Diogenes Syndrome: causes, symptoms and treatment

This disorder appears when garbage and useless objects accumulate at home for no apparent reason.

A lost screw, a T-shirt that no longer suits us, a wooden plank...

Many people keep objects and things that, although at the time we know we are not going to use them, for one reason or another (either because it brings back memories or because we believe that in the future they may be necessary) we decide to keep and conserve.

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

Diogenes syndrome: basic characteristics

Diogenes syndrome is a disorder characterized by sufferers collecting and storing a large number of belongings collect and store a large number of belongings and possessions, usually junk, 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 leftovers, 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 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 this conservation, people with Diogenes syndrome usually do not know how to explain it.

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

This leads to a lack of hygiene and self-abandonment.

In the long run, the accumulative behavior of these people causes the collected objects to occupy a large part of the individual's home, organizing themselves in a disorderly and expansive manner throughout the entire dwelling. This problem to the point that the functionality of the home is limited, as access to certain areas such as the bed or kitchen is not possible.The problem leads to the point that the functionality of the home is limited, not being possible to access certain areas such as the bed or the kitchen. In addition, the clutter 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 many areas, especially at the social level by causing problems of coexistence. Sufferers gradually withdraw from the world, isolating themselves and reducing contact with others to a minimum, due both to an increase in interpersonal conflicts due to their condition and to the time spent storing and accumulating things. They also begin to abandon some of the main hygiene habits, both home and personal.

These cases are often detected in advanced stages.The symptoms of Diogenes Syndrome are often reported by neighbors and relatives because of the unhealthiness of the affected person's home, the odor and the insects and rodents attracted by the objects.

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

Possible causes

Although the cause of cumulative behavior in cases of Diogenes syndrome is neither fixed nor fully known, Most sufferers are over 65 years of age, retired and often widowed.. 

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

A great part of the subjects with Diogenes Syndrome also present a previous mental or medical disorderbeing very frequent that they are immersed in processes of addiction to substances, dementia or major depressions, often with psychotic characteristics. There is therefore a probable deterioration at the cognitive level which causes the person to stop caring about sanitation and maintenance of health, food and hygiene.

Treatment of Diogenes syndrome

Diogenes syndrome is a complex disorder that requires treatment from different requires treatment from different approaches. People with this disorder do not usually come 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 his or her habits, since the accumulation of garbage becomes part of the person's daily life and it is difficult to break this dynamic. This is precisely why it is also necessary to act on the place in which one lives: focusing attention only on the person is not useful.

In many cases the authorities, alerted by complaints from neighbors and acquaintances, go to the homes of these individuals and end up cleaning and disinfecting the place. While this may temporarily this may temporarily eliminate the accumulated garbage, it does not solve the problemThis does not solve the problem or help the individual to deal with situations in a different way, and if the external action ends there, the individual will relapse again.

Evaluation and intervention

At the treatment level, it is a priority to evaluate the subject's state of health and to remedy 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 psychotic disorder, it will be necessary to apply the most appropriate strategies to treat the disorder itself, both psychologically and pharmacologically. Antidepressants such as SSRIs are frequently used to improve mood.

As far as psychological treatment is concerned it would be necessary first of all to point out the existence of a problem and the need to solve it, since most of those affected ignore or do not recognize their condition. It is also essential to provide training in hygienic and nutritional skills and behavioral patterns.

Since in a great majority of cases there is a high level of insecurity, this aspect must be worked on in therapy, as well as the existential passivity that most of these patients display. It is also necessary to reestablish the contact of the person with the world, through training in social skills and the participation of the patient in the therapy. social skills training and participation in community activities.. This helps to combat the loneliness and anxiety that this causes. The detachment of objects and residues and what the patient thinks of conservation must also be worked on.

As in the vast majority of mental disorders, social and family support is an indispensable factor. social and family support is an essential factor in the recovery for the recovery and/or improvement of the quality of life. Psychoeducation of the immediate environment is necessary in order to make the patient's condition understood and to follow up, and it is important to monitor their activity patterns and to ensure that they do not return to a state of isolation.

Difference with hoarding disorder

The characteristics of Diogenes syndrome are very similar to another disorder with which it is often confused, the so-called hoarding disorder or hoarding.

Both problems have in common the accumulation of a large number of objects and possessions that are difficult for sufferers to get rid of, together with the fact that this accumulation produces serious problems in the use of personal domestic space. In both cases anosognosia may occur, or even a delusional ideation that hoarding is not harmful, despite evidence to the contrary. despite evidence to the contrary (although the lack of recognition of the existence of a disorder is much more common in Diogenes syndrome).

In addition, in both disorders there are often problems in several vital domains, especially in interpersonal relationships, in many cases shying away from close contact with people.

However, in the case of hoarding disorder, or hoarding hoarding is entirely intentional and usually has a specific 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 process of deterioration, 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 an emotional protection mechanism).

In addition, while Diogenes syndrome is largely characterized by impaired personal hygiene and eating habits, hoarding disorder does not usually have these features, being its behavior relatively common outside of the collection of food..

Bibliographical references:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.

• Gómez, I., Prieto, F. (2008). Clinical forms of Diogenes syndrome. About 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: apropos of two cases. [Electronic version]. Psiquiatría. com, 7 (5).