Clearing the Fog Around Personality Disorders

For years they have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.

Their customs and rituals are as captivating as any tribe’s, and at least as mystifying. Every mental anthropologist who has visited their world seems to walk away with a different story, a new model to explain those strange behaviors.

This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.

Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, 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 new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all.

Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force updating the manual, would not speculate on which way the vote might go: “All I can say is that personality disorders were one of the first things we tackled, but that doesn’t make it the easiest.”

The entire exercise has forced psychiatrists to confront one of the field’s most elementary, yet still unresolved, questions: What, exactly, is a personality problem?

Habits of Thought

It wasn’t supposed to be this difficult.

Personality problems aren’t exactly 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 rogues’ gallery of vainglorious, murderous dictators.

Yet it turns out that producing precise, lasting definitions of extreme behavior patterns is exhausting work. It took more than a decade of observing patients before the German psychiatrist Emil Kraepelin could draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression or bipolar disorder.

Likewise, Freud spent years formulating his theories on the origins of neurotic syndromes. And Freudian analysts were largely the ones who, in the early decades of the last century, described people with the sort of “confounded identities” that are now considered personality disorders.

Their problems were not periodic symptoms, like moodiness or panic attacks, 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. They represented something else altogether.”

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.

In the late 1970s, Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, pulled together the bulk of the work on personality disorders, most of it descriptive, and turned it into a set of 10 standardized types for the American Psychiatric Association’s third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide.

These diagnostic criteria held up well for years and led to improved treatments for some people, like those with borderline personality disorder. Borderline is characterized by an extreme neediness and urges to harm oneself, often including thoughts of suicide. Many who seek help for depression also turn out to have borderline patterns, making their mood problems resistant to the usual therapies, like antidepressant drugs.

Today there are several approaches that can relieve borderline symptoms and one that, in numerous studies, has reduced hospitalizations and helped aid recovery: dialectical behavior therapy.

This progress notwithstanding, many in the field began to argue that the diagnostic catalog needed a rewrite. For one thing, some of the categories overlapped, and troubled people often got two or more personality diagnoses. “Personality Disorder-Not Otherwise Specified,” a catchall label meaning little more than “this person has problems” became the most common of the diagnoses.

It’s a murky area, and in recent years many therapists didn’t have the time or training to evaluate personality on top of everything else. The assessment interviews can last hours, and treatments for most of the disorders involve longer-term, specialized talk therapy.

Psychiatry was failing the sort of patients that no other field could possibly help, many experts said.

“The diagnoses simply weren’t being used very much, and there was a real need to make the whole system much more accessible,” Dr. Lenzenweger said.

Resisting Simplification 

It was easier said than done.

The most central, memorable, and knowable element of any person — personality — still defies any consensus.

A team of experts appointed by the psychiatric association has worked for more than 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.

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Sex, love, surrogacy and 'Sessions'

BERKELEY, Calif. — Cheryl Cohen Greene likes to spend weekends close to home with her husband, Bob, a former postal worker. Often, they go hiking in the Berkeley Hills that surround their neighborhood, or watch movies in the living room of their modest duplex.

At 68, Greene is trim for her age and says she'd lose 10 pounds if she didn't love food so much. She's a devoted grandmother who frequently visits with her two children and grandchildren.

No one would guess that more than 900 people have paid to have sex with her.

Greene has worked as a surrogate partner therapist for 40 years. During one-on-one sessions at her home, which doubles as an office, she uses sensual touch to guide those who struggle with sex and intimacy issues. She almost always removes her clothes. And — yes — she sleeps with her patients. In the bed, by the way, that she shares with her spouse.

VIDEO | The Envelope Screening Series: 'The Sessions'

"For a long time, I didn't bring it up at cocktail parties," says Greene, who keeps hand-carved wooden statues of genitalia in the nooks and crannies of her home. A close look at her bookshelves reveals "The Guide to Getting It On" and hundreds of other sex-related titles, along with "Calorie Counting" and "The Big Book of Jewish Humor." A big Tupperware container labeled "Cheryl's Vitamins" rests on a coffee table.

"If people have an attitude about my job," she says, "I just feel sorry for them for not understanding that there's a difference between me and a prostitute."

