Diogenes syndrome: causes, symptoms and treatment

A lost screw, a shirt that no longer suits us, a plank of wood...

Many of us save objects and things on some occasion that, although at that moment we know that we are not going to use them, for a reason or another (either because it brings back memories or because we believe that in the future they may be necessary) we decided to save and conserve.

It is something normal and that in principle does not suppose any problem in our life. But in people with Diogenes syndrome this phenomenon becomes a habitual and problematic tendency product of self-abandonment, accumulating a large number of objects and waste without any use and causing great personal and social deterioration in their lives.

Diogenes syndrome: basic characteristics

Diogenes syndrome is a disorder characterized in that those who suffer from it collect and store a large number of belongings and possessions, usually rubbish, in their home. They have a great inability to get rid of them, so they accumulate more and more.

The objects kept by individuals with this disorder can be very diverse, from objects of great value to waste and remains, not being the real or symbolic value of the object what produces its conservation.

As in hoarding disorder the person with Diogenes syndrome has great difficulty in discarding their possessions, needing to keep them with them and experiencing anxiety and discomfort at the thought of losing them. If asked about the reason for such conservation, people with Diogenes syndrome do not usually know how to give an explanation about it.

Some authors propose that Diogenes syndrome usually occurs in three phases. At first, I would highlight the attitude of self-abandonment, beginning to generate waste that is not eliminated and begins to accumulate. Subsequently, and as the number of rubbish increases, the individual passes into a second phase in which the profusion of rubbish and rubbish makes that it is necessary to start organizing (not necessarily ordering) the material and space available, while the deterioration of the habits. In a third and final phase, the individual not only does not get rid of his waste, but also begins to actively collect elements from the outside.

Leading to lack of hygiene and self-abandonment

In the long run, the cumulative behavior of these people causes the collected objects to occupy a large part of the individual's home, organizing itself in a disorderly and expansive way throughout the entire living place. This problem leads to the point where the functionality of the home is limited, not being possible access to certain areas such as the bed or the kitchen. In addition, the disorder and lack of cleanliness caused by the accumulation causes serious hygiene problems that can compromise the health of the individual.

This syndrome produces a high level of deterioration in multiple areas, especially at a social level by causing coexistence problems. Those who suffer from it little by little withdraw from the world, isolating themselves and reducing contact with others to a minimum, This is due both to an increase in interpersonal conflicts due to their status and to the time spent storing and accumulate things. They also begin to abandon some of the main hygiene habits, both at home and personally.

These cases are often detected in advanced stages., due to complaints from neighbors and relatives due to the unhealthiness of the affected person's home, the smell and the insects and rodents attracted by the objects.

It is also common for those with Diogenes syndrome end up having serious eating problems, presenting altered eating patterns and eating little, badly and at the wrong time. They may end up consuming food in poor condition (derived from a lack of hygiene at home or an indifference to its expiration date). This together with the health problems derived from poor hygiene and the avoidance of contact with others can weaken them to the point of having to be hospitalized, and even that a high percentage of them die within a few years of the onset of the syndrome.

Possible causes

Although the cause of the cumulative behavior in cases of Diogenes syndrome is not fixed or fully known, mostly those who suffer from it are people over 65 years of age, retired and often widows.

Thus, one of the most common features is the presence of loneliness before the accumulation begins. Whether due to the death of the partner or due to abandonment, this loneliness can lead to the progressive disappearance of concern for the hygiene, food and contact with others, also appearing behavioral and affective rigidity that favors the perseveration of the accumulation. They feel a great insecurity and half that they supply by means of the accumulation. There is usually a stressful event that triggers the onset of symptoms.

A large part of the subjects with Diogenes syndrome also have a pre-existing mental or medical disorder, being very frequent that they are immersed in substance addiction processes, dementia or major depressions, often with psychotic features. So there is probable cognitive impairment that causes the person to stop worrying about health and maintaining the state of health, food and hygiene.

