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Psychiatrists in US put religion in diagnostic manual

BMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6931.740 (Published 19 March 1994) Cite this as: BMJ 1994;308:740
  1. F B Charatan

    American psychiatrists will for the first time include religious and spiritual problems in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The manual will include these problems under a broad section called “other conditions that may be a focus of clinical attention.”

    Under the category of a religious or spiritual problem the manual states: “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 organised church or religious institution.” The category will also include “near death” and “after death” experiences.

    The proposal to include religious problems was made by Dr Francis Lu, associate clinical professor of psychiatry at the University of California Medical School, San Francisco, who approached the manual's task force in December 1991. He believed that people with religious or spiritual conflicts were being misdiagnosed as suffering from psychoses with religious content. The task force approved the proposal in January last year. Last May the board of trustees and the assembly of the American Psychiatric Association gave their approval to the new section.

    A patient could be classified as having an isolated religious or spiritual problem; a religious problem with an unrelated mental disorder; or a religious problem with a related mental disorder. These categories fit in with others such as marital problems and educational problems, which are seen as problems of living as opposed to mental disorder.

    Dr Harold A Pincus, deputy medical director of the American Psychiatric Association's office of research, said, “The addition of the new section has little to do with psychiatry's perspective on religion, as some media articles have implied. Rather, there is a need to be more systematic and inclusive within the category of conditions not considered mental disorders but which might yet be a reason for the person to consult with a mental health professional.” A five volume compendium, the DSM-IV Source Book, will be published this year to document the entire process of revising the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised.

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