Compulsive behaviors rarely lead to significant physical injury, but when they do, they can introduce challenges in treatment secondary to diagnostic uncertainty and introduce ethical and legal dilemmas when trying to optimize patient care. We discuss the clinical complexities in treating a patient with compulsive neck cracking as she navigates various clinical settings in hopes of alleviating the anxiety and pain that lead to her behaviors. Ultimately, the principles of beneficence and autonomy must be weighed when determining whether someone with a chronic risk of serious physical harm from compulsive behaviors requires involuntary psychiatric treatment.