What Should We Make of Personality Disorders?

What does the average pastor do when confronted with someone who exhibits troubling behavior that disrupts relationships and creates bedlam in the church? Unfortunately, because training for these types of issues is minimal, the response can create more problems. These types of inflexible thinking and behaviors have been placed into a modern category called Personality Disorders.

What is a personality disorder? Here is a definition from Chuck DeGroat’s book, Toughest People to Love:

Experts define a personality disorder as an "enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment." In theological terms, personality disorders reflect that long-term and chronic relational pattern Martin Luther describes as "homo incurvatus in se" – "people turned in on themselves (p. 46)."

Another way of defining these patterns is found in Allen Frances’ book Essentials of Psychiatric Diagnosis: Responding to the Challenges of DSM-5:

Our characters strongly influence our fate. How we see the world and respond to it very much determines how the world sees and responds to us. “Personality” is an enduring pattern of thinking, feeling, interacting, and behaving that is who we are; it provides the texture of our relations with other people. Personality Disorders cause vicious cycles of negative expectation and self-fulfilling prophecies. Normal personality traits become Personality Disorders when they are inflexible and make people unable to adapt to the needs of the moment. The diagnosis of a Personality Disorder is made only if the resulting problems cause clinically significant distress or impairment (p.131).

Note the emphasis on inflexible and unable to adapt. For someone with a personality disorder, their normal personality has been geared to see and do life through a single lens (schemas) which incapacitates them from thinking and behaving differently according to the situation. The cause is not fully known, but most say that it is a combination of biological and situational factors. Situational factors can include some kind of childhood trauma.

Frances offers a very simple but helpful diagnostic question to determine if you or another person suffers with a Personality Disorder:

“Do you have a style of doing things and relating to people that gets you into the same kind of mess over and over again?”

The DSM-4-TR has 3 clusters that I find more helpful than the more current DSM-5:

• Cluster A. Odd/Eccentric: paranoid, schizoid, and schizotypal personality disorders.
• Cluster B. Dramatic/Emotional/Erratic: antisocial, borderline, narcissistic, and histrionic personality disorders.
• Cluster C. Anxious/Fearful: avoidant, dependent, obsessive-compulsive personality disorders.

These were classified as Axis II disorders along with the developmental disorders. The most recent DSM-5 offers 12 different types of Personality Disorders:

1. Borderline Personality Disorder
2. Antisocial Personality Disorder
3. Narcissistic Personality Disorder
4. Histrionic Personality Disorder
5. Obsessive-Compulsive Personality Disorder
6. Avoidant Personality Disorder
7. Dependent Personality Disorder
8. Paranoid Personality Disorder
9. Schizoid Personality Disorder
10. Schizotypal Personality Disorder
11. Personality Disorder Due to Another Medical Condition
12. Unspecified Personality Disorder

Allen Frances also provides a basic definition and description of each that is worth considering. The ultimate goal is not to find labels for people but to understand them so that you might engage in skillful ministry.

The Implications for Local Church Ministry

It doesn’t take long to serve in a leadership capacity in ministry to see these traits in certain congregants. Statistics reveal that about 10% of the population fit the various categories of personality disorders. That means that leaders need to be exposed to and aware of these various forms of struggle. It is necessary to be aware of these issues because, unfortunately, it is not uncommon for these individuals to do great harm in churches, either as leaders or attenders.

In DeGroat’s book, he highlights four of the personality disorders that are most troublesome and are often the reason many leave the ministry (p. 46-47). They include Narcissistic, Borderline, Obsessive-Compulsive and Histrionic Personality Disorders. Below are DeGroat’s descriptions of each:

Borderline Personality Disorder: the volunteer who spent years praising and supporting you, only to viciously turn on you, sending critical emails to everyone in the church.

Obsessive-Compulsive Personality Disorder: the nagging parishioner who gives a lot but pesters you with daily emails asking for specific details about the organization’s accounting. She is unable to see her own obsessiveness or to realize that her emails cause you anxiety and give you heartburn.

Narcissistic Personality Disorder: the power broker who intimidates you after you challenge him in a marital counseling session, demanding to see your notes from each session and threatening to get a lawyer to investigate you and the church.

Histrionic Personality Disorder: the leader who seems to ooze drama and is a magnet for each and every crisis in your church.

To these four, I would add one more:

Antisocial Personality Disorder (psychopath/sociopath): We typically relegate this category to serial killers but antisocial congregants often do their “killing” in other ways. These individuals are very adept at pairing off with others to breed suspicion and mistrust within a church in an effort to “kill” a leader.

Wisdom and Love

The call of every leader is pastoral care that incarnates the love of Christ. This is to be combined with great wisdom. In Matthew 10:16, as Jesus prepares the disciples to go and do ministry, he says, “be as shrewd as snakes and as innocent as doves.” In other words, as you go about your work as a pastor be aware that troubled people are in your midst. Don’t be paranoid but wise. Don’t be antagonistic but be wise in the way you interact with everyone.

Finally, as pastors and spiritual leaders encounter troubled people, be aware of the fact that some are uniquely challenging. Mark Yarhouse has this to say in his helpful resource Modern Psychopathologies: A Comprehensive Christian Appraisal:

The pastoral or leadership team also needs to be fully informed about problematic behaviors so there will be no manipulation or conning (Miller and Jackson 1995). Processing (debriefing and defusing) strong feelings of ambivalence and confusion, even anger and intense frustration, is often necessary. Further education about personality disorders, coupled with good professional consultation, can also be helpful. Ideally, they can help the pastoral or leadership team attack the problem(s) rather than the person (which would alienate or isolate those directly affected). In the long run, such an approach is much more helpful than to spiritualize the problem or to offer religious interventions that are misinformed about the painful realities of rigid, inflexible patterns of relating (p.285).

