Moral, Religious, or Spiritual Problem: An Expanded Z Code Diagnostic Category in the DSM-5-TR.

INTRODUCTION: The DSM has made advances in helping clinicians address cultural factors important in psychiatric care, including the acknowledgement of religious and spiritual problems that impact a patient's mental health. However, moral problems have been under-recognized as a culturally contextualized source of negative consequences for occupational, social, and other areas of functioning. METHODS: To recognize the clinical significance of moral problems, an expanded DSM Z-code diagnostic category entitled "Moral, Religious, or Spiritual Problem" was recently approved. RESULTS: In light of this development, this paper reviews the conceptual and empirical connections with regard to moral, religious, and spiritual problems. A definition of moral problems is presented in relationship to transgressions of an individual's moral identity, which may include moral dilemmas, moral distress, and moral injury. CONCLUSIONS: Various differential diagnostic issues are raised related to this expanded Z-code, as well as potential implications for clinical practice, public health, and future research.

Duke Scholars

Author Harold G. Koenig Psychiatry & Behavioral Sciences, Adult Psychiatry & Psychol ...