Non-obscene complex socially inappropriate behavior in Tourette's syndrome.

The authors surveyed 87 adolescent or adult patients with Tourette’s syndrome (TS) regarding the presence, characteristics, and functional impact of non-obscene socially inappropriate (SI) behavior. Reported behaviors included insulting others (22%), other SI comments (5%), and SI actions (14%). More often, subjects described having an urge to carry out these behaviors (30%, 26%, 22%, respectively), which they often attempted to suppress. Non-obscene SI behavior was usually directed at a family member or familiar person, at home or in a familiar setting. Social difficulties commonly resulted. Non-obscene SI behavior is a common and potentially disabling feature of TS. It is closely associated with conduct disorder and attention deficit disorder and may represent part of a more general dysfunction of impulse control in TS. (The Journal of Neuropsychiatry and Clinical Neurosciences 1996; 8:311-317) A lthough exhibited by only a minority of patients with burette’s syndrome (TS), the involuntary uttering of obscene sounds, words, or phrases (coprolalia) and the performance of obscene gestures (copropraxia) are responsible for much of the public notoriety of this illness. Shapiro and colleagues1 have suggested that coprolalia and copropraxia should be considered part of a spectrum of socially unacceptable verbalizations and actions for which the term coprophilia was used. The authors indicated that coprophilia can be “racial slurs, religious improprieties, political innuendoes, derogatory remarks, use of another person’s name, or any other method of expressing something socially unacceptable or forbidden” (p. 151). In Shapiro and colleagues’ series of 666 patients, 32% reported coprolalia, 13% reported copropraxia, and 38% had a history of any type of coprophilia! Although detailed information regarding the nature of coprolalia and copropraxia in studied populations has been presented by Shapiro et al. and others, 3 little attention has been focused on other, non-obscene coprophilic behaviors. In one study regarding a variety of sensory experiences, Cohen and Leckman found that of 28 TS patients interviewed, 36% reported “disinhibition behaviors,” defined as complex behaviors the patient knows are dangerous