Religious-spiritual crises include distress associated with the weakening or loss of faith, turbulent conversions, and affective states associated with negative spirituality. The differential diagnosis in regard to psychosis is often challenging. The purpose of the present study was to investigate the role of basic symptoms (changes in the subjective experience of perception, thinking, feeling, and self) in the differential diagnosis. We evaluated 106 help-seeking individuals with the Bonn Scale for the Assessment of Basic Symptoms (BSABS). The results indicated that religiousspiritual crises and psychotic states could be properly differentiated with the BSABS. Although the crisis and psychosis groups scored similarly on perplexity, self-disorder, depression, and anxiety, the disturbance of social contact and cognition was observed only in psychosis. These results indicate that the assessment of basic symptoms is useful in the differentiation of religious-spiritual crisis and psychosis, but it does not replace a multidisciplinary approach when, in addition to the routine psychiatric examination, the wider cultural context and the personal narratives are also considered.