Diogenes syndrome: symptoms, causes and treatment

Old clothes, magazines and organic garbage that are never thrown into the dumpster. Buckets, woods and even boxes that they find on the street. Junk objects, family mementos, stacked furniture. People with Diogenes syndrome collect, save and accumulate everything they find, even if it is useless and even unhealthy.

This condition that most of us have heard of is not a disease in and of itself. It is a neurobehavioral syndrome defined by a pathological accumulation, states of absolute misery and an almost defiant refusal to receive help. We see more and more cases.

It has been more than 40 years since this clinical reality was described for the first time. Despite this, geriatricians, psychologists and psychiatrists warn that we increasingly face this behavior of social isolation, insane hoarding and personal neglect. The lonely elderly are the most vulnerable.

What is Diogenes syndrome?

Few news are more regrettable than those that tell us about the discovery of people in terrible conditions, buried in mountains of garbage. In general, it is the neighbors who give the warning and alert of the bad smells or the plagues of insects or rodents coming from a particular house.

However, what are we talking about when we refer to Diogenes syndrome? Is it mere insanity, loneliness, obsessive-compulsive disorder? Studies, such as the one carried out at the University of Psychiatry of Limoges (France), indicate that it is important to differentiate this condition from hoarding syndrome. Furthermore, the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-V) already makes this distinction.

Diogenes syndrome has nothing to do with obsession or compulsion. We are facing a neurobehavioral problem in which frontotemporal dementias, schizophrenias, major depressions and even a clinical history of addiction are evident. There is a clinical profile that integrates various mental disorders.

Diogenes syndrome affects lonely people over 65 years of age to a greater degree.

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What symptoms does it present?

The person with Diogenes syndrome is a victim of uselessness and neglect, of social forgetfulness, of a complex network of mental disorders. Despite the fact that all of them show a similar pathological picture, each one has its history and its triggers.

On average it manifests itself as follows:

  • They are people who collect and save everything they find.
  • They are unable to throw anything away. They are attached to all objects, including the garbage they produce.
  • They store from objects of great value to organic waste.
  • In a good number of cases we find ourselves faced with false poverty. They are people without economic regrets who keep large amounts of money at home, hidden.
  • Homes are real dumps where there is hardly any space to live.
  • They are not bothered by the smell, lack of comfort and hygiene nor the insects that surround them.
  • It is common for them to be people over 65 years old.
  • They show great physical neglect and notable lack of sanitation. They can suffer from malnutrition and dehydration.

What are the causes of Diogenes syndrome?

Diogenes syndrome is a fascinating object of study. It is because we don't know too much about the condition. It was first discussed in 1966, but it became a diagnostic category in 1975. There is little scientific literature on its causes and triggers and also some disagreement among scientists.

For now, experts have made progress in differentiating this syndrome from hoarding disorder. Diogenes syndrome is more complex, diffuse, and encompasses multiple comorbidities. In general, the following causes are suspected:

  • An alteration in the frontal lobe of the brain, something common in the elderly. This would lead to social isolation, depression and a tendency to hoard.
  • Problems of excessive alcohol consumption.
  • There is, in turn, a wide manifestation of clinical problems: major depression, dementias, psychosis, schizophrenia.
  • Many have suffered losses: death of the spouses or the abandonment of their relatives.
  • We also find ourselves with serious personality problems: introversion, detachment, hostility, distrust, anger.

In many cases, institutionalization is the only resource to help the person with Diogenes syndrome.

Diogenes syndrome treatment

We do not have an effective treatment for Diogenes syndrome. We are facing such a serious social reality that the institutionalization of the patient is chosen. They are people with clear difficulties to live in society and community.

It works as follows:

  • Legal procedure in which the State takes care of the patient: it is common for the person with Diogenes syndrome to refuse to leave their home and receive assistance; therefore a legal and juridical resolution is necessary.
  • Institutionalization of the patient: their health and hygiene are attended to. Their nutritional deficiencies and physical problems are treated.
  • An adequate mental evaluation is carried out: then comes the treatment of these clinical realities with drugs.
  • Cognitive behavioral therapy is the most appropriate psychological approach: with it we treat thoughts, emotions and behaviors.

In all these cases, the performance of social services is key, as well as neighborhood and community care with which one can be aware of the elderly who live alone and of people who, due to their vulnerability, tend to isolation. We are an increasingly aging society and these types of realities will be more common.