Greene's career choice is getting newfound attention from "The Sessions," a movie based on the true story of Mark O'Brien, a journalist and poet paralyzed from the neck down. Greene, played in the film by Helen Hunt, was hired by the late O'Brien when he wanted to lose his virginity at age 38.

Not all of the attention is positive. Although some in the country's small community of sex surrogates are hopeful that "The Sessions" might inspire more people to join the profession, others say the movie does not accurately depict the career path and its therapeutic worth.

PHOTOS: Celebrity portraits by The Times

"I would never get naked in my first session with someone like Cheryl's character does in the movie," says Shai Rotem, a 43-year-old male surrogate, who began his career in his native Israel and now practices in Los Angeles. "We have to get to know one another first and develop a safe rapport."

Greene is one of fewer than 40 practicing partner therapists in the U.S. certified by the International Professional Surrogates Assn., a governing body for the industry.

Two decades ago, there were hundreds of surrogates working in the U.S. after sex researchers William Masters and Virginia Johnson popularized the idea in their 1970 book "Human Sexual Inadequacy." With the rise of AIDS in the mid-1980s, many spouses of surrogates insisted their partners quit the profession.

"There's no law against it because the intent is not to exchange sex for money," says IPSA president Vena Blanchard. "These clients are paying tons of money to sit and talk and do breathing exercises and learn about their body. So much of the work has nothing to do with intercourse or arousal."

Greene, who speaks with a thick Boston accent, was born in Salem, Mass., grew up Catholic and converted to Judaism after marrying her first husband, Michael Cohen. She and Cohen had an open marriage, which in the 1970s wasn't unusual among their Bay Area peers. She also worked as a nude art model and walked around her home naked, even with her children in the room.

THE ENVELOPE: Coverage of the awards season

She first considered becoming a surrogate after a friend handed her a copy of the pseudonymous "Surrogate Wife: The Story of a Masters & Johnson Sexual Therapist and the Nine Cases She Treated." The friend told her, "I think you would be good at this work."

She learned to practice conjoint therapy — where two or more people work through issues together — from two therapists who trained with Masters and Johnson. Soon, she began answering calls for the San Francisco Sex Information hotline, and discovered how much she liked helping people with their sex-related questions.

"I wasn't even thinking about the fact that I'd be sleeping with strangers," she says of her decision to become a surrogate. "I just liked the idea of guiding people to be more relaxed about their sexuality."

Greene sits in her bedroom as she talks, and through the window's plantation shutters, her son's home is visible. He and his family live behind Greene's residence.

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Alt Text: How to Tell Real SEALs From Basement-Dwelling Posers

The White House recently congratulated the makers of Troop ID, a service designed to help online merchants securely identify members of the armed forces. This was a significant recommendation, the first software application to be publicly praised by the president since he canceled a 2009 press conference in order to play Doodle Jump.

While I’m happy that troops will be able to claim their 10 percent discount on water bottles and mock turtlenecks, I’m a bit disappointed that the service is apparently only being used in a retail context. After the whole Stolen Valor saga, you’d think there’d be a huge demand for a secure way to vet self-described vets.

Here’s a statistic: While there are only 2,500 active-duty Navy SEALs at any given time, there are approximately 4 million people claiming to be current or former Navy SEALs in various chat rooms and message boards on the internet. This is because any argument is 200 percent more convincing when presented by a Navy SEAL.

A couple of examples:

Unconvincing: “As a mall food court assistant supervisor, I believe that our mission in Afghanistan is necessary to the stability of the Middle East.”
Convincing: “As a Navy SEAL, I believe that our mission in Afghanistan is necessary to the stability of the Middle East.”

Unconvincing: “As a teaching assistant in comparative literature, I believe that The Silmarillion is vastly overrated by Tolkien fans.”
Convincing: “As a Navy SEAL, I believe that The Silmarillion is vastly overrated by Tolkien fans.”

With results like that, it’s no wonder that people are attempting to fraudulently win arguments by pretending to be members of elite military squads like the SEALs, the Green Berets, the Army Rangers and occasionally G.I. Joe. It seems to me that Troop ID could be used to distinguish the Special Forces from the basement-dwelling posers.

Once we have that technology in place, we could easily expand it to ferret out other internet pretenders. For instance, before you claim that you’re going to show up at someone’s house and beat them up, or argue that you’d have a mugger in a headlock before he could say “hand over the cash,” you’d be expected to use the ToughGuy ID service to certify that you have actually, at some point, won a fight that wasn’t against a sibling at least four years younger than you.

