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


3 Comments

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.

Is Worry Making Us Sick?

Any quick search in Google or Amazon will confirm what we all already know; worry is harmful to our bodies. Here are a few physical symptoms associated with worry:

  • Difficulty swallowing
  • Dizziness
  • Dry mouth
  • Fast heartbeat
  • Fatigue
  • Headaches
  • Muscle aches
  • Muscle tension
  • Nausea
  • Rapid breathing
  • Sweating
  • Trembling and twitching

You can almost get exhausted and anxious reading that list. All of these can be experienced to varying degrees depending on how severe your worry is. Most of you can probably identify many of these as you reflect on an anxiety-producing experience in your life.

Unfortunately, this is not the only way we are impacted by worry. If not addressed, it can have a bigger impact on your overall health. People who worry consistently are more prone to the following physical consequences:

  • Suppression of the immune system
  • Digestive disorders
  • Short-term memory loss
  • Premature coronary artery disease
  • Heart attack

In light of this, it is not surprising when we discover the original meanings of the words we use today to talk about worry and anxiety. The English word “worry” comes from the Old English word meaning “strangle.” The word “anxiety” is of Indo-Germanic origin referring to suffering from narrowing, tightening feelings in the chest or throat.

Statistics reveal that nearly 20% of people living in the United States will experience life debilitating anxiety annually. That is nearly 65 million people! In 2008, American physicians wrote more than 50 million prescriptions for anti-anxiety medications and more than 150 million prescriptions for antidepressants, many of which were used for anxiety-related conditions. It is no over-statement to say that we have a problem of epidemic proportions.

What Would Your Doctor Say?

Physicians and counselors will tell you that diet, exercise, rest and some kind of meditation is a proven help when you are struggling with anxiety. Sometimes medication, when taken wisely, can be helpful. You can use your body to fight what is actually trying to undermine it. No one can deny that. But is there another part of dealing with worry that we need? While these things are important, we also need to know how to connect to God when our worries come. We need God’s grace even if we are going to pursue exercise and diet in a way that is most helpful.

Let’s consider the most fundamental aspect that must under-gird everything else we do when taking care of our bodies.

What Would Jesus Say?

Jesus lived at a time in human history that was very unpredictable and less safe than ours. It was a world in which worry was epidemic, too. In every instance where he encouraged people not to worry, he did so with compassion because he knew first-hand what it felt like to be a human being. In Luke 12:32, he spoke these encouraging words to anxious people, Do not be afraid, little flock, for your Father has been pleased to give you the kingdom. Those simple words sum up all that Jesus said over and over again. He commands them not to worry, but his command is one of encouragement, not shame. Let’s consider these simple but profound phrases:

Do Not be Afraid

Jesus knows that worry is a serious problem. He knows it is bad for you physically, as well as spiritually, and he gets right to the point because he loves you. His commands are always for your good. Whenever you are struggling with worry, it is connected to your relationship with God. The word “worry” that Jesus uses means “a divided mind.” Within the broader context of his teaching, Jesus says that worry happens when you try to love God and something in creation at the same time. As soon as you do this, you have begun to put your hope and security in something other than God. Anything else besides God is unstable (money, a relationship, a job, education, your own moral record, obedient children, your health). Do you see why Jesus is so straightforward? He cares for you. He knows that you can’t serve two masters (Matthew 6:24).

Little Flock

At the same time that Jesus speaks strong but encouraging words, he does so with a tone that is tender in its toughness, and compassionate in its candor. Don’t let this little phrase that Jesus utters evade you. Don’t miss those two powerful words: little flock. While Jesus challenges you to not worry or fear, he speaks to you as one who belongs to him, whom he is shepherding and for whom he laid down his life. You are unimaginably dear to him and loved by him. You are one of his sheep. Be reassured—he cares for you and loves you even as you struggle with worry, even as you forget him and his care, and give in to your tendency to worry. You may be prone to wander, but you will always be part of his flock.

For Your Father Has Been Pleased to Give You the Kingdom

If the promise of Jesus’ tender care is not enough, he adds something more! Your Father is not only going to care for you now, he is in the process and will ultimately give you His kingdom. Your future is certain and you can begin to experience it even now because His kingdom has broken into your life by the presence of the Holy Spirit. He is a deposit guaranteeing that you will get it all one day. So, right now, in the ups and downs of life, the stresses and strains of the uncertain future, let the certainty of your eternal future be what you cling to.

With all of this in mind, allow the truth of God’s care for you to work its way into your daily life. We are to prioritize the kingdom by viewing everything through the lens of our faith. When you begin to live for God instead of the things of the world, you may find that your tendency to worry will lessen and your response to God and to the world, spiritually and physically, will change dramatically.

Copyright © 2015 Timothy S. Lane


This is an adapted excerpt from Tim’s latest book, Living Without Worry, which can be purchased through The Good Book Company or on Amazon.

Comment

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.

Until the Dawn Appears

My daughter introduced me to Matthew Perryman Jones. That led to a birthday gift to see him at a classic, small venue in Atlanta, Georgia. Jones grew up in the greater Atlanta area and got his start where we saw him. We arrived early and managed to get a table that was about 3 feet from the stage. Early on, he sang a song entitled "Until the Dawn Appears". He said it was a song about hope. Ironically, it is a song about sorrow and suffering.

