DSM-IV Category: "Religious and Spiritual Problems"

In 1994, DSM-IV included a new V code entitled "Religious or Spiritual Problem": V62.89: This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of other spiritual values which may not necessarily be related to an organized church or religious institution.

Religious and spiritual problems is a new focus of clinical attention, creating the possibility of assessing religious and spiritual experiences as part of a psychiatric investigation without prejudging them necessarily as psychopathological experiences. Lukoff et al. [5], the first proponents of these concepts, defined religious problems as conflicts regarding faith and doctrine (such as loss or questioning of faith, conversions), and spiritual problems as conflicts involving the relationship with transcendental matters or deriving from spiritual practices. As far as examples of spiritual problems, the authors mention the mystical experiences triggered by meditative practices, near-death experiences, and spiritual emergence/emergency.

According to these authors [6], mystical experiences bring out feelings of unity and harmonious relationship with the divine but can also involve a loss of the functioning of the ego, alterations in the perception of time and space, and the sense of lack of control over the event, which could be seen as psychotic symptoms. American clinical psychologists report that 4.5% of their patients describe these experiences in their therapeutic sessions. The near-death experiences happen to some people who were very close to death, had a feeling of being out of their bodies, felt transported to another part of space, and came back from it with their lives transformed. Studies show that up to one third of people who were close to death had that experience.

Those religious/spiritual experiences usually do not present major psychological difficulties for those who experience them, but they may in certain situations be distressing and lead to the search for assessment and medical or psychological treatment. In this case, they would be called spiritual or religious problems that are not necessarily mental disorders and instead may be just an adaptation of the patients to a new phase or life experience with potentially positive future effects. 

Citations

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Religious and Spiritual Problems.

In J. R. Peteet, F. G. Lu, & W. E Narrow (Eds.), Religious and spiritual issues in psychiatric diagnosis: A research agenda for DSM-V (pp. 171–198). American Psychiatric Association. 2011

https://psycnet.apa.org/record/2010-18800-022

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Religious or spiritual problem. A culturally sensitive diagnostic category in the DSM-IV 

Journal of Nervous and Mental Disease, 1995

https://pubmed.ncbi.nlm.nih.gov/7623015/

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Religion and Spirituality in the DSM and ICD

Chapter 12 of the book "Spirituality and Psychiatry, Second Edition, Peteet and Lu, 2022 

Concerns that American psychiatry was neglecting an important dimension of human experience led to the introduction into DSM-IV of a V Code for a Religious or Spiritual Problem. Revisions in DSM-5 outlined several areas for future research into the implications of spirituality, religion and culture for diagnosis and treatment. 

https://www.cambridge.org/core/books/abs/spirituality-and-psychiatry/religion-and-spirituality-in-the-dsm-and-icd/D653E784AB0888F0EFD8F11C6D6D761D

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