Our founding fathers created the First Amendment protections on free speech for a good reason: because it’s freaking hilarious.

Or before you can declare that the solution to the “fiscal cliff” crisis is obvious to anyone who knows anything about economics, you’d be expected to provide proof to Expert ID that your main credentials in economics aren’t limited to having seen both Atlas Shrugged movies.

I say “expected to” because I’m not saying that you would have to sign up for these services. Goodness no, my ludicrous and improbable fantasies aren’t that tyrannical. I believe that our founding fathers created the First Amendment protections on free speech for a good reason: because it’s freaking hilarious. There’s nothing more fun than watching someone weave ever-more-desperate lies to cover up their unwillingness to either put, or shut, up.

However, I do think there’s one vital concern that overrides the right to free speech: Before commenting on a humor column on the web, everyone should be required to take a simple test that would confirm that they have the basic human ability to recognize sarcasm and hyperbole.

- - -

Born helpless, naked and unable to provide for himself, Lore Sjöberg overcame these handicaps to become a commando, a commandant and a cormorant.

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“Searching for Sugar Man,” “First Cousin Once Removed” Win at International Documentary Festival

LOS ANGELES (TheWrap.com) – “Searching for Sugar Man” is continuing to find critical acclaim.

Malik Benjelloul‘s documentary about musician Rodriguez, who abandoned music only to find his career resuscitated after becoming hugely popular in South Africa, won the Best Music Documentary award at the International Documentary Film Festival Amsterdam, the festival said Friday.

“Sugar Man” also took home the Audience award.

Alan Berliner’s documentary “First Cousin Once Removed,” about his uncle’s struggle with Alzheimer’s disease, also scored big, winning for Best Feature-Length Documentary.

Movies News Headlines – Yahoo! News

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The New Old Age Blog: Turning a Home Into a Hospital

At age 96, my mother moved to New York City to live with me and my family in our two-bedroom Manhattan apartment after becoming increasingly isolated while living alone in Florida. She moved into my sons’ bedroom surrounded by all manner of adolescent paraphernalia, including every style of trendy sneakers, a giant papier-mâché statue of Michael Jordan and a poster of Bob Marley.

Three years later, at age 99, she was hospitalized and diagnosed with pancreatic cancer. Because of her advanced age, there was little to do to except make the last months of her life more comfortable. Her doctor arranged for home hospice care through Calvary. But part of me wanted to place her in a nursing home.

The idea of hospice care in my home overwhelmed me. I did not want my apartment to become a nursing facility, and the idea of personally taking care of my mother was frightening. I was preoccupied with thoughts and fears of losing her, and I was very afraid of witnessing her physical deterioration and her death.

As a psychotherapist in private practice, I treat people with emotional problems like anxiety and depression. I am introspective enough to know that I am comfortable with treating the mind, but squeamish about medical problems, especially serious medical issues.

Now my mother was dying, and I had to live with the uncertainty of what was going to happen. When would she no longer be able to bathe herself? Was she going to be bedridden? Incontinent?

Step by step, I overcame my fears, accepting the reality of our new situation. Looking back, the choice was inevitable — and I am grateful I took the steps of that life-changing journey.

My husband encouraged me to take on the challenge of caring for my mother in our home. He thought it would be cruel to put her in a nursing home. Easy for him to say, I thought, since my mother’s physical care would fall predominately on me.

Upset over my dilemma, I was crying. My mother, in her hospital bed, asked, “Why?”

“I don’t know how I can continue taking care of you in our home,” I told her. But I asked her what she wanted to do.

“I want to go home,” she said. “We will manage.”

So she left the hospital to again live with us.

The Calvary hospice nurse walked me through all the steps of home hospice care. After the first home visit, the nurse ordered an oxygen tank and told me there could be no smoking in the home or even in the hallway outside my apartment door, because the oxygen was flammable.

That made me uneasy. Although I was instructed how to use the tank, I was anxious that I would forget how to use it when the moment arrived that my mother had difficulty breathing. In my panic, I called the medical home care supply company to take the tank back. When my mother’s doctor told me that it was critical to have the oxygen available in case of an emergency, I relented. I was terrified that she might suffer.

