DSM-IV religious or spiritual problem approach

Domain VII · Transpersonal, psychedelic & altered states · David Lukoff, Francis Lu, Robert Turner · 1991 · UCSF, San Francisco

What it is

This is not a therapy with its own manual. It is a diagnostic category plus a clinical framework built around it. In December 1991 Lukoff, Lu and Turner (UCSF Department of Psychiatry) formally submitted a proposed category called "Psychoreligious or Psychospiritual Problem"; the initial impetus…

Format

• The sources give no fixed session count or manualised stages. The structure below is the course's own sequence: types, then co-occurrence, then differential diagnosis, then interventions. Lesson 6.2 lays out the three-phase integration model.
• Stage A – Recognition and religious/spiritual history. Goal: notice that religion or spirituality is a focus of clinical attention and identify the problem type. The course divides these into religious problems (loss or questioning of faith; changes in membership, practice or belief, including…

Who practises it, and how they are trained or regulated

• Core idea of change. Distressing religious and spiritual experiences, from loss of faith to mystical, near-death or kundalini-type crises, are often non-pathological problems. Treating them as disorders produces misdiagnosis and iatrogenic harm. Change comes from three things. First, accurate recognition and differential diagnosis. Second, a supportive, normalising container during any acute crisis. Third,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Better sleep and orientation.
• Psychotic features (A3); inflation.
• This is one clue among several, never decisive alone.
• Withdrawal sliding into isolation. Keep supportive contact.
• Psychosis risk in people with a history of schizophrenia (A3, B4).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.