Personality Disorder: What Use Is This Label for a Counselor?

December 1, 2017

Picture a classroom of 9-year-olds. One boy slumps low in his chair, sneaking peeks at Snapchat. Nearby three girls in matching Katy Perry t-shirts steal glances at the “weird” new girl. The “weird” girl looks at the rain, her stare blank. Could one of these children one day fit the label of personality disorder? Perhaps.

Currently DSM-5 states that personality disorders are “enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts,” and “are inflexible and maladaptive, and cause significant functional impairment or subjective distress.”[1] It’s estimated that 0.5 percent to 2.5 percent of the general population fits a personality disorder label.

However, the Bible doesn’t use the term personality disorder. In fact, Scripture says the point of counseling is change in personality and behavior.

So what does a biblical counselor do with a personality disorder label? Do any of your counselees have this label from a psychotherapist? Do you suspect a counselee might fit the diagnosis? Does it even matter?

Biblical Definition of Personality Disorders

A statement from the Association of Biblical Counselors, headquartered in Texas, describes personality disorders biblically:

The so-called “Personality Disorders” (i.e. paranoid, narcissistic, etc.) are simply descriptions of long-term behavioral, emotional, interpersonal, and thought patterns developed by an individual over a period of time. The Bible clearly articulates the influence of depravity and sin on a person’s behavior, thinking, and feeling. Therefore the influence of the “law of sin” must be a focal point for individuals citing these labels (Eph. 2:3). Following the flesh always leads to further corruption, death, and darkness (Eph. 4:22-24, Rom. 8:5).[2]

Author and counselor David Powlison states that while psychiatric labels provide helpful descriptions, this is what they are—descriptions of symptoms. They do not give explanations or prescribe solutions that work, but Scripture does.[3] And biblical counselors provide hope!

Unlike most psychotherapists, biblical counselors believe people with a personality disorder label can indeed overcome the sins and circumstances that led to the development of symptoms of a diagnosis. But in the psychological world, the prognosis is grim.

Says Powlison of borderline personality disorder: “It’s considered the untreatable diagnosis. A death sentence.”[4]

3 Clusters of PDs

The DSM categorizes the ten personality disorders (PDs) in three clusters:

  • Cluster A — paranoid, schizoid, and schizotypal
  • Cluster B — antisocial, borderline, histrionic, and narcissistic
  • Cluster C — avoidant, dependent, and obsessive-compulsive

People in Cluster A tend to be withdrawn, cold, suspicious, and irrational. Those in Cluster B may be described as emotional, theatrical, and attention-seeking. And someone in Cluster C tends toward anxiety. Usually only folks in Cluster B seek counseling.

Let’s take a quick look at three of the PDs, one from each cluster: schizoid, borderline, and obsessive-compulsive. As you read the descriptions, consider what direction you might go in counseling and which Scriptures you’d use.

Schizoid: Loners

According to the DSM, people with schizoid PD appear unsociable, cold, and reclusive, and are indifferent to praise or criticism. They are loners and rarely marry. While in touch with reality, these folks may develop schizophrenia.

The biblical description of schizoid PD zeroes in on the counselee’s self-absorption, where all of his attitudes center on himself. He has made an idol of himself.[5] For lasting change, the afflicted person must learn to love God above all and to continue to practice serving God and serving others.

Powlison and counselor Michael Emlet agree that such counselees require profound reorganization in thinking and behavior. The wise biblical counselor also would involve the counselee’s family in data gathering and to offer them counseling as well.

Borderline: “Don’t Go Away, but Get Lost”

People with this diagnosis say they feel empty, have rapid mood swings and poor self-image, and often attach themselves strongly to others and then become hostile toward them. In fact, fear of abandonment is a hallmark of borderline PD. Many self-harm and some are suicidal, with up to 10 percent completing suicide.

A biblical counselor would say that the person with borderline PD has developed a sinful manner of life that is self-seeking and depends on people rather than God. Her core heart issue is pride, and she believes that others must organize their lives around her need for happiness.[6]

The solution is helping them understand that change happens as they put off issue-based identity (borderline PD) and put on their Christ-like identity (Eph. 4:22-24).[7] A biblical goal is learning to live in their identity in Christ even when they don’t feel as though they belong to Him.

Obsessive-Compulsive: Felix Unger to the Max

This PD is different from obsessive compulsive disorder. The latter describes a pattern of recurring, intrusive, and irrational thoughts leading to compulsions to relieve anxiety. In contrast, people with this personality disorder are so consumed with details that they get very little done. They have little time for friendships or recreation. And they may be very critical of their own mistakes.

Biblically, people with obsessive-compulsive behavior manifest ungodly fear. Through data gathering, a counselor would determine the root cause of the counselee’s fears. Then the counselor would help the counselee identify sins resulting from fear and repent. In addition, the counselee would no longer choose to focus on the fear, which leads to more fear. Instead, the counselee would focus on loving God and his neighbor (Matt 22:37-38).

Emlet says that the counselee needs to recognize the sovereignty of God and embrace the truth, “I don’t need to be in control.”[8]

Summing Up

Both biblical counselors and psychologists recognize the very real patterns of behavior leading to a personality disorder label. Truly these people are suffering and need compassion (2 Cor. 1:3-4).

Psychological treatments appear to have little success. However, biblical counseling is effective among believers diagnosed with a PD. As Scripture says, “His divine power has given us everything we need for a godly life through our knowledge of him who called us by his own glory and goodness” (2 Pet. 1:3).

Questions for Reflection

How has a counselee’s personality disorder label changed your counseling? Do these labels matter? If so, how? What are your favorite Scriptures for counselees diagnosed with a PD?

[1] V. Mark Durand and David H. Barlow, Essentials of Abnormal Psychology, Third Edition (Pacific Grove, CA: Wadsworth, 2003), 405.

[2] Association of Biblical Counselors, “General Personality Disorder Criteria,” accessed October 28, 2017, https://christiancounseling.com/resources/general-personality-disorder-criteria/.

[3] David Powlison, “What Hope of Healing Is There for Someone with Borderline Personality Disorder,” accessed October 31, 2017, https://www.ccef.org/resources/video/what-hope-healing-there-someone-borderline-personality-disorder.

[4]  Ibid.

[5] Marshall Asher and Mary Asher, The Christian’s Guide to Psychological Terms, Second Edition (Bemidji, MN: Focus Publishing, 2014), 179.

[6] Marshall Asher and Mary Asher, 30.

[7] Cathy Wiseman, Borderline Personality (Phillipsberg, NJ: P&R Publishing, 2012), 43, Kindle.

[8] Michael Emlet, “Understanding Obsessive-Compulsive Personality Disorder,” accessed October 31, 2017, https://www.ccef.org/resources/video/understanding-obsessive-compulsive-personality-disorder.

Lucy Ann Moll is an ACBC-certified counselor and a D.Min. candidate. She’s on staff with Biblical Counseling Center, founded in 1989 in greater Chicago. She and her husband, Steve, have three adult children and a grandbaby on the way.


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