My mother at that point had her full faculties and was able to get around. She could even walk, albeit very slowly, to the senior citizen’s center on our block and to the Jewish Community Center across the street, where she played mah-jongg and canasta. That stopped soon, however, and I had to order a wheelchair for her to use when she went out.

Calvary provided me with a home health aide for five hours a day and a social worker. That was helpful but stressful. Because of my work as a therapist, coordinating schedules was a challenge.

As she grew more ill, my mother became too weak to shower, dress or go to bathroom by herself. I had to hire an additional home health aide for the afternoon and for full days on weekends. Eventually, I needed to get an overnight aide.

I was surrounded by an army of hospital-like caretakers who used hand sanitizer immediately upon entering the apartment, ate in our kitchen, showered in the bathroom and slept with my mother in one of our two bedrooms. I felt the loss of control and a sense of chaos, which was made worse when my youngest son returned home after graduating from college and underwent emergency surgery for a torn A.C.L. He generously gave up his bedroom to my mother (and to the aide who slept there at night) and camped out in the living room.

My house had truly been turned upside down. But what kept me sane was knowing that the chaos was temporary, and that we were providing my mother with the care she needed, in the setting that had been her choice.

I had to learn to trust that the aides would act in my mother’s best interest. In fact, most of them were generous and devoted to my mother’s care to the end.

Her last days were not without a touch of humor. One night, the aide called me into the room telling me that my mother, still with her full faculties, was “seeing smoke.” I thought, “Is she hallucinating?”

I sat down on the bed. My mother pointed to the Bob Marley poster. She asked, “Is that famous man smoking?” She had looked at that poster for three years and never asked until then.

But another night, around 1 a.m., my son overheard my mother yelling, “Don’t touch me.” He found the nighttime aide pushing my mother back into bed. The aide wanted to sleep through the night and did not want to be bothered taking my mother to the bathroom. I fired the aide the next day.

Gradually, I surrendered to the reality that my apartment had been turned into a nursing home. My mother now had an oxygen tank, a walker, a wheelchair, a shower chair, a commode, Depends and bed pads.

Still, I had said from the beginning that I did not want a hospital bed in my home. Its name alone symbolized the transformation of my home into a hospital. But two days before my mother’s death, I relented. My mother could not get up from the bed that she had been using. She needed the adjustable bed to lift and transfer her.

With the arrival of that bed, I finally accepted the new reality: my home was indeed transformed into a nursing home, despite all my initial fears about living with my dying mother in that environment.

At 99, just 8 months short of a century, my mother died in my home surrounded by family and the Bob Marley poster. It was a peaceful passage. She died with grace and dignity.

As I reflect on the experience, I am glad that I was able to be with my mother through the end of her journey. It was tough to watch this once strong, vital woman become thin and fragile. And as my last living parent, she was the buffer between myself and the reality of my mortality.

Still, the experience was emotionally rich and liberating. And, in the end, we were both at peace.

Linda G. Beeler is a psychotherapist in private practice in Manhattan.

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Stocks Decline in the Early Going

Wall Street opened lower on Monday as investors returned to the market after a holiday-shortened trading week, focused on the meeting of euro zone finance ministers on Greece and negotiations over the United States budget.

The Standard & Poor’s 500-stock index fell 0.5 percent in morning trading, and the Dow Jones industrial average fell 0.6 percent. The Nasdaq composite index was off 0.1 percent.

Euro zone finance ministers and the International Monetary Fund were to release the second bailout package for Greece on Monday, but they first needed to agree if some of the official loans to Athens might eventually be forgiven to cut Greek debt.

In Washington, lawmakers made little progress in the past 10 days toward a compromise to avoid the harsh tax increases and government spending cuts scheduled to start taking effect on Jan. 1, a senior Democratic senator said Sunday.

On Friday, the Dow and S.&P. 500 both closed above key technical levels for the first time since Nov. 6. The Dow ended above 13,000 points, while the S.&P. broke above 1,400. For the week, the Dow rose 3.3 percent, while the Nasdaq jumped 4 percent. The Nasdaq had ended lower for the previous six weeks in a row.

