A patient mentions performing a repetitive action many times a day. Before revealing the answer, decide how you would explore whether this is a compulsion.

Ask whether the action is linked to an identifiable obsessional thought, image, fear, or impulse that precedes or accompanies it, since this connection is central to the concept. Ask directly whether the patient recognises the behaviour as excessive or unreasonable, even while feeling compelled to perform it, since this preserved insight is a key feature. Explore what happens when the patient tries to resist the urge, since resisting typically produces significant anxiety, which the action itself temporarily relieves, and this anxiety-relief pattern is an important part of establishing the diagnosis. Distinguish this pattern from a habitual or culturally sanctioned ritual, which would lack the anxiety-driven, excessive quality described here.