是时候重新思考抽动秽语综合征中的秽语症：“我发誓这不是抽动秽语综合征！”

HYPOTHESIS AND THEORY article

Front. Psychiatry

Sec. Psychopathology

Abstract

Coprolalia has only recently been recognized as a relatively rare type of complex vocal tic in Tourette syndrome (TS), although it remains the symptom most strongly associated with TS in the general public, contributing to the persistent stereotype of the disorder as the “swearing disease.” Swearing, however, also occurs as a normal expression of negative emotions and exists on a continuum from voluntary to involuntary behavior. In addition to coprolalia and copropraxia, patients with TS may exhibit non-obscene socially inappropriate symptoms (NOSIS), including socially inappropriate comments and actions. More recently, coprolalia has emerged as a core feature of functional tic-like behaviors (FTLB), a functional movement disorder that is distinct from, but frequently comorbid with, TS. This overlap raises an important clinical question: can coprolalia as a complex tic be reliably distinguished from coprolalia-like vocalizations occurring in FTLB? We propose a novel conceptual framework for the classification of coprolalia, copropraxia, and NOSIS. Based on current evidence, we suggest that obscene or socially inappropriate words, gestures, and behaviors should be regarded as more supportive of FTLB or TS with comorbid FTLB than as manifestations of primary complex tics, because true coprophenomena are uncommon in TS. Likewise, the construct of NOSIS may be better understood as representing comorbid FTLB rather than a distinct symptom entity within TS. This reconceptualization may explain inconsistencies in the literature regarding the prevalence and phenomenology of coprophenomena and has important clinical implications. More accurate recognition of FTLB may improve diagnostic accuracy, broaden access to appropriate psychological interventions, and reduce the risk of unnecessary or potentially harmful treatments, including invasive therapies intended for severe treatment-resistant TS.

Keywords

Coprolalia, coprophenomena, differential diagnosis, functional neurologic disorder, functional tic-like behaviors, Non-Obscene Socially Inappropriate Symptoms, Tourette sydrome

Received

25 July 2026

Accepted

04 September 2026

Copyright

© 2026 Müller-Vahl, Nilles, Debes, Szejko and Hedderly. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Natalia Szejko

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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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