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Religious and Spiritual Struggles

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (1994) added a code for “religious and spiritual problem” as an official clinical designation.  The new categorization was included in response to the prevalence of religious and spiritual issues among clients in clinical settings coupled with clinicians’ lack of training on how to address such issues (Lukoff, Lu, and Turner 1992).  Such issues can be “religious” in the sense of problems and conflicts with religious institutions, or “spiritual” in the sense of individualized problems with religious belief, practice, or affect (Lukoff, Lu, and Turner 1998). Mystical experiences are also often a component of religious and spiritual problems (Lukoff 1985), emphasizing the need to more thoroughly integrate demonic aspects of religious experiences (see Stark 1965) and images of God into the broader understanding of mysticism.

More recently, conceptualization of religious and spiritual struggles has grown out of an elaboration and extension of religious coping theories (Pargament et al. 2005).  Further refining the idea of negative religious coping, religious and spiritual struggles classify and measure whether “something in a person’s current belief, practice, or experience is causing or perpetuating stress” (Exline 2013: 459).  In essence it is an attempt to more thoroughly define and distinguish the “dark sides” of religion, which may cause or exacerbate negative affect.  Conceptualized broadly, religious and spiritual struggles have been posited as occurring along three dimensions: divine, intrapersonal, and interpersonal (Pargament 2007).  These domains have been further subdivided, operationalized, and empirically validated into six types of struggles: struggles with the divine, demonic struggles, interpersonal issues with religious institutions and people, struggles with moral imperfections, problems with ultimate meaning, and religious doubts (Exline et al. 2014).  Further analyses with other common indices of religiosity and personality suggest that religious and spiritual struggles are best understood as an independent but related aspect of religiosity with unique associations to personality traits and symptoms of psychological distress (Stauner et al. 2016).

Empirical studies have found that religious and spiritual struggles are relatively common, particularly among younger populations such as college students (Bryant and Astin 2008), as well as being more common among women, the unmarried, those with insecure or anxious attachment styles, and those with higher levels of negative affect, neuroticism, and sense of entitlement (see Exline 2013). Among clinical populations, patients were more likely to report religious and spiritual struggles if they had experienced lost relationships, were victims of sexual assault, and had problematic relations with peers (Johnson and Hayes 2003).  In parametric population samples, religious and spiritual struggles are associated with symptoms of psychopathology and lower levels of social support (McConnell et al. 2006).  Such struggles are also significantly associated with depression and suicidal ideation, particularly for those experiencing religious guilt and fear (Exline, Yali, and Sanderson 2000).

Images of God and beliefs about theodicy play an important role in the negative outcomes linked with religious struggles, particularly anger toward God and theodicies used for framing suffering experiences.  Those who frame suffering as part of God’s benevolent planning experience greater religious struggles, but also experience some positive well-being outcomes by virtue of a benevolent image of God, effectively resulting in neutralizing effects; however, those who perceive suffering experiences as divine punishment may experience both negative direct and indirect effects through a punitive God image and increased levels of spiritual struggle (Wilt, Exline, et al. 2016).  It deserves note that there are also positive potentials for well-being as a result of religious struggle for those who are able to positively frame their experiences as sources of growth, a process influenced by individual levels of religiosity and neuroticism, which in turn influence perceptions of the divine (Wilt, Grubbs, et al. 2016).

Overall, the understanding and study of religious and spiritual struggles has expanded rapidly in the recent decades following its recognition as a psychological issue, with studies documenting the applicability of the concept across religious traditions (Raiya et al. 2008), as well as outlining robust links to stressors, coping styles, and physical and mental well-being (see Exline 2013 for a thorough review).


American Psychiatric Association. 1994.  Diagnostic and Statistical Manual of Mental Disorders (4th edition). Washington, DC: American Psychiatric Publishing.

Bryant, Alyssa N. and Helen S. Astin.  2008.  “The Correlates of Spiritual Struggle During the College Years.”  The Journal of Higher Education 79(1): 1–27.

