Religious delusions: Definition, diagnosis and clinical implications

Abstract

The prevalence of the biopsychosocial model in psychiatry highlights the importance of investigating the clinical significance of religiosity in patients with psychotic disorders. Due to the spiritual and supernatural nature of religious beliefs, distinguishing them from religious delusions is a challenging endeavour. The self-referential nature of the beliefs, the presence of concomitant psychiatric symptomatology and the effect on functionality seem to play a key role in differential diagnosis. Religious psychotic symptoms are common in clinical practice. The study of these symptoms often becomes difficult due to varying definitions, the fluctuation they present over time and space and the strong influences of the social and cultural environment on them. There seems to be a positive correlation between religiosity and the occurrence of religious delusions in psychotic patients, but it is not clear that this indicates a causal relationship. The content of religious delusions seems to be significantly influenced by the immediate social environment rather than cultural background of the individual, as well as by the beliefs and attitudes of the patient's family environment. Religious delusions are characterized by increased conviction and pervasiveness, permeating to a greater extent the individual's whole experience. Their presence is associated with more severe symptoms, higher medication dosage, and poorer prognosis. The increased severity of psychosis with religious content symptomatology seems to be associated with genetic factors and greater genetic load. In addition, the increased duration of untreated psychosis is a determinant of prognosis. This may reflect a reduced alertness of the immediate environment of patients who develop psychotic symptoms with religious content for the first time. Other important prognostic factors are patients' lack of adherence to treatment, their greater resistance to psychiatric approach of the disorder and their exclusion from religious communities, as well as the special characteristics of religious delusions, which seem more corrosive to the patients' psyche than other delusions. Religion and spirituality are prominent in the lives of the majority of patients with psychosis, but they are often underestimated in clinical practice. Raising the awareness of mental health professionals on issues of a religious and spiritual nature can be beneficial in both preventing and treating psychotic disorders.

Full text

224 https://doi.org/10.22365/jpsych.2021.014 / Psychiatriki 2021, 32:224–231
Religious delusions:
Definition, diagnosis and clinical implications
Natasa Sofou,1 Orestis Giannakopoulos,2 Evangelia Arampatzi,3 George Konstantakopoulos1,4
1First Department of Psychiatry, Athens University Medical School, Eginition Hospital, Athens,
2251 Air Force General Hospital, Department of Psychiatry, Athens,
3414 Military Hospital, Department of Psychiatry, Athens, Greece
4Department of Clinical, Education and Health Psychology, University College London, UK
ARTICLE HISTORY: Received 28 September 2020/Revised 5 December 2020/Published Online 26 March 2021
Introduction
Despite the progressive “disenchantment” of the
world and the secularization of societies, the need for
transcendental and religious experiences still seems
to be a constant feature of the personal and social
lives of the majority of people. The role that religion
and religiosity play, in the development and the prog-
nosis of psychopathological conditions remains un-
clear and should be thoroughly investigated. A major
area of this line of research is psychotic symptoms
with religious content, which are so frequently found
in clinical practice.
Corresponding author: Natasa Sofou, First Department of Psychiatry, Athens University Medical School, Eginition Hospital, 72–74 Vas.
Sofias Ave., GR-115 28 Athens, Greece • e-mail: sofounatasa@gmail.com
Review
ABSTRACT
The prevalence of the biopsychosocial model in psychiatry highlights the importance of investigating the clinical significance of
religiosity in patients with psychotic disorders. Due to the spiritual and supernatural nature of religious beliefs, distinguishing
them from religious delusions is a challenging endeavour. The self-referential nature of the beliefs, the presence of concomitant
psychiatric symptomatology and the effect on functionality seem to play a key role in differential diagnosis. Religious psychotic
symptoms are common in clinical practice. The study of these symptoms often becomes difficult due to varying definitions, the
fluctuation they present over time and space and the strong influences of the social and cultural environment on them. There
seems to be a positive correlation between religiosity and the occurrence of religious delusions in psychotic patients, but it is
not clear that this indicates a causal relationship. The content of religious delusions seems to be significantly influenced by the
immediate social environment rather than cultural background of the individual, as well as by the beliefs and attitudes of the
patient’s family environment. Religious delusions are characterized by increased conviction and pervasiveness, permeating to a
greater extent the individual’s whole experience. Their presence is associated with more severe symptoms, higher medication
dosage, and poorer prognosis. The increased severity of psychosis with religious content symptomatology seems to be associ-
ated with genetic factors and greater genetic load. In addition, the increased duration of untreated psychosis is a determinant
of prognosis. This may reflect a reduced alertness of the immediate environment of patients who develop psychotic symptoms
with religious content for the first time. Other important prognostic factors are patients’ lack of adherence to treatment, their
greater resistance to psychiatric approach of the disorder and their exclusion from religious communities, as well as the special
characteristics of religious delusions, which seem more corrosive to the patients’ psyche than other delusions. Religion and spiri-
tuality are prominent in the lives of the majority of patients with psychosis, but they are often underestimated in clinical practice.
