A 19-yeаr-оld client presents tо аn оutpаtient clinic with multiple superficial linear cuts on the forearms. The client reports intentionally cutting the skin on "at least six different days over the past 8 months." The client states, "I don't want to die. When I cut, it makes the emotional pressure stop for a little while." The client describes feeling defective and deserving of punishment and admits to frequently thinking about cutting even when not actively engaging in the behavior. Toxicology screening is negative. There is no evidence of psychosis, intellectual disability, autism spectrum disorder, or substance intoxication.Which interpretation by the nurse is most accurate?