Exline, Julie J.  2013.  “Religious and Spiritual Struggles.”  Pp. 459–75 in APA Handbook of Psychology, Religion, and Spirituality: Vol. 1 Context, Theory, and Research, edited by Kenneth I. Pargament, Julie J. Exline, and James W. Jones.   Washington, D.C.: American Psychological Association.

Exline, Julie J. Kenneth I. Pargament, Joshua B. Grubbs, and Ann M. Yali.  2014.  “The Religious and Spiritual Struggles Scale: Development and Initial Validation.”  Psychology of Religion and Spirituality 6(3): 208–22.

Exline, Julie J., Ann M. Yali, and William C. Sanderson.  2000. “Guilt, Discord, and Alienation: The Role of Religious Strain in Depression and Suicidality.”  Journal of Clinical Psychology 56(12): 1481–96.

Johnson, Chad V. and Jeffrey A. Hayes.  2003.  “Troubled Spirits: Prevalence and Predictors of Religious and Spiritual Concerns Among University Students and Counseling Center Clients.”  Journal of Counseling Psychology 50(4): 409–19.

Lukoff, David.  1985.  “The Diagnosis of Mystical Experiences with Psychotic Features.”  The Journal of Transpersonal Psychology 17(2); 155–81.

Lukoff, David, Francis Lu, and Robert Turner.  1992.  “Toward a More Culturally Sensitive DSM-IV. Psychoreligious and Psychospiritual Problems.”  The Journal of Mental and Nervous Disease 205(1): 180(11): 673–82.

Lukoff, David, Francis Lu, and Robert Turner.  1998.  “From Spiritual Emergency to Spiritual Problem: the Transpersonal Roots of the New DSM-IV Category.”  Journal of Humanistic Psychology 38(2): 21–50.

McConnell, Kelly M., Kenneth I. Pargament, Christopher G. Ellison, and Kevin J. Flannelly.  “Examining the Links Between Spiritual Struggles and Symptoms of Psychopathology in a National Sample.”  Journal of Clinical Psychology 62(12): 1469–84.

Pargament, Kenneth I.  2007.  Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred.  New York: Guilford Press.

Pargament, Kenneth I., Nichole Murray-Swank, Gina N. Magyar, and Gene G. Ano.  2005.  “Spiritual Struggle: A Phenomenon of Interest to Psychology and Religion.”  Pp. 245–68 in Judeo-Christian Persepctives on Psychology: Human Nature, Motivation, and Change, edited by William R. Miller and Harold D. Delaney.  Washington, D. C.: American Psychological Association.

Raiya, Hisham A., Kenneth I. Pargament, Annette Mahoney, and Catherine Stein.  2008.  “A Psychological Measure of Islamic Religiousness: Development and Evidence for Reliability and Validity.”  International Journal for the Psychology of Religion 18(4): 291–315.

Stark, Rodney.  1965.  “A Taxonomy of Religious Experience.”  Journal for the Scientific Study of Religion 5(1): 97–116.

Stauner, Nick, Julie J. Exline, Joshua B. Grubbs, Kenneth I. Pargament, David F. Bradley, and Alex Uzdavines.  2016.  “Bifactor Models of Religious and Spiritual Struggles: Distinct from Religiousness and Distress.”  Religions 7(6), 68: 1–30.

Wilt, Joshua A., Joshua B. Grubbs, Julie J. Exline, and Kenneth I. Pargament.  2016.  “Personality, Religious and Spiritual Struggles, and Well-Being.”  Psychology of Religion and Spirituality 8(4): 341–51.

Wilt, Joshua A., Julie J. Exline, Joshua B. Grubbs, Crystal L. Park, and Kenneth I. Pargament.  “God’s Role in Suffering: Theodicies, Divine Struggle, and Mental Health.”  Psychology of Religion and Spirituality 8(4): 352–62.

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