In a Nutshell 


In a NutShell (previous articles)

ME (Myalgic Encephalomyelitis)
Is a serious debilitating chronic multisystem illness that can leave the sufferer house or bed bound. This condition is often misunderstood by many professionals (GP’s, consultants, physio’s, nurses) and lay people as 'all in the mind’ or viewing it as simply fatigue. This is despite having robust evidence showing it to be a biological illness. Affecting many systems of the body, symptoms include profound fatigue, post exertional malaise, sleep disturbance, cognitive impairment, postural orthostatic tachycardia, fibromyalgia type pain, sensitivity to sounds, smells, light, enlarged lymph nodes and IBS. It is diagnosed after having certain conditions ruled out through medical test such as Lyme’s disease, thyroid disease, anemia, Addison disease etc. It is crucial to obtain a early diagnosis from a qualified doctor and a consultant with an understanding of this condition. The hallmark symptom of ME/CFS isn’t fatigue at all: It’s a dramatic worsening of symptoms after exertion (which for some patients can be as little as washing themselves). Cognitive problems can be incapacitating whereby the person can’t talk or read; within half an hour of standing, their blood pressure drops or their heart rate soars; and sleep makes them feel no better. Given all the above many sufferers will, naturally, suffer from depression too. Associations: www.irishmecfs.org (frequent events with expert speakers). Reading: Living With M.E.: The Chronic, Post-viral Fatigue Syndrome by Dr. Charles Shepherd. For latest research: ME/CFS/PVFS An exploration of the key clinical issues (2017) from www.meassociation.org.uk. Investinme (research conferences). Article on M.E. (Myalgic Encephalomyelitis) in the Irish Times Tuesday Nov. 28th, 2019 (http://bit.ly/2ByC5zV)  Many doctors, psychiatrists, physio's and other professionals lack accurate understanding of ME and it is often misdiagnosed and sufferers given inapproriate and potentially harmful treatment. 

Dialectical Behavior Therapy (DBT) 
Is a modified cognitive behavioral treatment that combines behavioral science with acceptance and mindfulness. It was originally developed by Dr. Marsha Linehan to treat chronically suicidal individuals diagnosed with borderline personality disorder. DBT involves the learning and practicing of particular coping skills such as self monitoring, emotion regulation and tolerance, mindfulness and interpersonal skills. Extended group based programs are available in the HSE which also include individual therapy and phone coaching session. Resources: http://behavioraltech.org. 

Personality disorders
Are long-term patterns of behavior and inner experiences that differs significantly from the ‘norm’. The pattern of experience and behavior often begins in childhood and becomes clear by late adolescence or early adulthood and causes distress or problems in functioning. leads to substantial personal distress and/or social dysfunction, and disruption to others. Not diagnosed until after early adulthood and can be mild to severe in severity.

Borderline (emotionally unstable) PD Involves a pattern of instability in relationships, self image and affects, coupled with marked impulsivity. Others are regarded as dangerous and bad, and oneself as powerless and vulnerable (victim) as well as inherently bad and unacceptable to oneself and others. DSM Diagnostic Criteria for BPD: BPD is diagnosed on the basis of (1) a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following:

  • Frantic efforts to avoid real or imagined abandonment
  • Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  • Markedly and persistently unstable self-image or sense of self
  • Impulsivity in at least two areas that are potentially self-damaging (eg, spending, sex, substance abuse, reckless driving, binge eating) 
  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  • Affective instability due to marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper, constant anger, or recurrent physical fights)
  • Transient, stress-related paranoid ideation or severe dissociative symptoms

Treatment & Prognosis: DBT programmes and General psychiatric and psychotherapy support though the work is most applicable for very experienced psychotherapists and psychologists who have training and experience in this area.  

Remissions can occur but can also be lifetime. With support can learn to manage emotions, behaviour and thoughts better. There is some research showing that borderline personality disorder runs in families and individuals have a higher chance of developing BPD if experienced early sexual abuse or alcoholism in the family.


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