Raising the awareness of mental health professionals on issues of a religious and spiritual nature can be beneficial in both pre-
venting and treating psychotic disorders.
KEYWORDS: Delusions, religious delusions, religiosity, psychotic disorders.

Psychiatriki 225
in 1987 proposed the naming of such practices of
self-castration, in the context of religious delusions, as
Klingsor Syndrome,8 from the homonymous character
of Wagner’s opera “Parsifal”, who castrated himself as
he was unable to control his libido. It is noteworthy that
patients often report that they feel no pain but relief
during the act of castration, and then express little or no
remorse, as they do not recognize their behavior as irra-
tional, but as a means of purification and salvation. Most
of these patients refuse to undergo remedial surgery
and if they reluctantly accept it, they strongly resist the
subsequent treatment and rehabilitation process, while
there are many cases of patients who re-amputated the
rehabilitated body part themselves.9
To distinguish between delusions and non-delusional
religious beliefs, the DSM-5 adopts the criterion of ac-
ceptance of the religious beliefs by other community
members (“members of the person’s culture or subcul-
ture”), instead of a criterion about the control of beliefs’
validity. Consequently, religious beliefs could be consid-
ered non-delusional despite the blatant lack of scien-
tific validation. On the other hand, this DSM-5 criterion
seems to protect the believers of the established reli-
gious doctrines and consequently to easily pathologize
other temperamental and unpopular beliefs.10
This also raises the question: what happens if a de-
lusion is adopted by others. Based on the abovemen-
tioned criterion of “sharing”, it should be considered by
definition a non-delusional belief. Kauffman in 1939
notes that the person who believes he is the Messiah
is considered psychotic until there is a group of people
who will accept him as such and in this group this be-
lief represents a religious system. Beyond the delusional
system of the person claiming to be the Messiah, other
parameters in his delusion enable him to have an impact
on other people and help him cover some of his needs.10
However, delusion can also be shared, which is typ-
ically the case in shared psychotic disorder (follie a
deux). It usually occurs between two individuals, less
often in three and four individuals, but there have
been also cases involving many more people (follie a
famille or follie a douze).11 The question is how many
people have to share an idea in order to consider it
“normal”. Religious doctrines present a special chal-
lenge for answering this question. In the United States
of America, new religious groups with distinctive
and idiosyncratic beliefs, often emerge and they are
called new religious movements (NRMs). On the other
hand, small religious group can become an interna-
tionally accepted religion, as has already happened
with Mormons or even in the case of Christianity.10
Scholars who have studied the dynamics that develop
Differences between religious beliefs
and religious delusions
Distinguishing religious delusions from non-delusion-
al religious beliefs seems to be a difficult and multidi-
mensional task, which has aroused the interest of many
scholars internationally. As the content of religious
beliefs is supernatural and goes beyond the scientific
terms of understanding the world, religious beliefs can
be misinterpreted as delusional. The DSM’s definition
of delusional ideas and, consequently, the definition of
religious delusional ideas seem to be confusing due to
some disadvantages and ambiguities which we will try
to list.
