic is expressed either involuntarily or by impulse. Stressful situations and life changes increase the frequency of tic expression, while states of relaxation, sleep, or deep concentration usually have the opposite effect. As individuals with TS reach adulthood, tics tend to decrease in frequency. Some teens and adults even experience complete remission of symptoms. Less than 15% of TS patients report experiencing disruptive tics into adulthood.  

TS is believed to result from brain abnormalities combined with the inheritance of one or more dominant genes. People with the gene(s) for TS may display various ranges of severity of symptoms. Some experience only mild tics or obsessive-compulsive behaviors; others are mere carriers of the gene(s), meaning they experience no symptoms at all. TS symptoms are likely to be experienced alongside symptoms of other conditions such as attention deficit hyperactivity disorder (ADHD), depression, anxiety, and obsessive-compulsive disorder. Consequently, individuals with TS require comprehensive medical treatment plans that address all causes of tic expression.

Diagnosis of TS is usually quite complicated. In order for an individual to be diagnosed with TS, physical and vocal symptoms must be present for at least one year and start before the age of 18. Additionally, tics must be experienced several times throughout the course of a day, and they must cause distress or impairment. Diagnosis is usually completed simply through discussion and observation, but in some cases, laboratory tests, MRIs, and CT scans may be used to rule out the possibility of other conditions with similar symptoms. A combination of discussion, observation, tests, and brain scans may be necessary in cases of nervous system injury trauma or genetic predisposition. Many times, symptoms go unnoticed for significant periods of time; for example, parents may attribute rapid eye blinking to poor vision or frequent throat clearing to environmental allergies or seasonal colds. Additionally, symptoms may subside while in the presence of a doctor only to be experienced moments after leaving the doctor’s office, further complicating the process of TS diagnosis.

Most people with TS are able to function well and lead productive lives without medication. In fact, most patients with TS experience very mild symptoms. TS symptom severity usually oscillates throughout life in accordance with stress level, fatigue, social adjustment, and other factors. For those who have severe tics that are disruptive or dangerous, neuroleptic medicines and cognitive or behavioral therapies may be necessary to control symptoms; however, medicines are used only in severe situations due to their potential side effects. Currently, researchers are trying to identify the gene(s) linked to TS to better understand how the syndrome is inherited and expressed, and to find more effective therapies.

Incorrect diagnosis and public misunderstanding of the syndrome often cause people with TS to feel ashamed and socially isolated. The Tourette Syndrome Association offers support groups and other resources for people with TS and their families. The National Institute of Neurological Disorders and Stroke and Brain Resources and Information Network (BRAIN) may provide additional information about resources and support.

Tourette’s syndrome is a complex and frequently misunderstood condition. However, with the support of a doctor, a comprehensive treatment plan can be put into place to address symptoms and help a person achieve a high level of social and emotional adjustment.


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