A mental health nurse is reviewing the medical record of a client who self-harms.
Which of the following pieces of information should the nurse identify as placing the client at risk for self-harm behaviors?
The client has a history of bulimia nervosa.
The client has a parent who has dependent personality disorder.
The client recently received a promotion at work.
The client has borderline personality disorder.
The Correct Answer is D
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale for Choice A:
Pacing can be a physical manifestation of anxiety. It allows individuals to release some of the nervous energy that builds up during anxious moments. Restricting this behavior can potentially escalate anxiety.
Walking with the client can provide a sense of safety and support. It demonstrates to the client that they are not alone in their anxiety and that the nurse is there to help them.
Gradually slowing the pace of the walk can help to regulate the client's breathing and heart rate. This can have a calming effect on both the body and mind.
Walking can also be a form of distraction. It can help to take the client's mind off of their worries and focus on the present moment.
Walking can help to release endorphins, which have mood-boosting effects. This can help to counteract some of the negative emotions associated with anxiety.
Rationale for Choice B:
Escorting the client to their room may be perceived as restrictive and controlling. This could potentially increase the client's anxiety.
Removing the client from the public area of the unit may isolate them from other people and activities. This could make them feel more alone and anxious.
Rationale for Choice C:
Allowing the client to pace alone may not be safe. The client could potentially become agitated or injure themselves.
Pacing alone does not provide the client with any support or guidance. This could make it more difficult for them to manage their anxiety.
Rationale for Choice D:
Instructing the client to sit down and stop pacing may be perceived as dismissive and unhelpful. It does not address the underlying causes of the client's anxiety.
Forcing the client to stop pacing could potentially escalate their anxiety. This could lead to agitation, aggression, or other negative behaviors.
Correct Answer is A
Explanation
Choice A rationale:
1. Understanding OCD:
OCD is a chronic mental health condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions).
Individuals with OCD feel compelled to perform rituals to relieve anxiety or prevent perceived harm, even if they recognize the behaviors as excessive or irrational.
Rituals can consume significant time and interfere with daily functioning.
2. Rationale for Choice A:
Acknowledges the client's needs: Planning for rituals demonstrates understanding and acceptance of the client's experience, fostering trust and rapport.
Reduces anxiety: Allowing time for rituals can temporarily reduce anxiety, making the client more receptive to other interventions.
Gradual approach: It's a stepping stone towards Exposure and Response Prevention (ERP), the gold-standard treatment for OCD.
Enhances control: Scheduling rituals can help the client feel more in control, reducing the urge to engage in them compulsively.
3. Addressing potential concerns:
Reinforcing rituals: While there's a possibility of temporarily reinforcing rituals, it's a necessary first step to build trust and engagement in therapy.
Interfering with treatment: Scheduling rituals is a part of a comprehensive treatment plan that includes ERP and other therapies to address the underlying causes of OCD.
4. Importance of individualized care:
The specific approach to planning for rituals should be tailored to the client's unique needs, preferences, and severity of symptoms.
Collaboration with the client is essential to ensure their active participation in treatment. I'll now address the rationales for the incorrect choices:
Choice B rationale:
Setting strict limits on behaviors can be counterproductive: Triggers anxiety and distress
Impedes trust and therapeutic alliance Diminishes sense of control
Heightens resistance to treatment
Choice C rationale:
Confronting the client about the senselessness of rituals is ineffective and potentially harmful: Exacerbates anxiety and shame
Alienates the client
Disregards the involuntary nature of OCD Undermines motivation for treatment Choice D rationale:
Isolating the client is unethical and detrimental:
Increases distress and loneliness Impedes therapeutic interactions Reinforces negative self-perceptions
Lacks evidence of efficacy in OCD treatment
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