Patients with religious delusions seem to maintain
their beliefs in a qualitatively different way from healthy
religious individuals.1 The religious person may be pos-
sessed by doubts about his/her beliefs or at least recog-
nize that the existence of doubts in others is rational.2 In
addition, he/she may need even a hint of strengthening
his/her faith, while the person with religious delusions
has an unshakable and self-proven “faith”. Geiderman
suggests that religious belief exists only when there is
doubt.3 For the religious individual, faith is ultimately
a matter of choice, while in the person with delusions
“the absolute truth” is revealed to him/her, to which he/
she surrenders completely. Spitzer emphasizes that de-
lusions represent “claims of knowledge” and not “claims
of faith”.4
Delusions are not combined with intuition. Patients
with psychosis are usually unaware of the impossibility
and paradox of their claims and may even “embellish”
them, while the non-psychotic individuals usually ac-
knowledge the peculiar nature of their own claims of
faith.1,5
The way of thinking of the religious people is abstract
and spiritual. On the contrary, delusional thoughts, ex-
periences, actions are specific and literal. Typically, when
patients with delusions say that they feel God inside
them, they say it in a literal way and they can determine
exactly where they feel him (for example in a specific or-
gan or part of their body). That is, they describe it as a
physical and sensory experience.6
In addition, religion (especially the modern “secular-
ized” doctrines) is overwhelmed by symbolic speech,
while the understanding of the world in psychosis is
possessed by extreme literacy. This thought disorder,
the so-called concrete or rigid thinking, characterizes
the delusional structure of psychosis.6 Extreme exam-
ples of this delusional aspect are the cases of patients,
who performed self- or hetero-amputation operations
(castration, amputation of limbs, eye extraction) re-
ceiving with extreme literacy the scriptures.7–9 Ames

226 N. Sofou et al
in such groups, the so-called “charismatic groups” or
heresies, have found a “charismatic” leader, who forms
a belief system, develops a special atmosphere and
applies a control mechanism in order to suppress op-
posing views. In this way, the other members of the
group adopt a structure of beliefs, usually with sec-
ondary benefits and a sense of belonging somewhere
as a mental reward, so they do not meet the criteria
of having delusions. This holds true if we accept as
characteristic of delusions that they form either in
conditions of isolation of an individual, or despite the
opposite view of others.10 However, in the case of a
leader with delusional beliefs, the acceptance of his/
her delusions could fit the model of shared psycho-
sis, in which the other members of the closed and en-
trenched group play the role of the submissive and
dependent party.11
Criteria of functioning are the most practical and ap-
plicable for the evaluation of human behavior. Central
role in attempting to distinguish “normal” religious be-
liefs from religious delusions has the criterion of the ef-
fect of beliefs on the functioning of the person who em-
braces them.5 That is, if the social and professional life of
the person who has the religious beliefs or the religious
experience is not affected, then they are not considered
pathological.
Perhaps the most noticeable difference between a
healthy religious person and a person with religious de-
lusions is that the healthy person may consider that he/
she has a personal relationship with God, but this is in
line with the teachings of his/her religion and in the way
it is accepted to exist. In religiosity there is a religious
connection with the “sacred” element, but it is general-
izable. The believers do not consider that they have any
special relationship with God, but that everyone is con-
nected in some way with the divine. On the other hand,
patients with delusions believe that they have a unique
or privileged relationship with God, or even that they are
the religious entities themselves. The self is the center of
their religious delusions.12
Table 1 summarizes the differences between religious
beliefs and religious delusions.
Religious delusions
Psychotic symptoms with religious content are most
commonly presented as religious delusions and reli-
gious hallucinations. They are often encountered in
clinical practice and their rate has been estimated at
1.1–80% (20–60%).13 This large variation is due to some
methodological difficulties faced in the study of psy-
chotic symptoms with religious content, such as the
difficulty of defining them, i.e. distinction between re-
Table 1. Characteristics of religious delusions versus non-delu-
sional religious beliefs.
