Diogenes Syndrome: Identification and Distinction from Hoarding Disorder

Abstract

“Severe domestic squalor” or Diogenes syndrome is characterised by extreme self-neglect of environment, health, and hygiene, excessive hoarding, squalor, social withdrawal, and a distinct lack of concern or shame regarding one’s living condition. This report presents a case of a 51-year-old male admitted to the hospital psychiatric ward following the police removing him from his home. Police officers attended the man’s home following the alarm being raised by his stepfather that he had not been seen or heard from in 3 weeks. His home was covered in several feet of rubbish, rotting food, and debris and smelled intensely of rotting mould, urine, and faeces. He was found lying nude on top of garbage with a rug over him. Diogenes syndrome is highly comorbid with psychiatric and somatic disorders, including depression, obsessive-compulsive disorder, personality disorder, and stress. This case report provides a rare opportunity to better understand the distinction of Diogenes syndrome from the closely related condition hoarding disorder. Furthermore, creating an agreed-upon constellation of symptoms representative of Diogenes is essential to creating a formal Diagnostic and Statistical Manual of Mental Disorders (DSM) entry, which would facilitate the much-needed development of assessment measures to enable accurate diagnosis and treatment.

Castration and emasculation in the Middle Age. The andrological conundrum of Peter Abelard

“…68 Although similar, DS could be distinguished from the Hoarding disorder, being the former characterized by squalor and the latter by hoarding (syllogomania). 69 Interestingly, the DS patients express higher than average intelligence, a past of successful professional and business lives, with good family backgrounds and upbringing. 70 Personality characteristics, such as schizotypal or obsessive-compulsive personality disorders, are highly associated with DS and/or a pathological reaction late in life to major distress might also be a concurrent cause.…”

“…Additionally, it has also been hypothesized that Abelard suffered from a certain Diogenes syndrome (DS), which is characterized by an extreme self‐neglect, dirty, untidy life, social withdrawal, and a filthy personal appearance, named from Diogenes of Sinope, a Cynic Greek philosopher 68 . Although similar, DS could be distinguished from the Hoarding disorder, being the former characterized by squalor and the latter by hoarding (syllogomania) 69 . Interestingly, the DS patients express higher than average intelligence, a past of successful professional and business lives, with good family backgrounds and upbringing 70 .…”

Diogenes syndrome - causes and treatment of pathological hoarding and self neglect

“…The term refers to a Greek philosopher who rejected average functioning in society and chose destitution [3]. The condition was originally referred to as "senile squalor syndrome," [4,5] the more recent term "severe domestic squalor" is also accepted [5,6].…”

“…The main symptoms are syllogomania -excessive hoarding, extreme neglect of hygiene, health and living environment, living in squalor, refusal to help and lack of shame and concern for one's own condition and living conditions, loneliness, seclusion [5,7,8].…”

Household Factors and Prevalence of Squalor: Meta-analysis and Meta-regression

“…The person living in a consistently and significantly unclean and disorganised home is often referred to in research as suffering from Diogenes Syndrome (DS) [1][2][3][4][5] or they are said to be residing in Severe Domestic Squalor (SDS). Snowdon suggests that the term SDS should be used when "…a person's home is so unclean, messy and unhygienic that people of similar culture and background would consider extensive clearing and cleaning to be essential. "…”