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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Tim Lane

Dr. Timothy S. Lane is the President of the Institute for Pastoral Care and has a counseling practice in Fayetteville, GA. He is a minister in the Presbyterian Church in America (PCA), having been ordained in 1991 and a member of Metro-Atlanta Presbytery. Tim has authored Living Without Worry: How to Replace Anxiety with Peace, and co-authored How People Change and Relationships: A Mess Worth Making. He has written several mini-books including PTSD, Forgiving Others, Sex Before Marriage, Family Feuds, Conflict, and Freedom From Guilt.

He has experience in both campus ministry (University of Georgia, 1984-1987) and pastoral ministry where he served as a pastor in Clemson, SC from 1991 until 2001. Beginning in 2001 until 2013, he served as a counselor and faculty at a counseling organization  in Philadelphia, PA. Beginning in 2007, he served as its Executive Director until 2013.

In 2014, Tim and his family re-located to his home state, Georgia, where he formed the non profit ministry the Institute for Pastoral Care. His primary desire and commitment is to help pastors and leaders create or improve their ability to care for the people who attend their churches. For more information about this aspect of Tim's work, please visit the section of this site for the Institute for Pastoral Care. He continues to write, speak and travel both nationally and internationally. Tim is adjunct professor of practical theology at several seminaries where he teaches about pastoral care in the local church.

You Never Know Who Might be Listening

Recently, I had the opportunity to teach on a variety of issues including anxiety, depression, psychoses, anger, suicide assessment, addictions and personality disorders. Sometimes, because I think about these issues quite a bit, I approach them in a detached way. As I plough through my material, I can forget that the people I am teaching and equipping might be strugglers as well as helpers. Imagine that--people in training may be in the process of seeing God’s redeeming work of change in their own lives.

Let me share two examples with you:

Addictions

While teaching a seminary class on addictions, I mentioned the difference between substance addictions and lifestyle addictions. When most people hear the word “addiction” they immediately think alcohol, marijuana, or pain killers; the usual suspects. Yet, some people fail to see that issues like gambling, shopping, spending time on the internet, and pornography qualify as addictions, also. If you look at how either of these types of addictions affect the brain, you will notice clear similarities. Habituation and tolerance both arise as you indulge in the behavior. The person will experience similar withdrawal symptoms, too.

During the break, I was organizing my notes and a young woman approached me. I assumed she had a technical question about the syllabus or some assignment, but that was not why she wanted to talk. She discreetly and helpfully shared about her husband’s addiction to pornography and how it had impacted their marriage. While she was realistic, she was hopeful because of what God had been doing in their relationship. I was heartened and thankful that she was willing to share that with me. It changed the rest of my teaching on addiction that afternoon.

Suicide Assessment

Another startling example happened when I was teaching on suicide and suicide assessment. Once again, I found myself working through the details of suicide statistics. 41,000 people will commit suicide in the United States this year. Most of them will be men even though women will try more often. Men are more “successful” because they use more violent means.

After teaching on helpful ways to assess whether someone is seriously committed to harming themselves, I casually opened it up for some Q & A. A few technical questions were asked, and then another young woman shared her story. She said that one year ago, she had her suicide all planned out. She had written a note, had the means to kill herself and was going to follow through as soon as she returned home from a Christian camp! She then said that God had worked powerfully over the week and she had become a Christian. She returned home a radically different person. I was humbled by her confession. There she was, sitting in the front row, taking notes for about 45 minutes, and then she shared her story.

Once again, I was awakened to the fact that real sufferers are always in my audience. The impact was almost like a reset button for me. When I am teaching, I am more than a “talking head” disseminating information. Rather, I am a servant speaking words of life to people who need grace. You really never know who is listening.

Copyright © 2015 Timothy S. Lane

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Tim Lane

Dr. Timothy S. Lane is the President of the Institute for Pastoral Care and has a counseling practice in Fayetteville, GA. He is a minister in the Presbyterian Church in America (PCA), having been ordained in 1991 and a member of Metro-Atlanta Presbytery. Tim has authored Living Without Worry: How to Replace Anxiety with Peace, and co-authored How People Change and Relationships: A Mess Worth Making. He has written several mini-books including PTSD, Forgiving Others, Sex Before Marriage, Family Feuds, Conflict, and Freedom From Guilt.

He has experience in both campus ministry (University of Georgia, 1984-1987) and pastoral ministry where he served as a pastor in Clemson, SC from 1991 until 2001. Beginning in 2001 until 2013, he served as a counselor and faculty at a counseling organization  in Philadelphia, PA. Beginning in 2007, he served as its Executive Director until 2013.

In 2014, Tim and his family re-located to his home state, Georgia, where he formed the non profit ministry the Institute for Pastoral Care. His primary desire and commitment is to help pastors and leaders create or improve their ability to care for the people who attend their churches. For more information about this aspect of Tim's work, please visit the section of this site for the Institute for Pastoral Care. He continues to write, speak and travel both nationally and internationally. Tim is adjunct professor of practical theology at several seminaries where he teaches about pastoral care in the local church.