Jesse is a 22-year-old Hispanic male detained by police officers and taken to the hospital for burns on his hands after neighbors called to report a fire threatening to damage their home; a fire started by Jesse on his property claiming it was the only way to kill the evil living in the grass and trees there to take him. Neighbors and family reports that fire and law enforcement officials have been called out to the property several times before for the same reason. Jesse’s mother reports he tells her that fire is the only way for cleansing the evil from the property.

Jesse’s mother believes the episodes began after a traumatic event he experienced at age 17 in which he was caught in a cross-fire between neighbors in front of the property witnessing the death of a friend. Shortly after the incident Jesse’s mother and sister report he stayed in his room, seldom bathing, and seeing him mumbling quietly to himself and at times seemed to be talking to something or someone not there. Jesse was often heard yelling at someone on the property, but no one was around. His mother also reports Jesse was born prematurely and experiencing academic difficulties dropping out of school in ninth grade. However, has never been seen by a professional for a complete assessment or treatment because he refuses to follow through.

As of late, Jesse’s mom is concerned for him because he has burned his fingertips and burned his arms. Jesse says he feels something crawling under his nails and skin which he has tried to burn away after someone telling him to do so.

** Provide a differential diagnosis for explaining why this client has  schizophrenia spectrum disorder and not another psychotic disorder.