Diogenes syndrome is when someone does not take care of themselves or their surroundings. It may lead to hygiene, health, and social issues. It often occurs with other conditions such as dementia.
Also known as severe domestic squalor, people with Diogenes syndrome often show signs of severe self-neglect, social isolation, and hoarding. They may also live in unsanitary conditions. However, the person does not make a conscious decision to live in this manner.
Views on personal hygiene and safety can vary between people and cultures. As a result, many of the symptoms of Diogenes syndrome can also be difficult to assess and treat objectively. However, someone with this condition may be at risk of harm from hygiene issues or self-neglect.
Diogenes syndrome usually occurs with other conditions, and there is little research about it. Therefore, the current -Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) does not list it as a psychiatric condition.
It often involves a person’s home and personal hygiene degrading to a state that someone of similar culture and background would consider unacceptable and that extensive clearing and cleaning is essential.
Formerly, the condition was known as senile squalor syndrome. However, in 1975, researchers renamed it Diogenes syndrome. The name of the condition derives from Diogenes, a Greek philosopher who chose to live in squalor as a rejection of the outside world.
However, some argue that the name is inappropriate and instead suggest it should be known as severe domestic squalor.
Currently, the DSM-5-TR does not acknowledge Diogenes syndrome as a psychiatric condition. However, it does list syllogomania, or hoarding disorder, as a distinct condition.
Diogenes syndrome differs from hoarding syndrome, as someone with Diogenes syndrome neglects to clean up or throw away objects. Often, these will include rubbish, rotting food, and excrement. A person with hoarding syndrome keeps objects because they fear they might need them later or have an emotional attachment to them.
Symptoms vary, but a cluster of common features may be present, including signs of self-neglect.
These
- issues with insight or understanding of self-hygiene, public health, or safety
- distrust of society or strangers
- paranoia or general suspiciousness
- aloofness or detachment
- extreme social anxiety
- obsessive-compulsive tendencies
- not throwing away items and waste that they should discard
- unsanitary or unsafe living conditions
- issues with nutrition or diet
- unwillingness to accept outside help or intervention
- fear or distrust of medical professionals and settings
- hostility and aggression toward others
- a distorted concept of reality
- skin conditions due to hygiene issues, such as dermatitis passivata
- dental problems due to oral hygiene issues
Some health experts may categorize Diogenes syndrome into two types. The primary type occurs with no additional mental illnesses, while the secondary type occurs alongside an additional mental illness.
Other conditions that may occur with Diogenes syndrome include:
However, other research suggests there are more clinical types of Diogenes syndrome, which vary depending on the severity of hoarding, self-neglect, and social withdrawal.
Researchers are still unsure of the exact cause of Diogenes syndrome. Most of what people know about the condition comes from psychological case studies. These studies focus on individuals rather than large groups of people, so they provide a small sample size. This can be a drawback in research because what is true for one person may not be true for another.
As such, more research is necessary to understand the potential causes. However, it may occur due to multiple reasons, including neurological and psychological factors.
For example, a 2022 mini review suggests it may be a personality disorder that gradually develops into self-neglect and social retreat. Other factors, such as stressful life events or debilitating physical problems, may worsen symptoms.
Some health experts may describe Diogenes syndrome as a special presentation of hoarding disorder, the cause of which is unknown. However, it may relate to stressful life events and problems with information processing, such as planning, attention, and organization.
Currently, there is no formal diagnosis process for Diogenes syndrome.
After displaying behaviors that could suggest Diogenes syndrome, a doctor may recommend compiling the individual’s complete medical and psychological history. They will also perform a physical exam, blood screening, and organ function tests to assess the person’s health.
These findings may help identify potential causes and guide treatment.
Similarly, at present, there is no formal treatment plan for Diogenes syndrome. Due to a lack of official guidance, treatment can vary between individuals. Typically, it may involve psychological therapies and treatment for underlying health conditions.
Therapy and counseling may help someone to change certain behaviors. Medications for other conditions may help ease certain symptoms, such as paranoia or mania. In some cases, social support systems may also be beneficial. For example, cleaning and personal care services can help decrease the severity of symptoms.
Helping a person with Diogenes syndrome can be a challenge. Most people with the condition refuse help even from family members and close friends.
The tendency toward isolation and social anxiety means that many cases of Diogenes syndrome take a long time to identify and treat.
People with immediate or forced interactions are often the first to spot cases of the condition. These include neighbors, close family members, and mental health care workers.
They may be able to help by seeking the assistance of local social services, but any intervention requires care and sensitivity.
Some answers to common questions about Diogenes syndrome may include:
What is the cause of Diogenes syndrome?
Currently, researchers are still unsure of the exact cause of Diogenes syndrome. It may develop in response to stressful or traumatic events, such as the loss of a longtime partner.
Some other evidence suggests it may stem from a mental health condition or due to problems with certain regions of the brain.
What is the cure for Diogenes syndrome?
At present, there is no general treatment for Diogenes syndrome.
A doctor will provide the most suitable treatment options. This can include behavioral therapies, medications for underlying mental health conditions, and support groups. In other cases, a person may need inpatient treatment or monitoring from a caregiver.
What is the root cause of hoarding?
It is not currently clear what causes hoarding. Genetics, brain function, and stressful life events likely play a role.
For example, in some cases, it may relate to childhood experiences of losing things, not owning things, or feeling a lack of care from other people.
What to do if someone may have Diogenes syndrome but will not get help?
The help and support of others are important parts of a treatment plan for Diogenes syndrome. Although a person may not want to seek help, family and friends can encourage them to do so.
However, it is important to do so with sensitivity. People can try to highlight that these behaviors may be putting their health and safety at risk. In some cases with clear evidence of health risk, it may be necessary to involve law enforcement officers to bring individuals to a local emergency room for psychiatric evaluation.
A person with Diogenes syndrome tends to neglect their own physical needs, including health and hygiene. They may also engage in hoarding behavior. The exact cause is unknown but may involve multiple factors.
The individual will often not be keen to consult a doctor or seek help, but family and friends can encourage them to do so. However, this requires sensitivity. Treatment may involve counseling, social support, and medications to treat an underlying condition.