Client: A.S., 34-year-old male Setting: Outpatient Veterans Affairs Mental Health Clinic Presenting Complaint: "I can't sleep and I keep reliving what happened." History: A.S. is a recently discharged military veteran who survived an improvised explosive device (IED) attack during deployment. He reports persistent nightmares, emotional numbing, and avoiding crowded environments. His spouse notes increased irritability and detachment from family members. A.S. denies substance use and suicidal ideation but expresses "hopelessness about things ever changing." Exhibits Complete the following sentence by using the list of options. The client is at risk for developing dropdown Clinical Disorder/Clinical Manifestation due to dropdown

• Suicidal ideation: Hopelessness is a major psychological predictor of suicidal thoughts because the client perceives no future improvement. His statement about feeling “stuck in the past” and believing nothing will change increases vulnerability, even in the absence of a current plan. Persistent distress, impaired functioning, and PTSD further heighten this risk. • Hopelessness: The client verbalizes ongoing emotional numbness, avoidance, and lack of improvement, which reflects a persistent belief that recovery is unattainable. This emotional state undermines coping capacity and contributes to increased psychological instability. Hopelessness specifically elevates suicide risk among clients with PTSD. Rationale for Incorrect Choices • Alcohol use disorder – The client denies substance use, and no behavioral indicators suggest alcohol misuse. While PTSD increases risk for alcohol use, there is no evidence of selfmedication or cravings. Hopelessness alone does not directly predict alcohol misuse without supporting symptoms. • Ataxia – This is a neurological motorcoordination disturbance typically associated with intoxication, neuropathy, or cerebellar dysfunction. The client displays no motor deficits and ataxia is unrelated to psychological hopelessness. No medications or conditions present would cause balance or coordination issues. • Substance use disorder – Although trauma survivors are at increased risk for substance misuse as a coping mechanism, the client reports no use, and records show no behavioral cues indicating drug-seeking behavior. • Panic disorder – Panic disorder involves recurrent unexpected panic attacks with intense autonomic symptoms, which have not been documented. The client reports hyperarousal but not discrete panic episodes. Hopelessness does not directly cause panic attacks. • Sleep deprivation – Sleep deprivation is already present as a symptom, not a consequence of hopelessness. The client experiences nightmares and poor sleep, but these are existing issues, not outcomes predicted by hopelessness.