The sovereign wealth fund Qatar Holding has cashed in its remaining warrants in Barclays, a move that should yield a $280 million profit and still leaves the sovereign wealth fund as the bank’s top shareholder following a controversial fund-raising in 2008. Barclays fell 5.2 percent in New York.

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Attack on Pakistani Shia Muslims kills five, injures 70

ISLAMABAD, Pakistan — A bomb blast in northwest Pakistan killed five people and injured 70 others Sunday, provincial and local authorities said, the latest in a wave of attacks that have struck the country’s minority Shia Muslim community despite a host of stringent security measures, including wide-scale cellphone service bans and prohibitions on motorcycle riding in several cities.

The attack in Dera Ismail Khan was the second to strike the city of 119,000 this weekend and the fourth in five days directed at Shia Muslims as they commemorate the anniversary of the 7th century martyrdom of Imam Hussein, a grandson of the prophet Muhammad. A remote-controlled bomb planted in a shop exploded as a procession of Shia Muslims passed by, police said.  

On Saturday in Dera Ismail Khan, seven people were killed and 26 others injured by a remote-controlled bomb buried under a pile of garbage that exploded while a Shia Muslim procession moved past. Shia Muslims commemorate Imam Hussein’s death with large processions that wend their way through cramped neighborhoods in dozens of Pakistani cities, creating a formidable challenge for police assigned to provide security for the mourners.

No one had claimed responsibility for Sunday’s attack, though suspicion immediately focused on the Pakistani Taliban, the country’s homegrown insurgency. The group had previously said it was behind the wave of violence against Shia Muslims earlier in the week. The Shia Muslim community remains a prime target for the Pakistani Taliban and other Sunni militant groups, which regard Shia Muslims as heretics.

In one of the earlier attacks this week, a suicide bomber slipped into a procession of more than 150 Shia Muslims late Wednesday in the garrison city of Rawalpindi and detonated his explosives-filled vest, killing 23 people and injuring 62 others, according to Rawalpindi police. Earlier on Wednesday, militants detonated two bombs outside a Shia mosque in Pakistan’s largest city, Karachi, killing two people and injuring 12 others.

Anticipating a spike in attacks, Pakistani officials late last week announced a series of restrictions aimed at curbing violence against Shia Muslims.

Cellphone service was suspended in dozens of Pakistani cities over the weekend, a measure aimed at preventing the use of cellphones as remote-control detonators. Because assailants often use motorcycles to carry out attacks, motorcycle riding was banned in Islamabad, the capital, and the southern cities of Hyderabad and Quetta. The Pakistani newspaper Express-Tribune reported that the northwest town of Haripur imposed a 15-day ban on the wearing of shawls and coats to prevent would-be attackers from hiding explosives and other weapons.

ALSO:

Suicide bomber kills 3, wounds 90, in Afghanistan attack

Middle East shifts may weaken Iran's influence with Palestinians

Clashes erupt, offices ablaze after Egypt president expands power

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Tracking Mars: Curiosity Makes Its Mark on the Red Planet

Since Curiosity landed on mars on Aug. 6, the rover has traveled hundreds of feet over the Martian surface. In the process, it has tracked up the sandy, dusty terrain, leaving tire marks, scoop divots, Morse code and one tiny piece of itself behind.

Unlike the Apollo astronauts' footprints on the moon, Curiosity's trails will probably be wiped away by the planet's frequent wind and sand storms. But there is still something so incredible about these little ephemeral marks we are making on another world.

Though the physical traces won't last, their impact lives on in the images the rover is sending back to Earth. Here are some of our favorite shots of Curiosity's tracks on Mars.

Image: NASA/JPL-Caltech

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Deborah Raffin, Actress and Audio-Book Entrepreneur, dies at 59

LOS ANGELES (TheWrap.com) – Actress Deborah Raffin, who went on to found a profitable audio-book company, died Wednesday after a battle with leukemia, the Los Angeles Times reports. She was 59.

Raffin’s brother William told the Times that she had been diagnosed with the disease approximately a year ago. She died at the Ronald Reagan UCLA Medical Center.

The Los Angeles native landed early parts in the 1973 film “40 Carats” and in 1975′s “Once Is Not Enough,” adapted from the steamy Jacqueline Susann novel. In the 1980s, she became something of a TV-movie staple appearing in such fare as “Mind Over Murder,” “Willa” and “For the Love of It.”

