Diogenes Syndrome is a disorder characterized by self-neglect, poor grooming and hygiene, and very often a strong tendency toward hoarding.
Diogenes Syndrome occurs most often among older persons who live by themselves and who have above average intelligence, but it can afflict people of almost any age and any socioeconomic status. The affliction is considered rare in terms of its prevalence in society, but it is also hard to estimate its true spread because it is not well understood or recognized, so numbers may be significantly understated.
The latter is diagnosed when there are other medical conditions present in the patient, whereas the former is diagnosed when no other medical issues are present.
Diogenes syndrome is known by several other names, including severe social breakdown syndrome, senile syndrome, messy house syndrome, and squalor syndrome, but all of these refer to an individual’s lack of attention to personal living conditions and a tendency to ignore them altogether.
There are a number of symptoms which characterize Diogenes Syndrome, each of which relates to self-denial and tolerance of poor living conditions. People afflicted with the condition often have a poor sense of personal hygiene and safety, frequently appearing in a disheveled condition and lacking regard for cleanliness.
This lack of cleanliness and hygiene often leads to skin conditions which develop as a result of inattention to basic personal care like bathing and washing. This situation is often carried to an extreme, as the person afflicted can sometimes go for days and even weeks without any attempt at personal hygiene. Fleas and lice are often observed on the bodies of sufferers, with no apparent regard for them by the host.
Some of the most common manifestations of poor personal grooming and hygiene show up as long, untrimmed hair, quite often matted together from lack of washing, and from having collected foreign substances. Long fingernails and toenails are another characteristic of the bad grooming habit, and more often than not, Diogenes sufferers will also have an unmistakable body odor about them, stemming from the refusal to shower or bathe.
Unsanitary or unsafe living conditions are a hallmark of their normal existence, accompanied by poor nutrition and diet. When others attempt to intervene or assist, individuals with Diogenes Syndrome will generally reject all such overtures, preferring instead to rely on their own sense of well-being. Other habits characteristic of Diogenes sufferers are pronounced hoarding, fear of medical personnel and other professionals, and a very obvious hostility or aggression toward those people whom they do not trust.
Such people have a general distrust of other people, bordering on paranoia or suspicion where none is warranted. They are also generally aloof or indifferent and can be frequently anxious without apparent reason for it.
Another symptom often observed in people suffering from Diogenes Syndrome is a marked tendency toward hoarding. This hoarding habit usually has no basis in legitimate need or in the value of materials being stored – objects of the hoarding obsession are generally of little or no value, and can even be items of garbage.
Because of all the other symptoms like lack of hygiene and inattention to personal grooming, a whole catalog of other complications become possible, all of which stem from some of these base symptoms. It has been found, for instance, that the hoarding tendency has cluttered up residences of sufferers to the extent that tripping and falling become likely. It’s also not uncommon for the dwelling places of Diogenes patients to catch fire because of the hazardous collection of hoarded materials. When fires have occurred, they have often been intense, for just this reason.
It is also common for sufferers of Diogenes to be severely undernourished and/or dehydrated, simply because they don’t normally pay attention to their diet and do not eat regular meals that would help to sustain them. While it might strike observers as extremely odd that such people have so little care for their own health and welfare, and routinely practice extreme self-neglect, these are all aspects of life and daily living that are just not considered by people with Diogenes Syndrome.
Diogenes Syndrome can be triggered in people either by medical conditions or by non-medical reasons.
Stroke is one fairly common cause of the syndrome, especially when the stroke occurred without the victim receiving timely assistance so that the eventual impact became more severe than it would have otherwise.
A severe reduction in ambulatory capabilities sometimes leads to Diogenes Syndrome, because the victim has such drastically curtailed ability to move around. Being forced into pronounced inactivity can also lead to profound depression, which can also affect the sufferer and hasten the onset of the syndrome. For this reason, other sources such as recurring broken bones or chronic arthritis can become primary causes of the syndrome, dictating that the victim become far more sedentary than before.
The condition has also been known to be triggered by congestive heart failure, which causes fluids to build up in the body and negatively affect the normal operation of the major organs of the body. Problems with vision and increasing frailty of an older person can be somewhat more subtle triggers for the syndrome since they have a strong influence over the desire to remain in one place, rather than be active and mobile.
