Scrupulosity is a psychological disorder primarily characterized by pathological guilt or obsession associated with moral or religious issues that is often accompanied by compulsive moral or religious observance and is highly distressing and maladaptive. This paper provides a comprehensive overview of scrupulosity and an original conceptualization of the disorder based on an exhaustive literature review to increase awareness of the disorder among practicing clinicians and stimulate further research. It explores the clinical features of scrupulosity, classified as cognitive, behavioral, affective, and social features, as well as the epidemiology, etiology, and treatment of the disorder. Additionally, it is suggested that scrupulosity, despite its similarity to OCD, may merit a distinctive diagnosis, particularly considering its unique constellation and severity of symptoms and its treatment refractoriness, as supported by statistical analysis.