Treatment of Diogenes syndrome

Diogenes syndrome is a complex disorder that requires treatment from different approaches. People with this disorder do not usually go to therapy of their own free will, being referred by medical or judicial services or pressured by their families.

The multidisciplinary intervention is due to the fact that it is necessary to act both on the ideas and beliefs of the individual and on their habits, since the accumulation of garbage becomes part of the person's daily life and it is difficult to break that dynamic. Precisely for this reason, we must also act on the place where we live: focusing attention only on the person does not work.

In many cases, the authorities, alerted by complaints from neighbors and acquaintances, go to the home of these individuals and end up cleaning and disinfecting the place. Yes OK this can temporarily wipe out the accumulated garbage, does not solve the problem suffered by the subject nor does it help him to face situations in another way, so that if the external action ends there, the subject will relapse again.

Evaluation and intervention

At the treatment level, it is a priority to assess the health status of the subject and rectify the complications derived from the lack of food and hygiene. In cases where this syndrome is produced or aggravated by other disorders such as depression or a disorder psychotic, it will be necessary to apply the most appropriate strategies to treat the disorder itself, both psychologically and mentally. pharmacological. It is common to use antidepressants such as SSRIs to improve mood.

Regarding psychological treatment First of all, it would be necessary to show the existence of a problem and the need to solve it, given that most of those affected ignore or do not recognize their condition. It is also essential to carry out training in the skills and patterns of hygiene and eating behaviour.

Given that in a large majority of cases there is a high level of insecurity, this aspect must be worked in therapy, as well as the existential passivity that most of these types of patients. It is also necessary to restore the person's contact with the world, through social skills training and participation in community activities. This helps combat loneliness and the anxiety it causes. We must also work on the detachment of objects and waste and what the patient thinks about conservation.

As in the vast majority of mental disorders social and family support is an essential factor for the recovery and/or improvement of the quality of life. The psychoeducation of the closest environment is something necessary in order to understand the patient's condition and to its follow-up, being important to monitor its activity patterns and that it does not return to a state of isolation.

Difference with hoarding disorder

The characteristics of Diogenes syndrome closely resemble another disorder with which it is frequently confused, so-called hoarding disorder hoarding.

Both problems have in common the accumulation of a large number of objects and possessions that they have a hard time getting rid of. part of those who suffer from them, together with the fact that this accumulation produces serious problems in the use of personal space domestic. In both cases, it can occur anosognosia, or even a delusional belief that hoarding is not harmful despite evidence to the contrary (although failure to recognize a disorder is much more common in Diogenes syndrome).

In addition, in both disorders, problems usually appear in various vital domains, especially in the that refers to interpersonal relationships, avoiding in many cases close contact with the people.

However, in the case of hoarding disorder or hoardinghoarding is entirely intentional and usually has a concrete reason for wanting to keep it. It is a disorder linked to obsessive characteristics.

In the case of Diogenes syndrome, the accumulation is usually due more to a deterioration process, being common that there is an ongoing dementia process, and the accumulation is usually due more to unintentional passive elements (although in many cases they also collect and accumulate waste as a protection mechanism emotional).

Furthermore, while in Diogenes syndrome there is largely a deterioration in eating habits, personal hygiene and diet, in hoarding disorder these characteristics do not usually occur, being its relatively habitual behavior outside the respective collection.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Mason, Barcelona.

• Gomez, I., Prieto, F. (2008). Clinical forms of Diogenes syndrome. Regarding three cases. [Electronic version]. Biological Psychiatry, 15(3), 97-9.

• Marcos, m. & Gómez-Pellín, M.C. (2008). A tale of a misnamed eponym: Diogenes syndrome. International Journal of Geriatric Psychiatry, vol. 23, 9.

• Saiz, D., Lozano García, M., Burguillo, F., Botillo, C. (2003). Diogenes syndrome: about two cases. [Electronic version]. Psychiatry. com, 7 (5).