A mental health nurse is assessing the suicide risk of a group of clients on a mental health unit. Which of the following clients should the nurse identify as having a risk factor for a suicide attempt?

Choice A rationale:

Anger is a common and expected response to trauma, including sexual assault. It can stem from various sources, including:

Feelings of violation and powerlessness: Survivors may feel intense anger towards the perpetrator for taking control of their bodies and lives.

Betrayal: If the assault was committed by someone they knew or trusted, survivors may feel intense anger towards that person for breaking their trust.

Frustration and injustice: Survivors may feel angry at the injustice of the situation, the lack of control they had, and the ongoing impact of the trauma.

Difficulty processing other emotions: Anger can sometimes mask other emotions that are difficult to deal with, such as fear, sadness, or guilt.

Anger can manifest in various ways, including:

Irritability and outbursts: Survivors may have a short temper, snap at others easily, or have difficulty controlling their anger. Aggression: In some cases, anger can lead to physical or verbal aggression towards others or self-harming behaviors.

Withdrawal and isolation: Some survivors may withdraw from social interactions and relationships to avoid potential triggers for their anger.

Substance abuse: Some survivors may turn to alcohol or drugs to numb their feelings or cope with their anger.

Choice B rationale:

Sleeping 12 hours or more each day can be a symptom of PTSD, but it is not a specific indicator of anger. It can also be a sign of depression, anxiety, or hypersomnia, a sleep disorder characterized by excessive daytime sleepiness.

Choice C rationale:

PTSD can sometimes lead to an increased sense of detachment from others, rather than attachment. Survivors may feel emotionally numb, have difficulty trusting others, or withdraw from relationships.

Choice D rationale:

While some survivors of sexual assault may feel a need to talk about the event, it is not a universal symptom of PTSD. Some survivors may avoid talking about the event altogether due to the distress it causes.

Choice A rationale: Anorexia nervosa is an eating disorder characterized by relentless drive for thinness with a fear of gaining body weight associated with self-induced behaviors towards thinness. Symptoms include extreme weight loss, thin appearance, intense fear of gaining weight, bingeing and purging, abnormal blood counts, fatigue, insomnia, dizziness or fainting, bluish discoloration of the fingers, hair that thins, breaks or falls out, soft, downy hair covering the body, amenorrhea (absence of menstruation), constipation, dry or yellowish skin, intolerance of cold, irregular heart rhythms, low blood pressure, dehydration, osteoporosis, swelling of arms or legs. However, the client’s symptoms do not align with those of anorexia nervosa.

Choice B rationale: Bulimia nervosa is an eating disorder characterized by binge eating, followed by methods to avoid weight gain. Symptoms include binge eating, forceful vomiting, long-term fear of gaining weight, preoccupation with weight and body, a strong negative self-image, overuse of laxatives or diuretics, use of supplements or herbs for weight loss, excessive exercises, stained teeth (from stomach acid), calluses on the back of the hands, withdrawal from normal social activities. The client’s symptoms of using laxatives frequently and running for 1 hr after eating a very large meal, which happens at least 9 times a week, align with those of bulimia nervosa.

Choice C rationale: Histrionic personality disorder (HPD) is a mental health condition characterized by unstable emotions, a distorted self-image and a desire to be noticed. Symptoms include persistent attention seeking, dramatic behavior, rapidly shifting and shallow emotions, sexually provocative behavior, undetailed style of speech, and a tendency to consider relationships more intimate than they actually are. The client’s symptoms of feelings of anxiety and depression, starting smoking marijuana as that is what their “new friends do all the time”, and being recently arrested for stealing make-up from a local department store and acknowledging that this “is the first time I was caught” align with those of HPD.