The Keyring: A BPD Management System

by Sarah Myles

In the early days of my treatment, when I was newly diagnosed and having weekly visits from a Community Psychiatric Nurse, she asked my husband to attend a couple of our sessions.

This was invaluable for all involved. As experienced as my husband was at dealing with what we now understood to be my disorder, this was an opportunity for him to get some expert advice. For my CPN, it was a chance to get a different view of my behaviour, as my husband could better describe the contrast between my good days of being fairly balanced, and my bad days where I would swing from rage-filled Hulk to terrified dormouse to being silently locked away in my head and back again within minutes. He could describe what my compulsive behaviours look like from the outside, and the effect it has on our family unit. For both of us, we could hear how best to support the management techniques I would be learning to implement after I had accepted what was happening. It was also very reassuring, that my care would be approached in a ‘joined up’ way, making us feel less isolated.

In these shared CPN visits, the thing that became more and more clear was my difficulty in communicating during a BPD crisis. Often, I would become completely overwhelmed - the contents of my head becoming so big and unmanageable that it would cause a 'jam' and literally affect my ability to speak. I would become physically incapable of articulating what was happening, because I was emotionally incapable of acknowledging it and letting it out. From my husband's point of view, this was a problem. Wanting to help, but not knowing what was happening in my head meant he couldn't possibly read each situation to respond appropriately.

It was an obstacle we hadn't recognised until it became clear through this work with the CPN, and as such, we couldn't immediately see the repercussions, or the solution. Discussion helped us realise that this obstacle very much exacerbated any BPD crisis or emotional spiral. Each time, I would further internalise my inability to articulate as another failure on my part, leading to 'awfulising' - automatic negative thinking about my mental health destroying all of my relationships (though it hasn't), and that I would just die alone. Similarly, being questioned or challenged by anyone during this kind of 'locked up' episode would simply make me feel under extreme pressure and make the whole thing worse.

So, we brainstormed (or 'thought-showered') on solutions. How could we break through this obstacle in a safe and constructive way? The answer came from the CPN: a keyring. I have a keyring that is blue on one side and red on the other, and I would use this as a non-verbal signal. If my husband came home, hung up his keys, and saw my keyring was displaying blue, he would know I was coping well and all was relatively fine. If the keyring was displaying red, he would know I was in crisis, could look at my behaviours objectively, and respond appropriately. It allowed me to communicate what was happening, without the huge responsibility of verbalising my head-content in a non-upsetting way. It allowed me space, while ensuring I asked for support when I needed it. It also required that I acknowledge what was happening and take action, which provided me with a sense of control - vital for BPD patients - with the desire to overcome this relationship obstacle as motivation. It also provided a means of self-assessment: "Hey, I've had more blue days than red this week!"

This incredibly simple idea was a turning point in my recovery. I had a way to communicate my distress safely to my husband, my husband had greater understanding of my behaviours, and I was back in the driver's seat in terms of my illness. This support system really came into its own when I began Dialectical Behaviour Therapy, one-on-one with a psychotherapist, temporarily increasing my emotional dysregulation.

I haven't needed the keyring in over a year. It's still hanging on the rack - a reminder of how far we've come, the recovery journey on which I remain, and everything that can be achieved with teamwork.

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