Non-delusional religious
beliefs
Religious Delusions
Quality of faith
• Doubts about beliefs • Unshakable faith
• May need a hint of faith • Self-proven faith
• Faith is ultimately a matter
of choice
• Revelation of «the absolute
truth», followed by complete
surrender
• «Claims of faith» • «Claims of knowledge»
• Acknowledgement of the
peculiar nature of the
claims of faith
• Unaware of the impossibility
and paradox of the claims
of faith
Speech – thought
• Abstract and spiritual way
of thinking
• Concrete or rigid thoughts
• Symbolic speech and
scripts
• Specific experiences and lit-
eral actions
Share – acceptance of beliefs
• Religious beliefs accept-
ed by other community
members
• Delusional beliefs are
unpopular and not accepted
by others inside the com-
munity
Functioning
• Social and professional life
not affected
• Impaired social and profes-
sional life
Relationship with God
• No special relationship
with God, religious con-
nection is generalizable
• Unique or privileged rela-
tionship with God
• Everyone is connected in
some way with the divine
• The self is in the center of
the religious delusions
ligious delusions religious beliefs, difference between
religiosity and spirituality. Moreover, the prevalence
of religious delusions varies in different cultures and
different time periods.1,14 In Egypt, for example, fluc-
tuations in the prevalence of religious delusions over
a 20-year period have been linked to shifts in the em-
phasis on religious issues in Egyptian society, in times
of socio-political tension and an escalation of religious-
ly motivated violence.15 In addition, a retrospective
40-year sampling study in patients with schizophrenia
in Poland, found a gradual decrease in the prevalence
of religious delusions. This can be related to a cultur-
al shift from Catholicism to a more secular society. It is
worth noting that religious issues seemed to go hand
in hand with socio-political changes in the country,
such as the rise of the Polish Pope to the papal throne
or the rise of the Communist regime.16

Psychiatriki 227
Finally, social environment seems to play an important
role. In cultural environments that are more tolerant of
diversity religious delusions are underestimated, while
more conservative environments that maximize the pe-
culiarity of minority’s beliefs. Moreover, religious delu-
sions with content compatible with the religious beliefs
of each environment are less frequently identified as
pathological compared to religious delusions with con-
tent different from the dominant religious beliefs.
Etiology
No causal relationship between increased religiosity
and the prevalence of religious delusions in the gener-
al population has been found.17 On the contrary, there
appears to be a positive correlation between religiosity
and religious delusions in those already suffering from
a mental illness.18 This finding may indicate that when a
person develops a mental disorder, his delusions reflect
his own prevailing interests and concerns.6,19 The religi-
osity level seems not directly related to clinical severity,
but it seems to be a better predictor of religious delu-
sions than religious affiliation status.20 Moreover, people
who attribute their symptoms to religious explanations
are more likely to form religious delusions.
Recent studies have linked the increased likelihood
of religious delusions formation to both environmental
and genetic factors. Patients who report high religious
activity are more than three times more likely to experi-
ence religious delusions. Moreover, patients with schizo-
phrenic disorders who exhibit a high genetic predisposi-
tion are more likely to develop psychotic symptoms with
religious content.21
Content
Religious delusions may be presented in various ways
and their contents differ. The following categories can
be distinguished regarding the content of religious de-
lusions:
(1) Delusions of persecution (by the devil, demonic en-
tities etc.)
(2) Grandiose identity delusions (Messiah Syndrome, un-
dertaking special mission)
(3) Delusions of guilt or devaluation (unforgivable sins)
(4) Delusions of control or passivity phenomena
(5) Delusional misidentification syndrome or antichrist
delusion (the delusional misidentification of oneself
or others as the Antichrist, which, although relative-
ly rare, is of particular clinical significance, because it
is often accompanied by violent, mostly hetero-de-
structive, behaviors).22,23
Characteristics
The immediate social living environment has a greater
influence than the cultural background on the content
of delusions and hallucinations. In a study conducted in
UK the content of delusions and hallucinations was com-
pared in 3 groups of patients with schizophrenia, British
White (BW), British Pakistani (BP) and Pakistan Pakistani
(PP). The results showed a greater degree of similarity
of the content between of BW and BP than between BP
and PP.23
In addition, the influence of beliefs and attitudes of
the patients’ family environment play an important role
on the manifestation of religious delusions. In a survey
in Southwestern Greece, the majority of healthy moth-
ers (85%) of patients with delusions with religious or
magical content attributed their children’s mental illness
to demon possession or magical influence. This finding
was found mainly in families with low educational lev-
el, while it was quite common to resort to “therapeutic”
practices, except psychiatric treatment, such as exor-
cism.24,25
According to a study which was conducted in three
cities (Vienna, Tübingen, Tokyo), delusions with reli-
gious content are more common in European patients
(20–21%) than in Japanese patients (6.8%). In fact, while
