PERSONALITY DISORDER

saturday, december 8, 2012

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The new york Times inTernaTional weekly science & technology

Personality Disorders still hard to Define By BENEDICT CAREY

Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes include such well-known types as narcissistic personality disorder and avoidant personality disorder, as well as dependent and histrionic personalities. But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people. The American Psychiatric Association has recently confronted one of the field’s most elementary, yet

Problems that are neither psychotic nor neurotic. still unresolved, questions: What, exactly, is a personality problem? The association has been trying to clarify these diagnoses and better integrate them into clinical practice. Personality problems aren’t new or hidden. They play out in Greek mythology, from Narcissus to the sadistic Ares. They percolate through biblical stories of madmen, compulsives and charismatics. They are writ large across the 20th century, with its collection of vainglorious, murderous dictators. Yet it turns out that producing precise definitions of extreme behavior patterns is exhausting work. It took more than a decade before the Ger-

man psychiatrist Emil Kraepelin could draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression. Likewise, Freud spent years formulating his theories on the origins of neurotic syndromes. And Freudian analysts were largely the ones who described people with the sort of “confounded identities” that are now considered personality disorders. Their problems were not periodic symptoms but issues rooted in longstanding habits of thought and feeling — in who they were. “These therapists saw people coming into treatment who looked well put-together on the surface but on the couch became very disorganized, very impaired,” said Mark F. Lenzenweger, a professor of psychology at the State University of New York at Binghamton. “They had problems that were neither psychotic nor neurotic. ” Several prototypes soon began to emerge. “A pedantic sense of order is typical of the compulsive character,” wrote the Freudian analyst Wilhelm Reich in his 1933 book, “Character Analysis,” a groundbreaking text. “In both big and small things, he lives his life according to a preconceived, irrevocable pattern.” Others coalesced too, most recognizable as extreme forms of everyday types: the narcissist, with his fragile, grandiose self-approval; the dependent, with her smothering clinginess; the histrionic, always in the thick of some drama, desperate to be the center of attention. Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, pulled together the bulk of the work on personality disorders and turned

jonathon rosen

it into a set of 10 standardized types for the psychiatric association’s third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide. These diagnostic criteria led to improved treatments for some people. Today there are several approaches that can relieve borderline symptoms and one that has reduced hospitalizations and helped aid recovery: dialectical behavior therapy. But many in the field began to argue that the diagnostic catalog needed a rewrite. Some of the categories overlapped, and troubled people often got two or more personality diagnoses. “Personality Disorder-Not Otherwise Specified,” an encompassing label meaning little more than “this person has problems,” became the most common of the diagnoses. It’s a murky area, and many therapists didn’t have the time or training to evalu-

ate personality on top of everything else. Assessment interviews can last hours, and treatments for most of the disorders involve longer-term, specialized talk therapy. The most central and knowable element of any person — personality — still defies consensus. A team of experts appointed by the psychiatric association has worked for over five years to find some unifying system of diagnosis for personality problems. The panel proposed a system based in part on a failure to “develop a coherent sense of self or identity.” Not good enough, some psychiatric theorists said. Later, the experts tied elements of the disorders to distortions in basic traits. The team’s final proposal for narcissistic personality disorder involved rating a person on two traits, among them “manipulativeness,”

“histrionism” and “callousness.” The current definition includes nine possible elements. The proposed diagnostic system would be simpler, as well as “responsive to the array of diverse and sometimes contradictory suggestions made by other” personality disorders experts, wrote Dr. Andrew Skodol, a psychiatrist at the University of Arizona and chairman of the group proposing the new system, in a paper published last spring. But since then the outcry against the proposed changes has grown loud. Thomas Widiger, a professor of psychology at the University of Kentucky, likens the process of reaching a consensus to the parable of the six blind men from Hindustan, each touching different parts of an elephant. “Everyone’s working independently, and each has their perspective, their own theory,” he said. “It’s a mess.”

Developing a new Technology to search for images on the internet By JOHN MARKOFF

STANFORD, California — You may think you can find almost anything on the Internet. But search engines can ordinarily find a given image only if the text entered by a searcher matches the text with which it was labeled. And the labels can be unreliable, unhelpful or simply nonexistent. To eliminate those limits, scientists will need to create a new generation of visual search technologies — or else, as the computer scientist Fei-Fei Li of Stanford University in California recently put it, the Web will be in danger of “going dark.” Now, along with computer scientists from Princeton University in New Jersey, Dr. Li, 36, has built the world’s largest visual database in an effort to mimic the human vision system. With more than 14 million labeled objects, from obsidian to

orangutans to ocelots, the database has become a vital resource for computer vision researchers. The labels were created by humans. But now machines can learn from the vast database to recognize similar, unlabeled objects, making possible a striking increase in recognition accuracy. This summer, two Google computer scientists, Andrew Y. Ng and Jeff Dean, tested the new system, known as ImageNet, on a huge collection of labeled photos. The system performed almost twice as well as previous “neural network” algorithms — software models that seek to replicate human brain functions. Nor are the Google researchers the only ones who have used the ImageNet database to test their algorithms; since 2009, more than 300 scientific publications have used or cited ImageNet.

Machines can learn from world’s largest visual database. Computer vision is one of the most vexing problems facing designers of artificial intelligence and robots. A huge portion of the human brain is devoted to vision, and scientists are still struggling to unlock the biological mechanisms by which humans learn to recognize objects. “My dream has long been to build a vision system that recognizes the world the way that humans do,” said Dr. Li, whose Princeton colleague is the computer scientist Kai Li. When she began to assemble her system in 2007, Fei-Fei Li said, the

only alternatives were databases that recognized only a few types of objects. The challenge was how to increase the scale of the system to bring it closer to human capabilities, especially amid the rising torrent of online images. “In the age of the Internet, we are suddenly faced with an explosion in terms of imagery data,” she said. “Facebook has 200 billion images, and people are now uploading 72 hours of new video every minute on YouTube.” Dr. Li said that the task could take a student decades, but that Mechanical Turk, the Amazon. com system for organizing thousands of people to do small tasks, was the perfect way to assemble her database. Each year, ImageNet employs up to 30,000 people who are presented with images to label, receiving a tiny payment for each. Mechanical Turk

workers, known as “turkers,” identify about 250 images in five minutes. The ImageNet database now has 14,197,122 images. Samy Bengio, a Google research scientist, said ImageNet has “helped some researchers develop algorithms they could never have produced otherwise.” But he added that ImageNet was not perfect. To organize the vast collection of images, Dr. Li uses WordNet, a database of English words designed by the Princeton psychologist George A. Miller, who died in July at 92. For Dr. Bengio, its categories are too elevated. “I would have preferred if the categories chosen in ImageNet were more reflecting the distribution of interests of the population,” he said. “Most people are more interested in Lady Gaga or the iPod Mini than in this rare kind of diplodocus.”