People with the condition often show signs of severe self-neglect, social isolation, and hoarding. They may live in unsanitary conditions.
Diogenes was a Greek philosopher who lived in a barrel in the 4th Century and showed contempt for society.
A person with Diogenes syndrome can develop a skin condition called dermatitis passivata, where a horny crust develops over the skin. This is usually due to a lack of regular washing.
As Diogenes syndrome is normally linked to other conditions and is not fully understood, it is not listed as a psychiatric disease in the current Diagnostic and Statistical Manual of Mental Disorders 5th Edition, (DSM V).
What is Diogenes syndrome?
Diogenes syndrome may typically, but not always, affect older and isolated people.
Diogenes syndrome is typically observed as a behavioral disorder of the elderly, but it can affect men or women of any age and socioeconomic status.
However, Diogenes syndrome is most common among people with above average intelligence, who are over 60 years, and who live alone.
Approximately 0.05 percent of Americans aged 60 years and older may have Diogenes syndrome. It is considered rare, but there is a lack of research about its prevalence.
There are two forms of Diogenes syndrome: primary and secondary.
In primary cases, the syndrome is not triggered by other medical conditions that an individual already has. In secondary cases, the syndrome is the result of other mental health disorders.
Diogenes syndrome is also known as senile or severe social breakdown syndrome, self-neglect syndrome, senile squalor syndrome, and messy house syndrome.
Symptoms of the condition vary, but there is a cluster of common features that may be present, including signs of self-neglect
- Poor insight or comprehension 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
- Excessive hoarding or collecting of household items and waste
- Unsanitary or unsafe living conditions
- Poor nutrition or diet
- Unwillingness to accept outside help or intervention
- Fear or distrust of medical professionals and settings
- Hostility and aggression towards others
- A distorted concept of reality
- Skin conditions due to uncleanliness, such as dermatitis passivata
Link between hoarding and Diogenes syndrome
Diogenes syndrome has been described as "a special manifestation of hoarding disorder." Diogenes, the ancient Greek philosopher, is said to have shown a "lack of shame" and "contempt for social organization."
The home of a person with Diogenes syndrome can become so unclean and unhygienic that others from a similar cultural background would consider it necessary to clean and clear the envrironment.
What did Diogenes say to Alexander the Great?
Ancient tales explain that when Alexander the Great visited Corinth, Diogenes was the only person who did not go to pay his respects.
Alexander finding him lying in the sun, asked what he could do for him. Diogenes replied, "I would have you stand from between me and the sun."
Alexander was struck at what he considered the greatness of Diogenes, and reportedly said later that if he were not Alexander, he would choose to be Diogenes.
Other conditions with similar symptoms
The signs and symptoms of Diogenes syndrome are often difficult to distinguish from those of other medical conditions such as:
Diogenes syndrome may be difficult to identify from depression
- Syllogomania (hoarding)
- Frontotemporal dementia
- Obsessive-compulsive personality disorder
Research is still being conducted to improve understanding of Diogenes syndrome.
Most of what is known about the condition is based on psychological case studies. Some sources estimate that at least half of all cases occur in patients without prior mental health conditions.
When not associated with another medical condition, Diogenes syndrome may be brought on by a traumatic or stressful event, such as the death of a loved one.
During such periods, everyday activities like personal care tend to be disrupted or overlooked. Lack of self-care, extreme social isolation, and neglect tend to distinguish Diogenes syndrome from syllogomania.
Because little specific research is available, the health, social, and mental complications related to Diogenes syndrome are poorly understood.
However, the syndrome is thought to increase the likelihood of death.
There is no formal diagnosis or treatment plan for Diogenes syndrome.
Some studies recommend compiling a patient's complete medical and psychological history and performing a physical exam, blood screening, and organ function tests to work out a baseline of health.
Bereavement may be a trigger for Diogenes syndrome.
Some doctors may also do imaging tests to rule out the presence of other conditions that may cause similar symptoms. Other doctors conduct personality assessments, which may shed light on the root cause of the syndrome.
Currently, there are no medications or therapy options recognized or recommended specifically for managing Diogenes syndrome. Medications designed or prescribed to treat other medical conditions may help alleviate symptoms, such as paranoia or mania.
Psychological factors must also be taken into consideration, as they often lead to the development or continuation of the syndrome. Aggressive psychological therapy or counseling is sometimes necessary.
These treatments work best alongside other support systems designed to treat the underlying cause of the syndrome. For example, cleaning and personal care services can help decrease the severity of symptoms.
As people with Diogenes syndrome are frequently fearful of medical establishments, treatment is often carried out by home health or community care workers. Ethical and legal complications can complicate treatment as patients may persist in refusing medical intervention.
Because views on matters like self-hygiene and safety vary between people and cultures, many of the symptoms of Diogenes syndrome can also be difficult to objectively assess and treat.
Cases of Diogenes syndrome should be handled with extreme sensitivity by all involved. If a patient feels attacked, judged, or unsafe as the result of intervention, they are more likely to refuse further aid and to return to prior behaviors.
Tips for caregivers
Helping a person who has Diogenes symptom can be a challenge.
Most people who have the condition refuse help even from family members and close friends.
The tendency towards isolation and social anxiety means that many cases of Diogenes syndrome take a long time to identify and to 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 healthcare workers.