delusions of grandiosity are common in all three re-
gions, delusions of guilt and sin appear only in 2 out of
22 (9.1%) Japanese but in 12 out of 32 (37.5%) Germans
and in 9 out of 20 (45%) Austrian patients.26
In addition, delusions of guilt and sin seem to be
more prevalent in societies with a Christian Jewish re-
ligious tradition, while they are uncommon in Islamic,
Hindu, and Buddhist societies.26–28 Catholic Christian pa-
tients (15.5%) present more religious delusions of guilt
than Protestant or Muslim patients (3.8%).29 Protestant
patients report religious delusions more often than
Catholic patients or non-Catholic patients or patients
with no religion affiliation.30
Members of the New Religious Movements show
higher scores on the measurement scales of delusional
ideation in relation to members of Christian or no-reli-
gious social groups.31
Delusions of persecution and religious delusions
show the strongest impact on the lives of patients,
while there is over-representation of religious delu-
sions in schizophrenic patients compared to bipolar
or depressed patients. In fact, religious delusions show
higher scores in the dimensions of conviction and per-
vasiveness (pervasiveness reflects the degree to which
delusions permeates the entire experience of the indi-
vidual).32

228 N. Sofou et al
Finally, the delusional characteristics bizarreness, fre-
quency of psychotic symptoms, and degree of distress
were more prevalent for religious delusions than for any
other type of delusion.33
Prognosis
As early as in 1996, Thara & Eaton reported that specif-
ic symptoms at the time of hospital admission, namely
delusions of grandiose or regarding sexuality, bizarre
thoughts and blunted affect, are strongly related to poor
prognosis of patients with psychosis and religious delu-
sions.34
In a study conducted in UK a sample of 193 pa-
tients with religious delusions in Manchester hospitals
where compared to a group of schizophrenia patients
with delusions of different content and found that the
first group had higher scores in Positive and Negative
Syndrome Scale (PANSS), poorer functionality, meas-
ured using the Global Assessment of Functioning (GAF)
and higher doses of medication.18 On the other hand, it
has been proposed that possible biases in psychiatrists,
who are considered to be less religious, belong to a
group with lower rates of religious belief, may result in
more aggressive treatments towards patients with reli-
gious delusions.10 In the aforementioned UK study, the
response of the above patients to the treatment was
re-evaluated two years later. It was found that the symp-
toms of patients with religious delusions were more se-
vere both before and after treatment, but the response
to treatment was similar in both groups.34
The increased severity of psychosis with religious con-
tent symptomatology seems to be related to genetic
factors. Individuals with a higher genetic burden are
more likely to experience religious delusions.21
The duration of untreated psychosis (DUP) is a par-
ticularly crucial factor. It is reported that upon admission
patients with religious delusions show a more extensive
course of disease, i.e. they have been exposed for a longer
period of time to psychotic symptoms.35 Patients with re-
ligious delusions cause less anxiety in their family than
patients with delusions of other content. This is a possible
explanation for the fact that patients with religious delu-
sions present with a more severe symptoms at the time of
admission than other patients with delusions.18,35
Another dimension of great prognostic value is pa-
tient’s compliance with treatment. Religious delusions
can have a negative effect on a patient’s consistency in
treatment when he attributes his psychotic symptoms to
supernatural entities.36 Moreover, cases are often report-
ed of patients refusing to continue medication because
it prevents them from praying or because they prefer to
hear the voice of God or find answers in the Bible.36–38
Previous studies found that patients with religious de-
lusions did not have a worse clinical status than patients
with other delusions and concluded that the worst
prognosis of the former is due to the greater resistance
they show to psychiatric treatment and the less support
they receive from religious communities.20,36 These pa-
tients seem to be at a disadvantage as they are far from
both science (poorer therapeutic alliance-”competition”
between religion and psychiatry) and the religious com-
munity (rejection due to dysfunctional behaviors in-
duced by their delusions).36
Other studies in schizophrenia patients with religious
delusions have shown increased disease severity and
the poorer effects of treatment in these patients, which
were mainly attributed to: (a) delayed access to mental
health services (in religious settings religious delusions
skip the attention of their relatives or initially, religious
rituals are preferred as “therapy”), (b) to the reduced co-
operation in psychiatric treatment (due, for example, to
the patients’ preference to hear the voice of God), and (c)
to the special characteristics of the religious delusional
ideas, which seemed more corrosive to the patients’ psy-
che and were maintained with greater vigor.30,39–43
Discussion
We can think of religious beliefs as a continuum rang-
ing from normal religious beliefs to religious delusions.
Where a belief lies in this continuous depends on the
intensity of the various dimensions of delusionality.
Among them, the self-referential nature of the belief, the
presence of other psychiatric symptoms and the effect
on functionality seem to play a key role in differential di-
agnosis.
