Diogenes syndrome: What you need to know
People with the condition often show signs of severe self-neglect, social isolation, and hoarding. They may live in unsanitary conditions. The person does not make a conscious decision to do this.
Views on self-hygiene and safety vary can between people and cultures. As a result, many of the symptoms of Diogenes syndrome can also be difficult to assess and treat objectively.
However, a person with this condition may be at risk of harm from poor hygiene or self-neglect.
Diogenes was a Greek philosopher who lived in a barrel in the 4th Century.
As Diogenes syndrome usually occurs with other conditions and there is little research about it, the current Diagnostic and Statistical Manual of Mental Disorders 5th Edition, (DSM V) does not list it as a psychiatric condition.
What is Diogenes syndrome?
Aloofness, detachment, and self-neglect are signs of Diogenes syndrome.
Men or women of any age and socioeconomic status can have Diogenes syndrome, but it usually appears as a behavioral disorder in older people.
Research suggests that it is most common among people with average intelligence, who are over 60 years, and who live alone.
Around 0.05 percent of people aged 60 years and older may have Diogenes syndrome. It is considered rare, but there is a lack of research about its prevalence.
Diogenes syndrome can be primary or secondary.
Primary: No other existing medical condition triggers the condition.
Secondary: The syndrome results from another mental health disorders.
Other names for Diogenes syndrome include senile or severe social breakdown syndrome, self-neglect syndrome, senile squalor syndrome, and messy house syndrome.
Symptoms vary, but a cluster of common features may be present, including signs of self-neglect.
- poor 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
- 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 poor hygiene, such as dermatitis passivata
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.
Hoarding and Diogenes syndrome
Researchers have described Diogenes syndrome as "a special manifestation of hoarding disorder."
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 environment.
Hoarding can be a public health hazard as it attracts insects and rodents. The buildup of possessions and trash can also pose a fire hazard and make it difficult for the person to escape if a fire occurs.
What did Diogenes say to Alexander the Great?
Ancient tales explain that when Alexander the Great visited Corinth, the Greek minimalist philosopher Diogenes was the only person who did not go to pay his respects.
Alexander found him lying in the sun. He 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.
Diogenes' contemporaries, however, described him as showing a "lack of shame" and "contempt for social organization."
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:
- frontotemporal dementia
- obsessive-compulsive disorder (OCD)
- alcohol abuse disorder
Diogenes syndrome can result from a trauma, such as the loss of a loved one, or it may stem from a mental health issue.
Research is still being conducted to improve understanding of Diogenes syndrome. Most of what people know about the condition comes from psychological case studies.
Case 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.
Some sources estimate that at least half of all cases occur in people without prior mental health conditions.
In times of distress and grieving, everyday activities like personal care tend can become disrupted, or a person may overlook them. Lack of self-care, extreme social isolation, and neglect are what tend to make Diogenes syndrome different from hoarding.
Due to the lack of specific research, there is a poor understanding of the health, social, and mental complications related to Diogenes syndrome.
However, research has shown that people with the syndrome are at risk of having a shorter lifespan.
There is no formal diagnosis or treatment plan for Diogenes syndrome.
Some studies recommend compiling complete medical and psychological history for the individual and performing a physical exam, blood screening, and organ function tests to work out a baseline of health.
There may also be:
- imaging tests to rule out other conditions that may cause similar symptoms
- personality assessments, which may shed light on the root cause of the syndrome
Medications and counseling
There are currently no medications or therapy options specifically for managing Diogenes syndrome.
Medications for other conditions may help alleviate symptoms, such as paranoia or mania.
Psychological factors are also important to consider, as they can trigger the syndrome or cause it to continue. Intensive psychological therapy or counseling may help some people.
Withdrawal from society and a fear of medical and other institutions can make it hard to help a person with Diogenes syndrome.
These treatments work best alongside other support systems that can help treat the underlying cause of the syndrome.
For example, cleaning and personal care services can help decrease the severity of symptoms.
People with Diogenes syndrome are often fearful of hospitals and authorities. The individual may not want or see the need for help.
They may refuse medical intervention. This can lead to ethical and legal complications.
Whoever is involved with helping the individual needs to handle each case with extreme sensitivity. Home health or community care workers may be in the best position to provide assistance.
However, it is essential to be sensitive to the individual's needs and feelings. If the person feels that the health workers or other people are attacking or judging them, or if the intervention makes them feel unsafe, they are more likely to refuse further aid and to return to prior behaviors.
Tips for caregivers
Helping a person with Diogenes symptom can be a challenge. Most people with 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.
They may be able to help by seeking the assistance of local social services, but any intervention must be done with care and sensitivity.
A person with Diogenes syndrome tends to neglect their own physical needs, including health and hygiene. They may also engage in hoarding behavior.
The individual will often not be keen to see a doctor or seek help, but family and friends can encourage them to do so. However, this must be done with sensitivity.
I have become friends with a lady who I think has this condition. She talks to me and seems to trust me, and I just listen. However, I notice that she becomes afraid if anyone tries to help her, because she thinks they are trying to trap her. I worry about her mental and physical health. What can I do to help?
The most important question one must ask is whether or not the person is safe or if their behaviors are putting their health and safety or the health and safety of others at risk, for example by causing a public health issue.
You might want to consider contacting family members for assistance. If the lady has no family, law enforcement officials in most states can bring individuals who demonstrate clear and compelling evidence of being a danger to themselves or others to a local emergency room for psychiatric evaluation. This may be an option.
Although most people would be concerned about doing this, you need to consider the bigger picture. Would you prefer the lady be mad at you or sick or even possibly dead because of their illness?Timothy J. Legg, PhD, CRNP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.