Between faith and delusion: an update on the clinical boundaries of religious experience in psychiatry

Abstract

Introduction: Differentiating healthy religious experience from psychopathological symptoms with religious content is a recurring clinical challenge in psychiatric practice, particularly in religiously plural settings such as Brazil. Objective: To narratively review classic and contemporary literature on criteria for differentiating faith from delusion, emphasizing clinical applicability. Method: Non-systematic narrative review based on reference works in Brazilian and international psychopathology, complemented by indexed articles on the topic. Results: Historical literature describes religious delusion since 19th-century alienists, with classic cases such as Janet’s Madeleine and Freud’s Schreber. Criteria proposed by Sims and the critique by Jackson and Fulford reveal the fragility of purely phenomenological distinctions. World Health Organization epidemiological studies show that psychotic symptoms are common in the general population and rarely indicate mental disorder. The DSM-5 recognizes the category “Religious or Spiritual Problem,” and criteria proposed by Moreira-Almeida and Cardeña offer practical parameters for clinical evaluation, including absence of distress, absence of functional impairment, cultural compatibility, and potential for personal growth. Conclusion: Differentiating spiritual experience from psychopathological symptoms requires careful investigation of the patient’s religious and cultural context, avoiding both the pathologization of healthy experiences and the normalization of conditions that require treatment.