A new diagnostic category entitled religious or spiritual problem has been included in the fourth edition of theDiagnostic and Statistical Manual of Mental Disorders(DSM-IV) under Other Conditions That May Be a Focus of Clinical Attention. Along with several other changes, this category contributes significantly to the greater cultural sensitivity incorporated into DSM-IV. The authors review the approval process, including the changes that were made in both the proposed new category and the former V Code section of DSM-III-R. In addition, the definition, assessment methods, types, and clinical significance of religious and spiritual problems are clarified, along with the differential diagnostic issues raised by the definitional changes in the former V Code section. Finally, clinical issues involving cultural sensitivity and the implications for future research are addressed. The new category could help to promote a new relationship between psychiatry and the fields of religion and spirituality that will benefit both mental health professionals and those who seek their assistance.