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Dean was born and raised in one town and his father (a janitor) died when Dean was 18. His mother was a
stay at home mom. Neither parent finished high school, and Dean was born when they were 19 years old.
Dean is 52 years old and has been working as a driver for Canada Post for the past 20 years. He reports that
he likes his job and enjoys interacting with people. Dean was an only child getting a lot of attention. He
completed high school and then entered the work force.
Dean has been unmarried his entire life. He reports “I liked the girls OK and all that” but he never had a
permanent “relationship?”. He reports always being “nervous with the girls and such” and avoids significant
social engagement where women will be present. He meets his sexual needs by paying prostitutes, adding
they are safe and “we know what to do”. He will not elaborate, saying mother said never talk about “dirty
Dean takes long walks (lasting up to 5 hours). His neighbors get concerned seeing him walking alone late at
night and have called police. Recently, he has lost interest in the walks saying streets are dangerous. He goes
to church regularly; he has done throughout his life. People find him a bit odd but he is involved in church
activities. Over the past 2 years, coworkers have noted a gradual change in Dean. His social interactions seem
confused and inappropriate. He sometimes smiles when he is angry, and often seems distressed and agitated
when everyone else is laughing. Some thought he might be using hallucinogenic drugs. One dramatic event
seems to stand out where Dean was scheduled to make a postal delivery, but instead of taking the box into the
store, he handed it to a passerby on the street, explaining “Take this present from Jesus.” Dean was unable to
clearly recall the incident, and had no explanation for it. It was an isolated incident and he received a warning,
but he continues to be teased at work. This event diminished his already low self-image and ability to perform
his job. He is worried now and double-checks all duties. Dean is solitary in behaviour and watches a lot of
television. He lives in a comfortable neighbourhood, but is always checking his locks, and says that all the
young people in the area hate him and might want to “smash” his house. He disconnects his phone at night,
afraid of calls.
What diagnosis, if any, best explains this individual’s behaviour?
What observations support each diagnosis? Do any disconfirm the diagnosis?
What more do you need to know to make the diagnosis with greater certainty or to explore other possible
diagnoses? How would you get this information?
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