Diogenes syndrome, also known as senile squalor syndrome, is a disorder characterized by extreme self-neglect, domestic squalor, social withdrawal, apathy, compulsive hoarding of garbage or animals, and lack of shame. Sufferers may also display symptoms of catatonia.
The condition was first recognized in 1966 and designated Diogenes syndrome by Clark et al. The name derives from Diogenes of Sinope, an ancient Greek philosopher, a Cynic and an ultimate minimalist, who allegedly lived in a large jar in Athens. Not only did he not hoard, but he actually sought human company by venturing daily to the Agora. Therefore, this eponym is considered to be a misnomer, but he is actually a representative existence of self-neglect. Other possible terms are senile breakdown, Plyushkin's Syndrome (after a character from Gogol's novel Dead Souls), social breakdown and senile squalor syndrome. Frontal lobe impairment may play a part in the causation (Orrell et al., 1989).
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 in popular media rather than medical literature. The primary description of this syndrome has only been mentioned recently by geriatricians and psychiatrists.
Characteristics and causes
Diogenes syndrome is a disorder that involves hoarding of rubbish and severe self-neglect. In addition, the syndrome is characterized by domestic squalor, syllogomania, social alienation, and refusal of help. It has been shown that the syndrome is caused as a reaction to stress 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. 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 for a long period of time, these similarities are not considered as a definite cause to the syndrome. Research showed that some of the participants with the condition had solid family backgrounds as well successful professional lives. Half of the patients were of higher intelligence level. This indicates the Diogenes syndrome does not exclusively affect those experiencing poverty or those who had traumatic childhood experiences.
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.
The patients are generally highly intelligent, and the personality traits that can be seen frequently in patients diagnosed with Diogenes syndrome are aggressiveness, stubbornness, suspicion of others, unpredictable mood swings, emotional instability and deformed perception of reality. Secondary DS is related to mental disorders. The direct relation of the patients' personalities to the syndrome is unclear, though the similarities in character suggest potential avenues for investigation.
Diagnosis and neurology
Individuals suffering from Diogenes syndrome generally display signs of collectionism, hoarding, or compulsive disorder. Individuals who have suffered damage to the brain, particularly the frontal lobe, 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. Diogenes Syndrome tends to occur among the elderly. The behavioural patterns that is usually reflected by those living with this disorder are suffering from significant functional problem that is correlated with morbidity and mortality. 
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 in 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 are 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.
- Cybulska, E; Rucinski, J (1986). "Gross Self-neglect in Old Age". Br J Hosp Med. 36 (1): 21–23. PMID 3535960.
- Rosenthal, M; Stelian, J; Wagner, J; Berkman, P (1999). "Diogenes syndrome and hoarding in the elderly: case reports". The Israel Journal of Psychiatry and Related Sciences. 36 (1): 29–34. PMID 10389361.
- Macmillan, D; Shaw, P. (1966). "Senile breakdown in standards of personal and environmental cleanliness". BMJ. 2 (5521): 1032–7. PMC . PMID 5919035. doi:10.1136/bmj.2.5521.1032.
- Clark, AN; Mankikar, GD; Gray, I (1975). "Diogenes syndrome A clinical study of gross neglect in old age". Lancet. 1 (7903): 366–368. PMID 46514. doi:10.1016/S0140-6736(75)91280-5.
- Cybulska, E (1998). "Senile Squalor: Plyushkin's not Diogenes Syndrome". Psychiatric Bulletin. 22 (5): 319–320. doi:10.1192/pb.22.5.319.
- (01-28-2006) by Alicia M. Canto, in: "Uso y abuso de Diógenes"
- Marcos, M; Gomez-Pellin, MC. (2008). "A tale of a misnamed eponym: Diogenes syndrome". Int J Geriatr Psychiatry. 23 (9): 990–1. PMID 18752218. doi:10.1002/gps.2005.
- Cooney, C; Hamid, W (1995). "Review: diogenes syndrome". Age and ageing. 24 (5): 451–3. PMID 8669353. doi:10.1093/ageing/24.5.451.
- Orrell, M; Sahakian, B. (1991). "Dementia of frontal type". Psychol Med. 21 (3): 553–6. PMID 1946843. doi:10.1017/S0033291700022170.
- Hanon C, P. C. (2004). Diogenes Syndrome: A Transnosographic Approach. Encephale , 30 (4), 315-322.
- Reyes-Ortiz, C (2001). "Diogenes syndrome: The self-neglect elderly". Comprehensive Therapy. 27 (2): 117–121. PMID 11430258. doi:10.1007/s12019-996-0005-6.
- Clark, AN; Mannikar (February 15, 1975). "Diogenes syndrome. A clinical study of gross neglect in old age.". The Lancet. 1 (7903): 366–8. PMID 46514. doi:10.1016/S0140-6736(75)91280-5.
- Cipriani, Gabriele; Claudio Lucetti; Marcella Vedovello; Angelo Nuti (14 December 2012). "Diogenes syndrome in patients suffering from dementia". Dialogues in Clinical Neuroscience. 14 (4): 455–460. PMC . PMID 23393422.
- Radebaugh, TS; Hooper, FJ; Gruenberg, EM. (1987). "The social breakdown syndrome in the elderly population living in the community: the helping study". Br J Psychiatry. 151 (3): 341–6. PMID 3501323. doi:10.1192/bjp.151.3.341.
- Shah, AK (1990). "Senile squalour syndrome: what to expect and how to treat it". Geriatr Med. 20: 10–26.
- Wrigley, M; Cooney, C. (1992). "Diogenes syndrome--an Irish series". Ir J Psychol Med. 9: 37–41.
- Snowdon, J. (1987). "Uncleanliness among persons seen by community health workers". Hosp Community Psychiatry. 38 (5): 491–4. PMID 3596484. doi:10.1176/ps.38.5.491.
- Berlyne, N. (1975). "Diogenes syndrome". Lancet. 305 (7905): 515. doi:10.1016/S0140-6736(75)92850-0.
- Cole, AJ; Gillett, TP.; Fairbairn, Andrew (1992). "A case of senile self-neglect in a married couple: 'Diogenes a deux'". Int J Geriatr Psychiatry. 7 (11): 839–41. doi:10.1002/gps.930071111.
- O'Mahony, D; Evans, JG (1994). "Diogenes syndrome by proxy". The British Journal of Psychiatry. 164 (5): 705–6. PMID 7921736. doi:10.1192/bjp.164.5.705.
- 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.
- Roe, PF. (1977). "Self-neglect". Age Ageing. 6 (3): 192–4. PMID 899969. doi:10.1093/ageing/6.3.192.
- MacAnespie, H (1975). "DIOGENES SYNDROME". The Lancet. 305 (7909): 750. doi:10.1016/S0140-6736(75)91664-5.
- Wolfson, P; Cohen, M; Lindesay, J; Murphy, E (1990). "Section 47 and its use with mentally disordered people". Journal of public health medicine. 12 (1): 9–14. PMID 2390316.