“Copromessaging”: a new feature of Tourette’s syndrome?

Tourette syndrome (TS) is a neuropsychiatric disorder characterized by the presence of movement disorders, complex motor and vocal tics, psychiatric changes (such as obsessive-compulsive disorder, anxiety disorder, attention deficit/hyperactivity), and coprophenomena.¹ Here, we described a phenomenon observed in two patients, but which is likely much more frequent in clinical practice.

Patient one was a 13-year-old boy who presented for his first consultation with complaints of vocal and motor tics, coprolalia, coprophagia, anxiety disorder, and signs of obsessive-compulsive disorder. His mother noted that the patient had been called to the office at school for having sent explicit sex videos to a teacher via a mobile messaging app. Interestingly, this behavior reoccurred from time to time, when he would also send similar content to family members.

Patient two was a 16-year-old male who already had a diagnosis of TS and was being followed as an outpatient. When inquired as to the patient’s phone usage habits, his parents reported that, in times of stress, the patient would send pornography, pictures of bizarre deaths, or grotesque scenes to family groups on a popular messaging app. Initially, they believed it was the patient’s way of lashing out when he was angry at his parents, but soon realized he exhibited this behavior during periods of emotional stress in general.

Both patients reported regretting their behavior, but claimed to have no knowledge of the number of people who had received the messages nor any recollection of the content itself. They both stated that the symptoms are usually preceded by an urge, and that they do not understand the reason for their actions. Curiously, this urge or feeling of “need” to perform the act occurred precisely when they were already using their phones or the messaging app for another purpose, and after each act, both patients usually put their phones aside and moved on to another task - which suggests a temporary feeling of relief. Both patients repeated these actions occasionally, even though neither showed any sign of hypersexuality in other aspects of life. The phenomenon was closely related with emotional stress or anxiety episodes, and improved with treatment optimization.

Other coprophenomena common in TS include coprolalia (involuntary swearing or utterance of obscene or socially inappropriate words); copropraxia, defined as involuntary actions such as performing obscene or forbidden gestures; and coprographia, characterized by obscene writings or drawings.²,³

In recent years, with the advent of new technologies, these acts surely must have become more frequent, especially among younger people with a diagnosis of TS. The term “copromessaging” might be applicable to this novel coprophenomenon of involuntarily sending obscenities or inappropriate images to another person by phone or video message. Future studies are needed to confirm whether this phenomenon is part of the spectrum of TS manifestations.

References

• ¹
  Robertson MM, Eapen V, Singer HS, Martino D, Scharf JM, Paschou P, et al. Gilles de la Tourette syndrome. Nat Rev Dis Primers. 2017;3:16097.
• ²
  Singer C. Tourette syndrome. Coprolalia and other coprophenomena. Neurol Clin. 1997;15:299-308.
• ³
  Freeman RD, Zinner SH, Müller-Vahl KR, Fast DK, Burd LJ, Kano Y, et al. Coprophenomena in Tourette syndrome. Dev Med Child Neurol. 2009;51:218-27.

Publication Dates

• Publication in this collection
  31 Aug 2020
• Date of issue
  Mar-Apr 2021

History

• Received
  13 June 2020
• Accepted
  22 July 2020