A nurse is caring for an adolescent client who has a recent diagnosis of conduct disorder.
The client has demonstrated episodic aggression toward animals and humans, and has been known to threaten individuals with a knife and has sexually assaulted another adolescent.
Nurses' Notes: - 09:00: Client showed signs of agitation during group therapy.
- 13:00: Client had a verbal altercation with another client.
- 17:00: Client participated in one-on-one counseling, showed some signs of remorse.
Medical History: - Numerous instances of property destruction (breaking windows, damaging cars, and setting small fires) of family members as well as neighbors.
- Guardians are fearful of the client being around their other children.
Select the three findings that indicate the client is experiencing positive outcomes from the prescribed treatment:

Choice A rationale:

This response is dismissive of the client's concerns and does not acknowledge their feelings. It also implies that the client is not knowledgeable about their own condition. This could make the client feel defensive and less likely to share their concerns in the future.

It focuses on the medical facts of the diagnosis rather than addressing the client's emotional state. It may come across as patronizing or judgmental, further alienating the client.

Choice B rationale:

This response demonstrates active listening and empathy. It acknowledges the client's feelings and validates their concerns. This can help to build trust and rapport with the client.

It encourages the client to express their fears and worries, which can be therapeutic in itself.

It opens the door for further discussion about the client's concerns and provides an opportunity for the nurse to offer support and education.

Choice C rationale:

This response is reassuring, but it does not address the client's underlying concerns. It may also come across as dismissive or patronizing.

It relies solely on the medical chart to make a judgment about the client's concerns, without taking into account the client's own perspective.

It does not provide an opportunity for the client to express their fears and worries.

Choice D rationale:

This response is a deflection and does not provide the client with the support they need in the moment. It may also make the client feel like their concerns are not being taken seriously.

It shifts the responsibility for addressing the client's concerns to the provider, which may not be helpful if the client is already feeling anxious or uncertain.

Choice A: History of bulimia nervosa: While eating disorders can be comorbid with self-harm, bulimia nervosa specifically is not a strong independent risk factor for self-harm. The focus of bulimia nervosa lies on purging behaviors to counteract weight gain, and while self-harm can co-occur, it's not directly linked to the core symptoms of the eating disorder.

Choice B: Parent with dependent personality disorder: Personality disorders in family members can create complex family dynamics and contribute to emotional distress, but inheriting a personality disorder is not possible.

Additionally, dependent personality disorder specifically is characterized by excessive reliance on others, not behaviors associated with increased risk for self-harm.

Choice C: Recent promotion at work: Positive life events like a promotion are unlikely to directly increase the risk of self-harm. In fact, achieving goals and milestones can be protective factors for mental health.

Choice D: Borderline personality disorder: Borderline personality disorder (BPD) is a well-established risk factor for self-harm. Individuals with BPD often experience emotional dysregulation, impulsivity, and fear of abandonment, which can lead to self-injurious behaviors as a coping mechanism. The intense emotions and unstable interpersonal relationships associated with BPD make individuals more vulnerable to engaging in self-harm to manage overwhelming distress.

Further Explanation:

BPD is characterized by a pattern of five or more of the following symptoms:

Fear of abandonment: Frantic efforts to avoid real or imagined abandonment.

Unstable relationships: Intense and unstable relationships with a pattern of idealization and devaluation. Identity disturbance: Markedly unstable sense of self-image or self-worth.

Impulsivity: In at least two areas that are potentially damaging (e.g., spending, unsafe sex, substance abuse). Suicidality: Recurrent suicidal threats, gestures, or attempts, or self-mutilating behavior.

Affective instability: Marked mood swings (e.g., intense episodes of anger, dysphoria, anxiety, or despair lasting a few hours and up to a few days).

Chronic emptiness: Feelings of emptiness or boredom.

Dissociation: Transient, stress-related episodes of derealization or depersonalization.

Research indicates that individuals with BPD have a significantly higher risk of self-harm compared to the general population, with estimates ranging from 70% to 90%. This increased risk is attributed to several factors associated with BPD, such as:

Emotional dysregulation: Difficulty managing intense emotions, leading to self-harm as a way to cope with overwhelming distress.

Impulsivity: Engaging in harmful behaviors without considering the consequences, including self-harm.

Fear of abandonment: Self-harm can be used as a way to punish oneself or manipulate others to prevent perceived abandonment.

Negative self-image: Low self-esteem and feelings of worthlessness can contribute to self-harming behaviors as a form of self-punishment.

Conclusion:

While other factors may contribute to self-harm risk, borderline personality disorder remains a significant and well- established risk factor. A mental health nurse reviewing a client's medical record should prioritize identifying BPD as a potential indicator of increased risk for self-harm behaviors.

Choice A: History of bulimia nervosa: While eating disorders can be comorbid with self-harm, bulimia nervosa specifically is not a strong independent risk factor for self-harm. The focus of bulimia nervosa lies on purging behaviors to counteract weight gain, and while self-harm can co-occur, it's not directly linked to the core symptoms of the eating disorder.

Choice B: Parent with dependent personality disorder: Personality disorders in family members can create complex family dynamics and contribute to emotional distress, but inheriting a personality disorder is not possible.

Additionally, dependent personality disorder specifically is characterized by excessive reliance on others, not behaviors associated with increased risk for self-harm.

Choice C: Recent promotion at work: Positive life events like a promotion are unlikely to directly increase the risk of self-harm. In fact, achieving goals and milestones can be protective factors for mental health.

Choice D: Borderline personality disorder: Borderline personality disorder (BPD) is a well-established risk factor for self-harm. Individuals with BPD often experience emotional dysregulation, impulsivity, and fear of abandonment, which can lead to self-injurious behaviors as a coping mechanism. The intense emotions and unstable interpersonal relationships associated with BPD make individuals more vulnerable to engaging in self-harm to manage overwhelming distress.

Further Explanation:

BPD is characterized by a pattern of five or more of the following symptoms:

Fear of abandonment: Frantic efforts to avoid real or imagined abandonment.

Unstable relationships: Intense and unstable relationships with a pattern of idealization and devaluation. Identity disturbance: Markedly unstable sense of self-image or self-worth.

Impulsivity: In at least two areas that are potentially damaging (e.g., spending, unsafe sex, substance abuse). Suicidality: Recurrent suicidal threats, gestures, or attempts, or self-mutilating behavior.

Affective instability: Marked mood swings (e.g., intense episodes of anger, dysphoria, anxiety, or despair lasting a few hours and up to a few days).

Chronic emptiness: Feelings of emptiness or boredom.

Dissociation: Transient, stress-related episodes of derealization or depersonalization.

Research indicates that individuals with BPD have a significantly higher risk of self-harm compared to the general population, with estimates ranging from 70% to 90%. This increased risk is attributed to several factors associated with BPD, such as:

Emotional dysregulation: Difficulty managing intense emotions, leading to self-harm as a way to cope with overwhelming distress.

Impulsivity: Engaging in harmful behaviors without considering the consequences, including self-harm.

Fear of abandonment: Self-harm can be used as a way to punish oneself or manipulate others to prevent perceived abandonment.

Negative self-image: Low self-esteem and feelings of worthlessness can contribute to self-harming behaviors as a form of self-punishment.

Conclusion:

While other factors may contribute to self-harm risk, borderline personality disorder remains a significant and well- established risk factor. A mental health nurse reviewing a client's medical record should prioritize identifying BPD as a potential indicator of increased risk for self-harm behaviors.