Ms. A, a 19-year-old patient, had suffered from motor and vocal tics since the age of 6. Her vocal tics included grunting, snorting, neighing, palilalia, and motor tics, such as beating and strangling herself. Additionally, she developed compulsions of washing and controlling. The course of her illness was chronic, not waxing and waning. She had experienced no tic-free interval during the last 13 years.