I like how the song does not tie up all the confusing realities around suffering, while still capturing a Christian vision of wisdom and hope. It is also one of many ways that God comes to us in our sorrows. Songs and lyrics touch someone at a level that mere words sometimes do not. Poetry is intended to capture the whole person.

Before listening to the lyrics, here are some thoughts on the song's content:

1. Stanza one encourages the listener to take a good look at one's sorrows. This is helpful because the inclination is to avoid and not grieve.

2. "How Long"....is the cry of the Psalmist. It is also the appropriate cry of the believer. "How Long, O Lord, will you allow this to go on and on?"

3. Stanza two is a wise calling to avoid any form of bitterness or self-medication in an attempt to kill one's sorrows. If you do, they will take over your entire life and soul.

4. Stanza three introduces the Man of Sorrows and a Crystal Sea. Crucifixion, Resurrection and complete Cosmic Restoration. This stanza moves you through these epoch aspects of the Christian faith. No other world religion can offer this kind of hope.

5. Ending Chorus: Words of comfort for the child of God. He will not let us go!

I’ve been turning up the stones in my own discontent
And I’m finding out where all my hidden sorrows went
They’ve been laying there for years,
I kept them out of view
But it's time I dust you off and take a good look at you

Oh how long?
Oh How long?

Well it's easier to clench your fist and grind your teeth
Then to look into the sadness that lives underneath
You can kill off all those feelings
They’ll just turn to ghosts
They will take over your house and become the host

Oh how long?
Oh how long?

Well the Man of Sorrows walked the shores of Galilee
And his eyes were cast with joy towards the crystal sea
Well the shadows will be gone and all these bitter tears
And my heart will hang on that until the dawn appears

Oh how long
Oh how long
Oh You, You won’t let me go
Oh no, no. 
Oh no You won’t let me go
Oh no, oh no, You won’t let me go
Oh no, oh no You won’t let me go

Copyright © 2014 Timothy S. Lane

1 Comment

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.

Can Blessings be a Trial?

Do you find yourself in the midst of blessings? Your marriage is strong. Your children seem to coast along. Everything is going well at work. Your health is decent. Finances are sufficient to pay the bills. Friendships seem to be easy and fun. Overall, life is going your way and you couldn't be happier. Is this a good thing or a bad thing?

According to James 1:9-15, it is both. In these seminal verses, James says that poverty and riches are a trial. Both blessing and hardship are equally tempting. If you don't believe me, read this from James 1:9-11.

The brother in humble circumstances ought to take pride in his high position. But the one who is rich should take pride in his low position, because he will pass away like a wildflower. For the sun rises with scorching heat and withers the plant; its blossom falls and its beauty is destroyed. In the same way, the rich man will fade away even while he goes about his business.

According to James, there ARE two kinds of trials; adversity and prosperity. Have you ever thought about trials in this way? If not, you should. All of those wonderful blessings in your life open a vat of temptation as wide as the hardships.

I have heard it said that the most troubling life is the life without trouble.

With that in mind, let's try these questions again. Is your life coasting along? Are your relationships unhindered? Does your spouse think you hung the moon? Do your children hang on every word that flows from your mouth with humble and prompt obedience? Are your finances and future retirement plans secure? If so, be vigilant. You are highly susceptible to the schemes of the Evil One and his schemes are most likely passive. He sits back and watches ungodly pride, confidence and self-sufficiency do their dirty work.

James wasn't the first one to highlight the challenges brought upon us by blessings. When the children of Israel were delivered from slavery in Egypt and moved into the promised land, they were told this by Yahweh in Deuteronomy 6:10-12;

When the Lord your God brings you into the land he swore to your fathers, to Abraham, Isaac and Jacob, to give you--a land with large, flourishing cities you did not build, houses filled with all kinds of good things you did not provide, wells you did not dig, and vineyards and olive groves you did not plant--then when you eat and are satisfied, be careful that you do not forget the Lord, who brought you out of Egypt, out of the land of slavery.

Wow! You can pick up your Bible and keep reading the history of Israel. This is exactly what they did time and time again. This is a warning that is too often unheeded by those who are experiencing a season of blessing. It is why the apostle Paul's counsel to give thanks all the time is so critical. Thanksgiving is a tangible expression of gratitude for God's grace. We don't deserve good things, yet in God's goodness and grace He allows us to enjoy blessings. Jesus is the greatest of blessings. We would never think to presume we deserve his mercy. James, Paul and the rest of Scripture are cautioning us against thinking that we deserve any good thing. We don't, but He gives them anyway.

Every good thing you are enjoying right now is a gift that you do not deserve. So take a moment and enumerate the many blessings in your life. Let the weight of them bring you to your knees in humble gratitude. If you do, this is the surest way to fight against pride and self-sufficiency.

Blessings are a trial that can lead to pride or gratitude. Which is it for you right now?

Copyright © 2014 Timothy S. Lane. All rights reserved.

Comment

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.