The difficulty of distinguishing religious delusions
from religious beliefs is more prominent in multicultural
societies (where a person’s peculiar beliefs, which seem
strange and can be misinterpreted as delusional, may
correspond to a peculiar cult). In societies with a domi-
nant religion, like Greece, the problem is not so obvious,
but taking into account the constant movement of pop-
ulations and the increase of the immigrant and refugee
communities, it is something that can be a particular
challenge in the future.
While religion and religiosity are prominent in the
lives of many psychotic patients, in clinical prac-
tice issues of a religious and spiritual nature may be
overlooked and sometimes devalued by clinicians.
Indicatively, it is reported that while 90% of Americans
say they believe in the existence of God, only 40–70%
of psychiatrists and 43% of psychologists share this
belief, and this may be reflected in a bias towards
identifying pathological aspects of religiosity.10 This

Psychiatriki 229
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divergence is certainly not just a phenomenon of the
modern age. As early as the turn of the last century, the
founder of psychoanalysis, Sigmund Freud, adopted a
strong anti-religious stance that had a great influence
on the scientific community.44 Although there has been
a historical rivalry between the fields of psychiatry and
religion and prejudices and dogmas have prevailed on
both sides, due to their different and largely opposite
ontological approach and interpretation of the world,
we must not forget that the common denominator is
human mental pain and its relief.
It could therefore be considered more than reason-
able, if not necessary, for mental health professionals
to be aware of issues of a religious nature because of
the importance that patients attach to them. Several
authors, moreover, suggest the establishment of an al-
liance between mental health clinicians and religious
ministers.20 Psychiatrists could be more sensitive to re-
ligious and spiritual aspects of patients’ personalities
and their potential positive effects on mental health,
while religious practitioners could better identify the
boundaries between healthy religiosity and the patho-
logical experiences or denial of mental illness and
treatment due to religious beliefs. The benefits of such
a therapeutic partnership can be of great importance
both for the prevention and for the more effective
treatment of mental disorders.
Acknowledgemens
To the loving memory of Dr. Panagiotis Oulis,
Associate Professor of Psychiatry at University of Athens,
in Eginition Hospital, whose contribution to the original
idea of this article was invaluable. He was a brilliant and
dedicated clinical psychiatrist, an exceptional psycho-
pathologist and researcher and an inspiring mentor. We
will always remember him.

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Psychiatriki 231
Θρησκευτικές παραληρητικές ιδέες:
Ορισμός, διάγνωση και κλινική σημασία
Νατάσα Σοφού,1 Ορέστης Γιαννακόπουλος,2 Ευαγγελία Αραμπατζή,3
Γιώργος Κωνσταντακόπουλος1,4
1Α΄ Ψυχιατρική Κλινική, Ιατρική Σχολή Πανεπιστημίου Αθηνών, Αιγινήτειο Νοσοκομείο, Αθήνα,
2251 Γενικό Νοσοκομείο Αεροπορίας, Ψυχιατρική Κλινική, Αθήνα,
3414 ΣΝΕΝ, Ψυχιατρική Κλινική, Παλαιά Πεντέλη,
4Department of Clinical, Education and Health Psychology, University College London, UK
ΙΣΤΟΡΙΚΟ ΑΡΘΡΟΥ: Παραλήφθηκε 28 Σεπ τεμβρίου 2020/Ανα θεωρήθηκε 5 Δεκεμβρίου 2020/Δημοσι εύθηκε Διαδικτυακά 26 Μαρτίου 2021
Ανασκόπηση
Συγγραφέας επικοινωνίας: Νατάσα Σοφού, Α΄ Ψυχιατρική Κλινική, Ιατρική Σχολή Πανεπιστημίου Αθηνών, Αιγινήτειο Νοσοκομείο, Λεωφ.
