Diogenes syndrome
Encyclopedia
Diogenes syndrome, also known as senile squalor syndrome, is a disorder characterized by extreme self-neglect
Self-neglect
Self-neglect is a behavioural condition in which an individual neglects to attend to their basic needs, such as personal hygiene, appropriate clothing, feeding, or tending appropriately to any medical conditions they have. Extreme self-neglect can be known as Diogenes...

, domestic squalor, social withdrawal, apathy
Apathy
Apathy is a state of indifference, or the suppression of emotions such as concern, excitement, motivation and passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical or physical life.They may lack a sense of purpose or meaning in...

, compulsive hoarding
Compulsive hoarding
Compulsive hoarding is the acquisition of possessions in excess of socially normative amounts, even if the items are worthless, hazardous, or unsanitary...

 of rubbish, and lack of shame.
The condition was first recognized in 1966 and designated Diogenes syndrome by Clark et al. The name derives from Diogenes of Sinope
Diogenes of Sinope
Diogenes the Cynic was a Greek philosopher and one of the founders of Cynic philosophy. Also known as Diogenes of Sinope , he was born in Sinope , an Ionian colony on the Black Sea , in 412 or 404 BCE and died at Corinth in 323 BCE.Diogenes of Sinope was a controversial figure...

, an ancient Greek
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...

 philosopher, a Cynic and an ultimate minimalist
Simple living
Simple living encompasses a number of different voluntary practices to simplify one's lifestyle. These may include reducing one's possessions or increasing self-sufficiency, for example. Simple living may be characterized by individuals being satisfied with what they need rather than want...

, who allegedly lived in a bathtub. Not only did he not hoard, but he actually sought human company by venturing daily to the Agora
Agora
The Agora was an open "place of assembly" in ancient Greek city-states. Early in Greek history , free-born male land-owners who were citizens would gather in the Agora for military duty or to hear statements of the ruling king or council. Later, the Agora also served as a marketplace where...

. Therefore, this eponym is considered to be a misnomer
Misnomer
A misnomer is a term which suggests an interpretation that is known to be untrue. Such incorrect terms sometimes derive their names because of the form, action, or origin of the subject becoming named popularly or widely referenced—long before their true natures were known.- Sources of misnomers...

. Other possible terms are senile breakdown, Plyushkin's Syndrome (after a character from Gogol
Nikolai Gogol
Nikolai Vasilievich Gogol was a Ukrainian-born Russian dramatist and novelist.Considered by his contemporaries one of the preeminent figures of the natural school of Russian literary realism, later critics have found in Gogol's work a fundamentally romantic sensibility, with strains of Surrealism...

's novel Dead Souls
Dead Souls
Dead Souls is a novel by Nikolai Gogol, first published in 1842, and widely regarded as an exemplar of 19th-century Russian literature. Gogol himself saw it as an "epic poem in prose", and within the book as a "novel in verse". Despite supposedly completing the trilogy's second part, Gogol...

, social breakdown and senile squalor syndrome. Frontal lobe
Frontal lobe
The frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...

 impairment may play a part in the causation (Orrell et al., 1989).

History

The origin of the syndrome is unknown, although the term “Diogenes” was coined by A. N. G. Clarke et al in the mid 1970s, and has been commonly used since then. Diogenes syndrome was acknowledged more prominently as a media phenomenon than as medical literature. The primary description of this syndrome has only been mentioned recently by geriatricians and psychiatrists.

Characteristics and Causes

Diogenes syndrome is known as a disorder common in elderly people that involve hoarding of rubbish and severe self-neglect. In addition, the syndrome is characterized by domestic squalor, syllogomania, social alienation
Social alienation
The term social alienation has many discipline-specific uses; Roberts notes how even within the social sciences, it “is used to refer both to a personal psychological state and to a type of social relationship”...

, and refusal of help. It has been shown that the syndrome is caused as a reaction to stress
Stress
- Mechanical :* Stress , the average amount of force exerted per unit area* Compressive stress, the stress applied to materials resulting in their compaction...

 that was experienced by the patient. The time span in which the syndrome develops is undefined, though it is most accurately distinguished as a reaction to stress that occurs late in life.

In most instances, patients were observed to have an abnormal possessiveness and patterns of compilation in a disordered manner. These symptoms suggest damages on the prefrontal areas of the brain, due to its relation to decision making
Decision making
Decision making can be regarded as the mental processes resulting in the selection of a course of action among several alternative scenarios. Every decision making process produces a final choice. The output can be an action or an opinion of choice.- Overview :Human performance in decision terms...

. Although in contrast, there have been some cases where the hoarded objects were arranged in a methodical manner, which may suggest a cause other than brain damage.

Although most patients have been observed to come from homes with poor conditions, and many had been faced with poverty
Poverty
Poverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...

 for a long period of time, these similarities are not considered as a definite cause to the syndrome. The severe neglect that they bring on themselves usually results in physical collapse or mental breakdown. Most individuals who suffer from the syndrome do not get identified until they face this stage of collapse, due to their predilection to refuse help from others.

A typical portrayal of the symptoms in the media can be seen in the characterization of the crazy cat lady, Eleanor Abernathy, in The Simpsons
The Simpsons
The Simpsons is an American animated sitcom created by Matt Groening for the Fox Broadcasting Company. The series is a satirical parody of a middle class American lifestyle epitomized by its family of the same name, which consists of Homer, Marge, Bart, Lisa and Maggie...

. The patients are generally highly intelligent, and the personality traits that can be seen frequently in patients diagnosed with Diogenes syndrome are aggressiveness, emotional liability, group dependant, and reality deformed. The direct relation of their personalities to the syndrome is unclear, though the similarities in character suggest potential avenues for investigation.

Diagnosis/Neurology

Individuals suffering from Diogenes syndrome generally display signs of collectionism, hoarding
Hoarding
Hoarding or caching is a general term for a behavior that leads people or animals to accumulate food or other items in anticipation of future need or scarcity.-Animal behavior:...

, or compulsive disorder. Individuals who have suffered damage to the brain, particularly the frontal lobe
Frontal lobe
The frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...

, may be at more risk to developing the syndrome. The frontal lobes are of particular interest, because they are known to be involved in higher order cognitive processes, such as reasoning, decision-making and conflict monitoring.

Strategies of Management

It is ethically difficult when it comes to dealing with diagnosed patients, for many of them deny their poor conditions and refuse to accept treatment. The main objectives of the doctors are to help improve the patient’s lifestyle and wellbeing, so health care professionals must decide whether or not to force treatment onto their patient.

In some cases, especially those including the inability to move, patients have to consent to help, since they cannot manage to look after themselves. Hospitals or nursing homes are often considered the best treatment under those conditions.

When under care, patients must be treated in a way in which they can learn to trust the health care professionals. In order to do this, the patients should be restricted to the number of visitors they are allowed, and be limited to 1 nurse or social worker. Some patients respond better to psychotherapy, while others to behavioral treatment or terminal care.

Results after hospitalization tend to be poor. Research on the mortality rate during hospitalization has shown that approximately half the patients die while in the hospital. A quarter of the patients are sent back home, while the other quarter is placed in long time care. Patients under care in hospitals and nursing homes often slide back into relapse or face death.

There are other approaches to improve the patient’s condition. Day care facilities have often been successful with maturing the patient’s physical and emotional state, as well as helping them with socialization. Other methods include services inside the patient’s home, such as the delivery of food.

Further reading

  • Post F. "Functional disorders: 1. Description, incidence and recognition". In: Levy R, Post F, eds. The psychiatry of late life. Oxford: Blackwell, 1982;180-1.

External links

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