In short, pastors, elders, deacons and leaders in local churches need to find those who can help them grow in wisdom as they pastor and shepherd the flock. This is a short blog raising big issues and questions. What would you add to this conversation? I would love to hear your thoughts.

Copyright © 2015 Timothy S. Lane

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Resources mentioned:

• Toughest People to Love by Chuck DeGroat
• Essentials of Psychiatric Diagnosis: Responding to the Challenges of DSM-5 by Allen Frances
• Modern Psychopathologies: A Comprehensive Christian Appraisal by Mark Yarhouse

A Web of Care: Internal Resources

The other day, I was doing some cleaning in my basement. While working in a particular corner, I walked right into a spider web. My entire face was consumed. As I tried to get loose, pieces of the web kept sticking to other parts of my body; my fingers, arms, shoulders and even my torso! I could not get free of the web's embrace no matter how hard I tried.

Later that day, I was having a conversation with a fellow pastor about discipleship, counseling and pastoral care in the local church. In a serendipitous moment, I made a connection between my bad experience with the spider's web and a positive one as it relates to pastoral care.  When we think about caring for people within the context of the local church, the image of a web is helpful. We want to create a web of care so that people find it hard to hide, get lost, slip away or fall through the cracks.

I started thinking about the various strands of what that web would include. You see, a spider's web does it's job well because the spider spins many strands. A single strand will not suffice if the spider is going to catch its prey. Likewise, no single strand will suffice if the church is going to guard and feed the sheep. Here is a list of some of the strands.

Strand One: The Pastor. This is the first and most important strand, yet many churches think this is the only strand. When they do, people are not cared for. It only takes a congregation of 25 to overwhelm one pastor!

Strand Two: Spiritual Leaders. Any church worth its salt will have a number of spiritual leaders who assist the pastor and help provide stability for the people. If this is going to happen, it will mean that the lead pastor/pastors will have a vision and plan for equipping these leaders with interpersonal ministry skill.

Strand Three: Pastoral Staff. Most churches, even if they are small, have staff; a secretary, receptionist, nursery coordinator, children's minister, youth pastor and other assistant pastors. Every staff person must be adequately trained to know how best to help others grow in grace. Once again, it is the responsibility and calling of the lead pastors to provide this kind of training so that key staff are adequately able to know how to assist in the growth process of others.

Strand Four: Uniquely gifted lay-people. There are always a number of people who have gifts of mercy and are relationally strong in helping others with wise counsel. Often, they have gained these skills and character qualities through the hard knocks of life. You know who they are because people talk about how they have been helped by them. If this strand is going to be leveraged to the fullest, know who they are and create a natural but more formal connection with them and the other strands.

Strand Five: Small group leaders. In most cases, equipping for small group leaders has one of three legs missing. The two legs that are often present are: 1) training in how to lead a Bible study and 2) training in group dynamics and how to lead the group in discussion. The third leg that is often missing is what to do if an individual or couple approaches the small group leader after the meeting and asks for help with a problem in their lives. When small group leaders are given this third aspect of training, they become a vital part of the overall web of care.

Copyright © 2014 Timothy S. Lane 

Pursuing Strategic Change

How can a church and her leaders begin to improve the care they provide in light of the hindrances that were mentioned in the previous post? There is much that can be said, but let me highlight a few.

1. Recognize that there are two groups of people in local churches, each with a different need.

• The first group is made up of people who need a vision for inter-personal ministry that emerges from Scripture. Begin with the positive things God is doing in the church. All churches have strengths and weaknesses. My previous posts are full of passages that cast this kind of vision.
• The second group is made up of people who already grasp the vision, but are afraid to get involved because they need to be equipped. The have bought the vision of  helping others, but actually helping someone may terrify them. 

2. Begin to think of the various groups that need to be taught and equipped. Assess and strategize for each group. Change in the local church is often slow, so give yourself time. Think in terms of years, not months. Here are a few different groups that you will want to consider.

• Employed Pastoral staff
• Non-employed leadership (elders/deacons)
• Key Lay-Leaders: 
• Small Group Leaders
• Other Ministry Leaders: Sunday school teachers, worship, evangelism, mercy, missions, men’s ministry, women’s ministry, youth group leaders.
• Every Member: parents, children, teenagers, married couples, elderly, and all friendships
• Professional counselors, physicians and psychiatrists in your church and broader community

3. Utilize existing structures as much as possible. You want to avoid the impression that you are starting another program. Most churches are already busy.

• Pulpit 
• A new members’ class
• Officer training
• Leadership meetings
• Scheduled committee meetings
• Mentoring

This post is simply to help you get a sense of the big picture. For a more detailed explanation of this concept, feel free to download and read the chapter entitled “One Church’s Story” from the book How People Change. *

How People Change Chapter 16 Download: One Church's Story

Copyright © 2013 Tim Lane. All rights reserved.

*This article is adapted from How People Change, Copyright©2006 by Timothy S. Lane and Paul David Tripp. Used by permission of New Growth Press and may not be reproduced and/or distributed without prior written permission of New Growth Press.