Vol. I (1),4-23,1988 ofuse, making it likely that uhimately di5S0ciatian will be under­ The BASK Model of Dissociation stood along muhiple lines ofstudy. TM BA.SK modd amaptualM the complex phenommowgy ofdis­ For reprints write: sociation along with dimensionsof&hauior, Affed, Sensation, alld Walter C. Young, M.D. KnfJWkd~. The jmJUSJ ofdissocia'ion ilstlf, h)'Jmosis, and tkclin­ National Center for the Treaunent of ital mental d.i.umlers that constitute the dissociative disorders art Dissociative Disorders tk$cribui in tenru ofthis nUJ(M. alld iUustraud. 1300 Soulh POlomac, Suite 152 For reprints write: Aurora, CO 80012 Bennen G. Braun, M.D. 9701 Knox Avenue, Suite 103 Vol. I (I), 3946,1988 Skokie, lL 60076 DSM-Ill-R Revisions in the Dissociative Disorders: An Exploration or their Derivation and Rationale Vol. I (1),24-32,1988 The authors liescribt and explore changes in the dissociative disor­ The Switch Process in Multiple Personality Disorder and ders indutkd in the new DSM-IlI-R. The classification itself was Oilier State-Change Disorders redefined to minimize inadvertent areas ofuumap with other clas­ This papn- aplurts the properties ofstales ofrons~as they sifications. Rtantfindings hawmassitaUd substantial mri.sions art revtakd by the jJrtJaS$ ofstak-duln~orswilchi1lg. Drawingon oftlu critrna and texl for muhipk personality disorder. Ga'lser'S examples ofstate of ronsci()US1USS tronsiLi01ts in infants, alU:Ttd Syndrome, listed as afaditious disorckr in DSM-ill, is reclassified states ofconsciousness, and psychUUric disorders, a number ofrom­ on the basis ofrtU1lt research as a dissociatiw disorder not other­ mon prinaples arederiV«i. TheYindwktheobseroation thai states wise specijiLd. The examplesfor dissociative disorder not otherwise ofronsciousness art dismteSLlf-organixingpatJerns ofbehaviordif sfJecifml. hUlJi! been exj>atukd to bttur accommodate recogtliud dis­ feri'llg along axes ofaffed, access to memory, allention and cogni­ sociative .ryndromes toot dv notJall within thefourfonnally dtfirud tion, regukltory physiology, and sense ofself. State transitions are dissociative disorders. Several novel diagnostic entities and reclas­ marked by non-linear changes in these variables. A developmental sifications were !n'Oposed that were reJltcted for DSM-I1I-R because model is outlined and the implications Jor treatment and further there is insufficient S11P/Jmting dala at this point in time. Thesepro­ research an discu.s.sed. posals idenlifj issues that will requirt reconsideration for DSM-IV. For reprints write: For reprints wrile: Frank W. PUUlam, M.D. Richard P. KJuft, M.D. Room 105 Dissociative Disorders Program Building 15-K., NIMH The Institute of Pennsylvania Hospital 9000 Rockville Pike III onh 49th Street Bethesda, MD 20892 Philadelphia, PA 19139 Vo!. I (1),33-38,1988 Vo!'1 (1),47-53,1988 Psychodynamics and Dissociation: AU iliat Switches Psychophysiologic Aspects of Multiple is nol Splil Personality Disorder: A Review This paper amtrosiS the roles ofsplitting and dissociation in mul­ Muhiple personality disorder has been associated with marked ps~ tiplepersonality disorder. /l is proposed that dissociation is aunique chophysiologic alterations ever since careful clinical observations defensive process that serves to protect the patient from the over­ have bem TIUUie on this perplexingdisorrkr. Physical symptoms known whelmingtlJects ofseuere trauma and that multiple personality dis­ to be associated with multiple personality include headaches, con­ order nuti not call ufHm splitting as its central defensive process. vtrrionsymptoms, changesin voice, stUurt-likeadivity, untxfJklintd Fantasies ofrestitution may be incorporaUd into the dissociativt pain or insensitivity to pain, alterations in hantkdnLSS f7f" hand­ defense. Psydwiogical, physiological, and behavioral mOlhls aLL an! wriling style, palpitations, aheralions in respiration, gastroinlesti- 43 ----~- ------" , naldisturoanas im:luding bulimia and anorexia, menstrual img­ ddnminants. ull'lrities, 5l!XUol dJ$Ju nclion, andthnnaloWgimiamdiuon$indutt For reprints write: ing unusual alhrgic responses and differential respoTUe5 to nmii­ George B. Greaves, Ph.D. rntion.EarlyscimlijiCSludiesonthegalvanicskinmportMinmulJiple 529 Pharr Road personality disortkr were conducted by PritlU in lM early twentieth Atlanta, GA 30305 U1ltUry. Since 1970 IMrf has been a murgenu afinterest in mul­ liple personality disorder includingsophisticated studies a/physical Vol. I (1),67-72,1988 symptoms, brain-wave activily, visual evoked pOlentia~ rtgional The Management of Malevolent Ego States in Multiple cerebral blood flow, visual refraction, muscle activity, cardiac and Personality Disorder respiratory activity, galvanic skin rtsponse, and the switch