Dwight is a character in the famous and popular comedy series The Office. Case story:
Dwight works at a paper company and his position mainly consist of sales. He also owns a family farm where he grows beats. Dwight has been assigned 20 hours of therapy because of dangerous and harassing behavior on his work place. This disturbing behavior was especially towards one of his co-workers named Jim Harpert. Reportedly, Dwight had put Jim Harpers desk on fire, unfortunately ending up burning down his own desk too. Therapy session:
Dwight enters the room, takes a deep breath and ignores me greeting him. He studies the room and turn directly towards the office leather couch placed behind my desk. He smells the couch and thereafter touches the couch and says “this is a good quality cow”. He continues “fact, did you know the best way too slay a cow without damaging the leader is to stab them in the ear, directly centered towards the middle of the brain” I ask him if he would like to sit or lie down in the couch. He looks at the coach and answers me that he never lies down. He could be attacked by alien warriors that are trying to implant baby aliens in his body. Finally, he chooses to sit down in the couch. In our session I start out talking about his work. He seemingly enjoys his job assignments while discussing his duty’s at the firm. Continuously, he mentions that he is the assistant to the regional manager. When I ask him about his coworkers he tells me that they are all just useless peasant that puts the company to shame. The conversation quickly turns towards the incident burning down the two desks. Dwight ignores the severity in his actions. Explaining me Harper has been a nuisance every day since they worked together the last 4 years, and adds, that he could possibly be a shape shifter. He shows no signs of remorse, but acts as if it is justified by his annoyance with Harper. I asked him if burning down the desk was an impulsive action or a planned one. Dwight’s response was “Fact, alpha male never kills without planning, it would be dull” I continue the session asking more about the alleged aliens he mentioned earlier. Dwight explains to me that the aliens live on his farm and destroys his beat harvest, and that he is fortunately trained in a mixture between martial arts and Asian dance style. Mental status:
Dwight’s perception of reality is distorted. He acts paranoid, delusional and has grandeur thought about himself, almost narcissistic. There is evidence that he has some cognitive dysfunction as well. His thought process is not very mature. It seems to always revolve around surviving in an unrealistic context. One aspect that could indicate cognitive dysfunction is his childish fantasies about shape shifters, aliens and warriors. He shows abnormalities in his language use, but not dysfunction. He starts sentences with the word “fact”, thereafter providing disturbing information involving violence. I would also say he even shows psychotic behavior, this includes delusions, but not necessarily hallucinations. His mood and affect is not that abnormal. Even though he might have some mental dysfunction, it does not seem to have a big impact on his social/occupational dysfunction. He seems to function normally on a day to day basis without problems with his social life or work life. His college accepts his abnormal behavior, sometimes leading to humor on his dispense. Dwight is not always aware of this. Also he does not understand the severity’s of his actions, and lacking empathy and understanding the consequences of his actions. He therefore also clearly lacks insight and judgment. Diagnosis:
Dwight is suffering from the mental disorder, schizophrenia. He exhibits several diagnostic criteria’s, but not all of them. According to DS-IV-TR you must have minimum two of the following symptoms, each presenting a majority of the time during 1-month period: delusions, hallucinations,...