Dementia is one last medical condition which can lead to Diogenes Syndrome, and it is one of the most common of all the causes. When an elderly person experiences the typical effects of dementia (disorientation, confusion, forgetfulness), especially in its later stages, these can easily be extended into the kinds of symptoms which characterize Diogenes Syndrome, e.g. self-neglect, et al.
Apart from the medical conditions which can trigger Diogenes Syndrome in victims, there are also a number of non-medical reasons someone might fall prey to the condition. For instance, it’s very common for someone who has suddenly lost a trusted companion or spouse to be plunged into the confounding mindset of Diogenes Syndrome.
Those people who have a history of mental illness are also at greater risk for having that illness deteriorate into the condition characterized by Diogenes. Substance abusers are also at greater risk of contracting the disease because brain patterns have been so frequently and intensely disrupted.
There are several situations in childhood and adulthood that can have a tremendous impact on a person, which do not necessarily get manifested at the time, but which do show up later in life. These kinds of triggers do not always lead to Diogenes Syndrome of course, but if they are present during younger years, it becomes that much more likely that a person could be afflicted as a senior by them.
One major condition like this is being routinely abused, and this can be very impactful at almost any age, even though consequences may not appear until much later in life. People who have developed certain personality traits from their younger years and throughout adulthood can have a much greater tendency toward contracting Diogenes Syndrome. Some of these traits include being strongly introverted, being suspicious and unfriendly in nature, and having a powerful detachment from others, i.e. the ‘loner’ personality.
Complicating any kind of treatment program for Diogenes Syndrome is the fact that most patients afflicted have no idea that they are suffering from it in the first place, and understandably tend to resist all attempts at such treatment. Still, it is very important that people with this disorder receive some form of treatment, because of the greatly increased risk of life-threatening illness and injury.
The unhealthiness of their lifestyles can also lead to disease and gradually deteriorating health if the downward spiral is not interrupted. It can also be dangerous to live with or be around someone with this disorder, for the same reasons that the victim is at risk.
When treatment is initiated, a physician will attempt to determine the cause of the disorder in the first place, because without addressing the cause, the symptoms will continue to be manifested indefinitely. It’s also extremely important to assess how competent the patient is so that it can be determined whether or not they can become a participant in their own treatment.
In cases where the patient is deemed capable of participating, behavioral therapies can be very effective in managing and reversing some of the attendant habits of the disorder. Sometimes being involved with support groups and networking with others can be very beneficial, provided that the patient’s resistance to such activities can be overcome and their voluntary participation can be counted on.
It’s fairly common for treatment programs to include medications as well since these can be used to deal with anxiety and mistrust, depression, psychosis, and the characteristics of obsessive-compulsive disorder. Patients who are in an advanced stage of Diogenes syndrome may have to be treated on an inpatient basis, partly to administer appropriate care for their condition and partly to monitor potentially dangerous behaviors.
There are also cases of Diogenes Syndrome where the affliction is much less serious and only requires periodic check-ins by a caregiver, to ensure that daily living requirements are being satisfied and that dangerous habits are being avoided.
Since the causes of Diogenes Syndrome are so diverse, any program of prevention would be very difficult to implement. For those cases brought on by medical conditions, prevention of Diogenes would require prevention of the original medical condition, e.g. dementia, heart failure, stroke, and loss of mobility.
In cases where Diogenes was triggered by a non-medical condition, such as the loss of a spouse, there is no realistic way to avoid the major life events which happen to everyone. Being abused earlier in life should ideally be avoided, but abuse occurs without the consent of the victim in virtually all cases, so that is likewise unrealistic.
Personality traits which ultimately are exaggerated and intensified into the characteristics of the disorder are only slowly acquired throughout childhood and adulthood, and they are not often subject to reversal.
However, the best hope for prevention is always in identifying the disorder in its early stages and enlisting the aid of qualified medical personnel to arrest the condition before worsening takes place. Elderly loved ones should be monitored closely when they exhibit any of the classic symptoms of the disorder such as hoarding, self-neglect, poor hygiene, and unsocial behavior.
If the disorder can be diagnosed soon enough, it becomes much more likely that a treatment program will be effective and that the worst characteristics of the disorder can be either lessened or avoided altogether. One of the most important requirements of treatment and prevention, therefore, is that a friend or loved one becomes involved and helps the afflicted person receive proper medical care.