Βασιλίσσης Σοφίας 72–74, 115 28 Αθήνα, Διεύθυνση e-mail: sofounatasa@gmail.com
ΠΕΡΙΛΗΨΗ
Η επικράτηση του βιοψυχοκοινωνικού μοντέλου στην επιστήμη της ψυχιατρικής αναδεικνύει την σπουδαιότητα της διερεύ-
νησης της κλινικής σημασίας της θρησκευτικότητας σε ασθενείς με ψυχωτικές διαταραχές. Λόγω του πνευματικού και υπερ-
φυσικού χαρακτήρα των θρησκευτικών πεποιθήσεων, η διάκριση αυτών από τις θρησκευτικές παραληρητικές ιδέες αποτελεί
απαιτητικό εγχείρημα. Καίριο διαφοροδιαγνωστικό ρόλο φαίνεται να διαδραματίζουν η αυτοαναφορική φύση της δοξασίας, η
παρουσία συνοδού ψυχιατρικής συμπτωματολογίας και η επίδραση στη λειτουργικότητα. Τα ψυχωτικά συμπτώματα με θρη-
σκευτικό περιεχόμενο απαντώνται συχνά στην ψυχιατρική κλινική πράξη. Η μελέτη των ανωτέρω συμπτωμάτων καθίσταται
δυσχερής, λόγω αντικειμενικών δυσκολιών που αφορούν τις διαφοροποιήσεις στον ορισμό αυτών, την διακύμανση που πα-
ρουσιάζουν στην πορεία του χρόνου και την ισχυρή επιρροή που ασκείται από το εκάστοτε κοινωνικό και πολιτισμικό περι-
βάλλον σε αυτά. Φαίνεται να υπάρχει θετική συσχέτιση μεταξύ θρησκευτικότητας και εμφάνισης θρησκευτικών παραληρητι-
κών ιδεών στους πάσχοντες ψυχωτικούς, χωρίς όμως να είναι ξεκάθαρο αν η σχέση είναι αιτιοπαθογενετική. Το περιεχόμενο
των θρησκευτικών παραληρητικών ιδεών φαίνεται να επηρεάζεται σημαντικά από το άμεσο κοινωνικό περιβάλλον διαβίωσης
του ατόμου καθώς και από τις πεποιθήσεις και στάσεις του οικογενειακού περιβάλλοντος του ασθενούς. Οι θρησκευτικές
παραληρητικές πεποιθήσεις χαρακτηρίζονται από αυξημένες τιμές βεβαιότητας διαποτίζοντας σε μεγαλύτερο βαθμό το σύ-
νολο των εμπειριών του ατόμου. H παρουσία τους σε ασθενείς με ψύχωση συνδέεται με βαρύτερη συμπτωματολογία, υψη-
λότερη δοσολογία φαρμακευτικής αγωγής και πτωχότερη πρόγνωση. Η αυξημένη βαρύτητα της ψύχωσης με θρησκευτικού
περιεχομένου συμπτωματολογία φαίνεται να συνδέεται με γενετικούς παράγοντες και μεγαλύτερο γενετικό φορτίο. Επιπλέον,
καθοριστικό προγνωστικό παράγοντα αποτελεί και η αυξημένη διάρκεια της μη θεραπευμένης ψύχωσης (DUP). Αυτό μπορεί
να αντανακλά μειωμένη εγρήγορση του εγγύτερου περιβάλλοντος των ασθενών που πρωτοεμφανίζουν ψυχωτική συμπτω-
ματολογία με θρησκευτικό περιεχόμενο. Άλλες σημαντικές διαστάσεις προγνωστικού χαρακτήρα αποτελούν η ελλιπής συμ-
μόρφωση των ασθενών στη θεραπεία, η μεγαλύτερη αντίσταση που προβάλλουν απέναντι στην ψυχιατρική αντιμετώπιση
της διαταραχής και τον αποκλεισμό τους από τις θρησκευτικές κοινότητες, καθώς και τα ιδιαίτερα χαρακτηριστικά των θρη-
σκευτικών παραληρητικών ιδεών, οι οποίες φαίνονται περισσότερο διαβρωτικές για τον ψυχισμό σε σύγκριση με άλλες παρα-
ληρητικές ιδέες. Η θρησκεία και η πνευματικότητα κατέχουν προεξαρχουσα θέση στη ζωή της πλειονότητας των ασθενών με
ψύχωση, ωστόσο στην κλινική πράξη συχνά υποτιμώνται. Η ευαισθητοποίηση των επαγγελματιών ψυχικής υγείας πάνω σε
ζητήματα θρησκευτικής και πνευματικής φύσεως μπορεί να αποδειχθεί ωφέλιμη τόσο για την πρόληψη όσο και για τη βέλτι-
στη αντιμετώπιση των ψυχωτικών διαταραχών.
ΛΕΞΕΙΣ ΕΥΡΕ ΤΗΡΙΟΥ: Παραληρητικές ιδέες, παραληρητικές ιδέες θρησκευτικού περιεχομένου, θρησκευτικότητα, ψυχωτικές
διαταραχές.