process. "Malevolmt" persolwlities create tremendous frroblems to both tM In addition 10 tkscribing these studies, the etioroliJ ojmultlpte per­ patient and the therapist. The dangers ofpossible suicide, homicide sonalily duorderand!uturedinctions in resLaTCh will be disl.'U.JMd. and other nding-old by such angry states multiply tM diffilUllitts For reprints write: in achieuing jJt:r3onality inugration. Such entities originally devel­ Philip M. Coons. M.D. oped to jJrrHed tM individuaL They represent a defenufor- the abusM Larue D. Carter Memorial Hospital child wlw was conJronud with a situation with which he could not 1315 West 10th Srreet cope. Suggestions by tM therapist that the trMJ,ment gool is ".fusion B Indianapolis, IN 46202 constitute a threat to the e:mtmce ofaller personalities, and mobi­ liu their resistance. E~stale tMary Iwlds that "dividing B lies on a Vol. I (1). 54-60,1988 continuum, rangingJrom normal, adaptive difJermtiu.tion (as rep­ Munchausen's Syndrome as a Dissociative Disorder restmted by different moods) to jJalhowgical dissociation (as rejm­ A patient is described who was diagnosed as havingMunchausen 's sented by tnu multiplepersonality disorder). &tween lie covert "egcr Syndrome and Munchausen's by Proxy as wells as Multiple states"which areorganizations ofbehaviorandexperitmu separated Personality Disorder. Commonalities belween Munchaust11 j (lnd by snni-permeable boundaries. In this theory, treatment ofMultiple Multiple Personality Disorder include: multigenerational patterns, Pmonality Disorder involves reducing the rigidity ofthe boundarie.s selfmutilating fNhaviors, mllitiple .fOmatic symptoms, having been a'nd mOIlingthem down tM continllU m11 ntilthey fNcomugo-stat~ accused ofLying. use ofmany difJermt natll~, andfuguelilu dis­ such as are found in normal subfrcts under hJPnosis. From this appearances. Com/'1Wflalities fNtwmt Mundulllsni 's andchild abuse point ofview malevolent alters nNt! nol to be threatened with non­ nlated ~haviors incllUk hospitalperegrination and tM productitm existence, but are promised amtinutd selfness and identity within ofirnukquak explanations for injlided injuries. The pment case a larguorganiUJti01wljramDJJtl'fk. Such an approach lowers thrir is one ofa snies ofMunchausen 's Syndrome uue rrpoTts in which resistance to treatment, and "integration" (which is 'not the same as extreme abuse has been documented in the patient schildhood. ".fusWn") is moreMSilyattairud. ThetherapistfNcomes their jriend" For reprinlS write: rather than their "enem)'. " Jean Goodwin, M.D., M.P.H. For reprints write: Depanment of Psychiatry John G. Watkins, Ph.D. University ofTexas Medical Branch 413 Evans Street Galveston, TX 77550 Missoula, MT 59801 Vol. 1 (1),61-66, 1988 Vol. I (1),73-76,1988 Common mors in the Treatment of Multiple Multiple Personality Disorder and Transference Personality Disorder The aptn"eciation, interpretation, and management oftransJermce Psydwthnafrists report withl:y different expmenas in tMiraunnplS constitutes a crucial dimension in the treatment of multiple per­ at treating multiple personality disonin' (MPD) patients. So~ have sonalilJ disorder. TM auilwroffers remarks atui observations bastd dnpened thrir intmsts and d~lopedfulJAiJ7U specialiud practius on a considerable body ofdirea clinico.l expmenct! and consulta­ with this clinical population. OthDJ have declined to have anyfur­ tions to colJeagu~. The most commonly encountered problematic ther contact with them at all, nfe:rri"g possible MPD patients to col­ transference in work with MPD, tM hostile, erotic, and dependent. !Lapes when they first susput that this disordermll)' be presmt. Still are illustrated and discussed. others have decided against treating more than one or two MPD For reprinlS write: patients. These diverse decisions are examined with a focus upon Cornelia B. Wilbur, M.D. tM effects oftherapist' uneven allention to the fonnal paperties of 408 .Bristol Road the dyadicpsychotherapeutic experiences as apossible i njluence upon Lexington, KY 40502 thnrfuture work with MPD. Problems concerning tM..framework of psychotherapy andthe cou nterlra'nsff:'(ence conflicts which oflen mow the therapist unconsciously and irrationally to altf:'( tM canons of psychotherafrJ in mutually detrimental ways appear to be crucial 44 0I'11,(1( 1\[10\ \,,1 \ \" I \I~,,~ 1'I'Il~ ! VOLUMES 1-IV, 1988 - 1991 Vol. I (1),77-83,1988 Vol. I (2), 16-23, 1988 Multiple Personality Disorder Misdiagnosed as Mental The BASK Model of Dissociation: Clinical Applications Retardation: A Case Report This article is a continuation ojthe BASK Modd ofDissociation: A woman was diagnosed as mLntolly morded when SM was)nM Part I, which disCUSSLd the phnJornena and tlmTry ofdWodation. a~ Jtars of and spenl 1M next