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Near-death experiences (NDEs) often produce profound changes in attitudes and behavior that can lead to psychosocial and psychospiritual problems. The diagnostic label of religious or spiritual problem, included in DSM-IV under the category of other conditions that may be a focus of clinical attention, was originally proposed to encompass NDEs and their aftereffects. Four cases are discussed in which patients presented with NDE-related problems, and differential diagnosis and current treatment strategies are reviewed. The inclusion of this new diagnostic category in the DSM-IV permits differentiation of NDEs and similar experiences from mental disorders and may lead to research into more effective treatment strategies.