A nurse is caring for a client who has a binge-eating disorder. Which of the following statements should the nurse expect from this client?

Choice A Reason:

“I’d rather be dead than living like this. I do not want to be alive.”

This statement reflects a common symptom of major depressive disorder, which is suicidal ideation. Individuals with major depressive disorder often experience feelings of hopelessness and worthlessness, leading them to believe that life is not worth living. This statement is a clear indication of the severity of the individual’s depressive symptoms and the need for immediate intervention to ensure their safety.

Choice B Reason:

“If I can just keep ignoring feelings.”

This statement is less likely to be heard from a client with major depressive disorder. Ignoring feelings is a coping mechanism that some individuals might use, but it does not directly reflect the core symptoms of major depressive disorder, which include persistent sadness, loss of interest in activities, and significant impairment in daily functioning. Therefore, this choice is not as indicative of major depressive disorder as the other statements.

Choice C Reason:

“I deserve to be this way. I’ve not accomplished anything important in my life.”

This statement reflects feelings of guilt and worthlessness, which are common symptoms of major depressive disorder. Individuals with this disorder often have a negative self-view and believe that they are failures or that they deserve to suffer. This statement highlights the individual’s low self-esteem and the pervasive negative thoughts that characterize major depressive disorder.

Choice D Reason:

“This is a bad episode, but I will be well soon.”

This statement reflects a more optimistic outlook, which is less common in individuals with major depressive disorder. However, it can still be heard from some clients who experience episodic depression and have hope for recovery. This statement indicates that the individual recognizes their current state as temporary and believes in the possibility of improvement, which can be a positive sign in the context of treatment.

Choice E Reason:

“I am determined to fight this episode and get through it.”

This statement reflects a proactive and positive attitude towards managing depression, which is less characteristic of major depressive disorder. While determination and resilience are important for recovery, individuals with major depressive disorder often struggle with motivation and energy, making it difficult for them to adopt such a mindset. Therefore, this choice is less likely to be heard from a client with major depressive disorder.

Conduct Disorder

Choice A Reason: Childhood Depression

Childhood depression is a mood disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest in activities. Symptoms can include changes in appetite, sleep disturbances, and difficulty concentrating. While depression can lead to behavioral issues, it is less likely to be associated with the specific behaviors described in the scenario, such as running away and being abusive towards parents. These behaviors are more indicative of a disruptive behavior disorder rather than a mood disorder.

Choice B Reason: Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) is characterized by a pattern of angry, irritable mood, argumentative/defiant behavior, or vindictiveness. Children with ODD often lose their temper, argue with adults, and refuse to comply with rules. While ODD can involve some of the behaviors described, such as being abusive towards parents, it typically does not include the more severe behaviors like running away or engaging in illegal activities such as prostitution. Therefore, ODD is not the most fitting diagnosis in this case.

Choice C Reason: Conduct Disorder

Conduct Disorder is a more severe behavioral disorder characterized by a repetitive and persistent pattern of behavior that violates the rights of others or major age-appropriate societal norms or rules. Symptoms include aggression towards people and animals, destruction of property, deceitfulness or theft, and serious violations of rules, such as running away from home and engaging in illegal activities like prostitution. Given the behaviors described in the scenario, Conduct Disorder is the most appropriate diagnosis. Adolescents with Conduct Disorder often exhibit a lack of remorse or guilt and may have a history of problematic behaviors that escalate over time.

Choice D Reason: Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by difficulties with social interaction, communication, and repetitive behaviors. While individuals with ASD may exhibit challenging behaviors, these are typically related to difficulties in understanding social norms and communication rather than intentional defiance or rule-breaking. The behaviors described in the scenario, such as running away and engaging in prostitution, are not characteristic of ASD, making it an unlikely diagnosis in this context.