She also starred in a short-lived TV series based on the Goldie Hawn/Chevy Chase film “Foul Play,” assuming Hawn’s role of Gloria Mundy.

Raffin and her husband, producer Michael Viner, launched the audio-book company Dove Books-on-Tape in the mid-’80s, publishing a profitable mix of titles that included Sidney Sheldon’s “The Naked Face” and Stephen Hawking’s “A Brief History of Time.”

Viner and Raffin, who had one child together, divorced in 2005. Viner died in 2009.

In later years, Raffin had a recurring role on the WB drama “7th Heaven” and appeared in three episodes of ABC Family’s “The Secret Life of the American Teenager.”

TV News Headlines – Yahoo! News

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Lobbying, a Windfall and a Leader’s Family

The New York Times

Ping An, one of China’s largest financial services companies, is building a 115-story office tower in Shenzhen. The company is a $50 billion powerhouse now worth more than A.I.G., MetLife or Prudential.

SHENZHEN, China — The head of a financially troubled insurer was pushing Chinese officials to relax rules that required breaking up the company in the aftermath of the Asian financial crisis.

The survival of Ping An Insurance was at stake, officials were told in the fall of 1999. Direct appeals were made to the vice premier at the time, Wen Jiabao, as well as the then-head of China’s central bank — two powerful officials with oversight of the industry.

“I humbly request that the vice premier lead and coordinate the matter from a higher level,” Ma Mingzhe, chairman of Ping An, implored in a letter to Mr. Wen that was reviewed by The New York Times.

Ping An was not broken up.

The successful outcome of the lobbying effort would prove monumental.

Ping An went on to become one of China’s largest financial services companies, a $50 billion powerhouse now worth more than A.I.G., MetLife or Prudential. And behind the scenes, shares in Ping An that would be worth billions of dollars once the company rebounded were acquired by relatives of Mr. Wen.

The Times reported last month that the relatives of Mr. Wen, who became prime minister in 2003, had grown extraordinarily wealthy during his leadership, acquiring stakes in tourist resorts, banks, jewelers, telecommunications companies and other business ventures.

The greatest source of wealth, by far, The Times investigation has found, came from the shares in Ping An bought about eight months after the insurer was granted a waiver to the requirement that big financial companies be broken up.

Long before most investors could buy Ping An stock, Taihong, a company that would soon be controlled by Mr. Wen’s relatives, acquired a large stake in Ping An from state-owned entities that held shares in the insurer, regulatory and corporate records show. And by all appearances, Taihong got a sweet deal. The shares were bought in December 2002 for one-quarter of the price that another big investor — the British bank HSBC Holdings — paid for its shares just two months earlier, according to interviews and public filings.

By June 2004, the shares held by the Wen relatives had already quadrupled in value, even before the company was listed on the Hong Kong Stock Exchange. And by 2007, the initial $65 million investment made by Taihong would be worth $3.7 billion.

Corporate records show that the relatives’ stake of that investment most likely peaked at $2.2 billion in late 2007, the last year in which Taihong’s shareholder records were publicly available. Because the company is no longer listed in Ping An’s public filings, it is unclear if the relatives continue to hold shares.

It is also not known whether Mr. Wen or the central bank chief at the time, Dai Xianglong, personally intervened on behalf of Ping An’s request for a waiver, or if Mr. Wen was even aware of the stakes held by his relatives.

But internal Ping An documents, government filings and interviews with bankers and former senior executives at Ping An indicate that both the vice premier’s office and the central bank were among the regulators involved in the Ping An waiver meetings and who had the authority to sign off on the waiver.

Only two large state-run financial institutions were granted similar waivers, filings show, while three of China’s big state-run insurance companies were forced to break up. Many of the country’s big banks complied with the breakup requirement — enforced after the financial crisis because of concerns about the stability of the financial system — by selling their assets in other institutions.

Ping An issued a statement to The Times saying the company strictly complies with rules and regulations, but does not know the backgrounds of all entities behind shareholders. The company also said “it is the legitimate right of shareholders to buy and sell shares between themselves.”

In Beijing, China’s foreign ministry did not return calls seeking comment for this article. Earlier, a Foreign Ministry spokesman sharply criticized the investigation by The Times into the finances of Mr. Wen’s relatives, saying it “smears China and has ulterior motives.”

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