Diagnostic Criteria
Arguments for Making A Diagnosis (Separate page)
Diagnosistic Criteria for Spiritual Emergency
Normative Religious Beliefs and Experiences vs. Psychotic Symptoms
DSM-IV on Cultural Differences
Diagnostic criteria for Spiritual Emergency
The proposed operational criteria are intended to allow cases of positively-transformative psychotic episodes to be recognized with a high degree of accuracy (referred to as validity) and consistency across different diagnosticians (referred to as "reliability").
The specific criteria proposed below represent hypotheses that must be subjected to reliability studies to determine whether they achieve acceptable levels of interrater agreement. Validation studies also need to be conducted to determine whether they accomplish the objective of accurately identifying positively transforming experiences. Ideally a trial of this operational definition would use the criteria as a screening instrument to make diagnostic decisions in situations where discriminating spiritual emergencies from psychotic disorders is the issue. Follow-up evaluations over several years might be required to understand the outcomes of cases handled in this manner. This type of prospective study is the most valuable for yielding information which could lead to refinements of the criteria. In addition, studies of samples of individuals who retrospectively report spiritual emergencies could also yield information useful for honing the selection criteria
Criterion I: There is phenomenological overlap with a type of intense spiritual experience that has been identified, including:
Loss, questioning or change of spiritual values
Mystical or unitive experience
Psychic opening
Kundalini
Possession States
Shamanistic crisis
UFO abduction
Near-death experience
Dying, grief, and life-threatening illness
As one example, for Mystical or unitive experience
A. Ecstatic mood
B. Sense of newly-gained knowledge
C. Perceptual alterations
D. Delusions with themes related to mythology
E. No conceptual disorganization
Criterion II: Positive outcome likely
A. Good pre-episode functioning
B. Acute onset (3 months or less)
C. Stressful precipitant
D. Positive exploratory attitude
Criterion IV: Low risk of suicide or homicide
These criteria are described in Diagnosis of Mystical Experience with Psychotic Features, originally published in the Journal of Transpersonal Psychology, in 1985.
Normative Religious Beliefs and Experiences vs. Psychotic Symptoms
Below are diagnostic criteria proposed by two Israeli psychiatrists working with orthodox Jewish patients:
Psychotic episodes:
1) are more intense than normative religious experiences in their religious community;
2) are often terrifying;
3) are often preoccupying;
4) are associated with deterioration of social skills and personal hygiene;
5) often involve special messages from religious figures.
Greenberg, D., & Witztum, E. (1991). Problems in the treatment of religious patients. American Journal of Psychotherapy, 45(4), 554-565.
DSM-IV on Cultural Differences
The DSM-IV specifically no tes that clinicians assessing for schizophrenia in socioeconomic or cultural situations different from their own must take cultural differences into account:
Ideas that may appear to be delusional in one culture (e.g., sorcery and witchcraft) may be commonly held in another. In some cultures, visual or auditory hallucinations with a religious content may be a normal part of religious experience (e.g., seeing the Virgin Mary or hearing God's voice). |
