What diagnosis is most likely for a client exhibiting confrontational behavior and self-mutilation threats to prevent family abandonment?

The diagnosis of borderline personality disorder is most appropriate in this scenario due to the specific behaviors exhibited by the client, such as confrontational behavior and self-mutilation threats. Individuals with borderline personality disorder often experience intense emotional instability, fear of abandonment, and impulsive actions that can include self-harm as a means of expressing distress or as a way to manipulate situations to prevent perceived rejection or abandonment by loved ones.

This disorder is characterized by a pattern of unstable interpersonal relationships, self-image, and emotions. The combination of confrontational behavior, which may reflect an emotional reaction to perceived threats of abandonment, alongside the use of self-mutilation as a coping mechanism, aligns well with the symptomatology seen in borderline personality disorder.

While other options present valid conditions—such as narcissistic personality disorder, which involves a pattern of grandiosity and a lack of empathy, and paranoid personality disorder, characterized by pervasive distrust and suspicion of others—these do not typically present with the same emotional turbulence or self-harming behaviors targeted as a response to abandonment fears. Similarly, posttraumatic stress disorder primarily relates to the aftermath of traumatic experiences and is less likely to involve such direct confrontational strategies or self-harm as a means to influence relationship dynamics.

Thus,