“A.B.” is a Caucasian man who was referred to our specialty clinic for tic disorder at the age of 18 because of a 7-year history of multiple motor tics. These included frowning, raising his eyebrows, nasal twitching, grimacing, jaw protrusion, head-nodding, and neck-stretching. By the age of 15, he had also developed phonic tics, namely throat-clearing, gulping, sniffing, and coughing. On neuropsychiatric assessment, the longest tic-free period was approximately 20 minutes, with anxiety, excitement, and tiredness as exacerbating factors. All tics characteristically exhibited a waxing and waning course and were partially suppressible with voluntary effort, at the expense of increasing inner tension and subsequent rebound effect. The patient scored 64% on the Diagnostic Confidence Index, which is in line with scores from specialist TS clinics, and 42% at the Yale Global Tic Severity Scale, indicating moderate severity. He also reported a reduction in health-related quality of life as assessed by a disease-specific instrument.4 With regard to behavioral problems, there was evidence of obsessive-compulsive symptoms (excessive orderliness, rigid routines). There was no family history of tics, but obsessive-compulsive disorder, alcoholism, Down's syndrome, autism, bipolar disorder, and agoraphobia were all present across family members.