Doubt: A Diagnosis

Diagnostic Criteria:
Doubt is diagnosed when one or more of the following symptoms have been present during the same 2-week period and represent a change from previous religious experience; at least one of the symptoms is either (1) skepticism about the existence of God or (2) emotional distress associated with the "loss of God."

(1) Skepticism about the existence of God. The doubt is expressed intellectually as an ontological concern.

(2) Emotional distress associated with the "loss of God." The doubt experience is predominately emotional, a distress associated with the experience of Divine "absence."

(3) Apathy toward the faith (its beliefs and practices) often characterized by an experience of indifference or "deadness."

(4) A skeptical stance regarding the central claims of the faith. Doubts about the truthfulness of Scripture, founding events (generally those associated with the "miraculous" ), or metaphysical claims.

(5) Loss of an evangelistic zeal often replaced by a curiosity or acceptance of outgroup members.

(6) Feelings of distance and separateness during worship or rituals, a sense of "observing" the proceedings.

(7) Expressions of lament, frequently similar to grief or bereavement responses.

(8) A reappraisal of God's defining characteristics (e.g., benevolence, omnipotence). For example, God's benevolence might be replaced by judgments that God is indifferent or malevolent.

Given the diversity of clinical presentations, a diagnosis of Doubt is given one of the following Type specifiers:

Type Specifiers:

• Intellectual Type: Cognitive and intellectual features are predominant, often in the form of intellectual objections or skepticism
• Emotional Type: Emotional distress is predominant, similar to a grief response
• Apathetic Type: Features of indifference are predominant, a loss of zeal or interest in religious belief and/or practice
• Undifferentiated Type: A mixed presentation, where no one feature is predominant

A diagnosis of Doubt is also given an Onset/Course specifier:

Onset/Course Specifiers:

• Episodic (Single Episode/Reoccurring): Doubt manifests as a discrete temporal episode, often with alternating periods of "remission." Additional specifiers for a diagnosis of Episodic Doubt are Single Episode or Reoccurring. Single Episode Doubt is diagnosed when there have been no other discernible episodes of Doubt in the past. Reoccurring Doubt is diagnosed if the individual has met diagnostic criteria for Doubt in the past.
• Chronic: Chronic doubt has no discrete temporal onset and periods of "remission," if they occur at all, are short lived. Chronic doubt emerges slowly and can persist for years, often throughout the lifespan.

Examples of various Doubt diagnoses illustrating the use of the Type and Onset/Course specifiers are as follows:

• Doubt-Intellectual Type-Chronic
• Doubt-Emotional Type-Episodic, Single Episode
• Doubt-Undifferentiated Type-Episodic, Recurring
• Doubt-Apathetic Type-Chronic

Supplemental Information:

Prevalence and Occurrence Data:
Epidemiological research suggests that 30% to 50% of persons in religious populations have met diagnostic criteria for Doubt at least once in their lifetime. Some research has found incidence rates has high as 90% in certain populations.

Causes and Risk Factors:
Doubt has a variety of known causes. Some research has indicated that doubt may be influenced by personality suggesting that doubt may have heritable components. Traumatic life events are frequently implicated in the onset of doubt, particularly Episodic Doubt. Chronic doubt has also been linked to advanced education or intellectual exposure to ideas, information, or ways of knowing that create epistemological pressures upon religious belief.

Developmental Issues:
Doubt can occur at any time during the lifespan. Generally, the first episodes of Doubt occur in late adolescence and early adulthood. However, there are many documented cases of late onset doubt.

Demographic Correlates:
There are no known demographic risk factors associated with Doubt. Doubt is equally prevalent across gender, ethnic groups, and socioeconomic groups.

Treatment:
There are no known treatments for Doubt. Consequently, most treatments for doubt are palliative rather than curative.