What Is Diogenes Syndrome?

Diogenes syndrome is a behavioral-health condition characterized by poor personal hygiene, hoarding, and unkempt living conditions. It is most common in older men and women, which is why it is also called senile squalor syndrome. Persons with Diogenes syndrome demonstrate little concern for self-care or a clean living environment and seem frankly undisturbed about their condition or how others respond to it. It is thought that, in some cases, Diogenes is a response to late-in-life trauma, such as the loss of a longtime spouse or caregiver. Treatment is often difficult because the individual resents intrusions on the way he or she is living, leading to resistance and a lack of cooperation. 

If a family member is showing signs of self-neglect or an inability to maintain clean or safe living conditions, the psychiatric specialists at Baptist Health may be able to help.

What Are the Symptoms of Diogenes Syndrome?

The following symptoms are typical of someone with Diogenes syndrome:

• Poor personal hygiene, including body odor, rashes, unwashed hair, untrimmed nails, and malnutrition
• Unsanitary living conditions, including undisposed trash or garbage, rodent and insect infestations, and odors of rotting food and other forms of decay
• Cluttered and disorganized surroundings that result from hoarding
• Unawareness of and a lack of shame regarding current living conditions
• Adamant refusal of offers for assistance or medical care 

There are two forms of Diogenes: primary and secondary. Primary Diogenes refers to individuals displaying symptoms with no further evidence of a mental-health condition. Secondary Diogenes manifests in conjunction with one or more mental-health conditions and may be either a cause or an effect of those conditions. Diagnoses are split about evenly between these two forms. 

Diogenes symptoms often develop gradually over time. Because many of the individuals suffering from it live alone, it often goes undetected until after the symptoms are full-blown. 

What Causes Diogenes Syndrome? 

Scientists are currently researching the cause or causes of Diogenes syndrome. Most of what is known results from individual case studies where certain patterns of behavior have become evident. There is some suggestion that Diogenes develops in response to stressful or traumatic events, such as the loss of a longtime spouse or partner. A temporary decline in self-care during a period of mourning seems to be extended indefinitely in a Diogenes state. 

The following risk factors appear to apply:

• Old age
• Living alone, due to divorce, abandonment, or death of a loved one
• A tendency toward introversion and social withdrawal
• History of mental illness
• Dementia
• Damage to the frontal lobe, the decision-making center of the brain
• Alcohol or drug abuse

The latter is a particularly important factor. Addictive behaviors are common among persons with Diogenes syndrome, presumably as a coping mechanism for depression, loneliness, and social isolation. 

How Is Diogenes Syndrome Diagnosed?

Because many Diogenes sufferers live isolated lives, a family member is often required to bring their situation to the attention of medical personnel. Alternatively, conflict with neighbors over odors, pests, or dilapidated surroundings will sometimes result in the involvement of police or other civic authorities, who can encourage medical engagement, especially if a public hazard is present (e.g., the threat of fire based on hoarding newspapers and other combustibles).   

Medical researchers have yet to develop a recommended diagnosis or treatment plan for Diogenes syndrome. A physician or mental-health provider will likely want to document symptoms, learn the individual’s medical history, and conduct a physical examination to rule out possible non-psychiatric causes for self-neglect, hoarding, and the other observed behaviors. This may involve the use of imaging technology to establish the presence of brain damage in the frontal lobe. 

The physician or mental-health provider will also look for signs of other behavioral-health conditions, including alcoholism and drug abuse. Treatment of those conditions will follow from diagnoses. 

How Is Diogenes Syndrome Treated?

There is no generally recognized means of treating Diogenes syndrome. individuals with secondary Diogenes will have their other behavioral conditions addressed. This may include the use of medications for treating depression or psychosis. Detoxification programs exist for persons undergoing drug or alcohol withdrawal. Support groups may also be available, for those willing to participate in them. 

Depending on the person’s condition when he or she begins receiving medical care, hospitalization may be required. Unfortunately, established patterns of behavior often return when the individual is released from the medical facility. It is important that he or she begin to receive regular visits from a caregiver, preferably a trusted friend or family member. The caregiver can check on the person’s ability to adequately take care of him or herself. This can be a difficult task, because many Diogenes sufferers resent outside interference and will actively oppose attempts to help them. 

What Are the Complications of Diogenes Syndrome? Does It Ever Get Better?

Recovery from Diogenes syndrome has occurred but relapses to old ways are frequent. Finding a means of ending the person’s social isolation and indifference to self-care seems to be critical in effecting lasting improvement. 

Learn More About Diogenes Syndrome at Baptist Health

Helping a loved one with Diogenes syndrome can be a challenge. Just remember: the caring providers at Baptist Health are on your side. If you’re looking for treatment options or more information about Diogenes syndrome, please contact a behavioral health provider with Baptist Health today.