Personality disorders occupy a contested space between psychiatric science, moral responsibility, and theology, raising pressing questions about equality, inclusion, and justice. Contemporary psychiatric frameworks, such as the ICD-11 dimensional model, describe persistent patterns of cognition, affect, and behavior that shape relational and social functioning. These insights challenge traditional theological assumptions of humans as moral agents oriented toward virtue and relational flourishing. If enduring traits constrain capacities for empathy, self-regulation, and relational engagement, how can theology address moral responsibility without perpetuating stigma or injustice? This paper argues that theology, informed by psychiatric knowledge, can develop a nuanced account of culpability attentive to both personal and structural inequalities - and which recognises the role of stigma and notions of biological determinism that impact upon medical care and criminal justice involvement. Recognising constraints on affective and relational capacities helps faith communities, pastoral caregivers, and healthcare practitioners respond ethically, supporting inclusion while clarifying moral responsibility. At the same time, theology offers frameworks for moral formation and growth: sacramental life, spiritual disciplines, and relational practices can foster ethical and relational flourishing even when personality traits persist. By integrating psychiatric and theological perspectives, this approach illuminates both the inequalities faced by those with personality disorders and the responsibilities of communities and institutions. It highlights pathways for justice-oriented pastoral care, ethical engagement, and social inclusion, showing that moral and spiritual development remains possible amid enduring psychological patterns. In doing so, it situates personality disorders within broader questions of equality, relational responsibility, and the moral life of communities.