Diogenes syndrome: causes, symptoms and treatment

A lost snail, a t-shirt that no longer suits us, a wooden board …

A lot of people sometimes keep objects and things that, although at this point we know that we won’t use them, for one reason or another (either because it brings back memories to us or because we think that in the future may be necessary) we decided to save and preserve.

It is a normal thing and in principle it is not a problem in our lives. But in people with Diogenes syndrome, this phenomenon becomes a common and problematic trend product of self-abandonment, continuing to accumulate a large amount of objects and waste without any use and causing great personal and social deterioration in their life.

Diogenes syndrome: basic characteristics

Diogenes syndrome is a disorder characterized by those who suffer from it they collect and store a large amount of belongings and goods, usually garbage, in their home. They have a great inability to get rid of it, so they accumulate more and more.

The objects preserved by individuals with this disorder can be very diverse, from objects of great value to debris and debris, and it is not the real or symbolic value of the object that produces its preservation. As in accumulation disorder the person with Diogenes syndrome has great difficulty throwing away their belongings, keeping them with them, and experiencing anxiety and discomfort at the thought of losing them. If asked the reason for this conservation, people with Diogenes syndrome usually do not know how to give an explanation.

Some authors suggest that Diogenes syndrome generally occurs in three phases. First, I would emphasize the attitude of self-surrender, starting to generate waste that is not eliminated and begins to accumulate. Subsequently and as the number of litter increases, the individual passes to a second phase in which the profusion of litter and litter obliges to begin to organize (not necessarily to sort) the material and the space. available, while the deterioration of habits is aggravated. In a third and final phase, the individual not only does not throw away his waste, but begins to actively collect elements from the outside.

Drifting for lack of hygiene and self-abandonment

In the long run, the cumulative behavior of these people causes the collected items to occupy a large part of the individual’s house, arranging haphazardly and expansively throughout the house. this issue leads to the point that the functionality of the house is limited, And access to some areas like the bed or the kitchen is not possible. In addition, the clutter and lack of cleanliness caused by the accumulation cause serious hygiene problems that can compromise the health of the individual.

This syndrome produces a high level of deterioration in several areas, especially at the social level when caused coexistence problems. Those who suffer from it gradually withdraw from the world, isolating themselves and minimizing contact with others, due to both an increase in interpersonal conflicts due to their condition and the time spent storing and accumulating things. They are also starting to give up some of the main hygiene habits, both household and personal.

These cases are often detected at advanced stages, Due to complaints from neighbors and relatives about the unsanitary house of those affected, the smell and insects and rodents attracted to the objects.

It is also common for people with Diogenes syndrome they end up having serious feeding problems, Have modified eating habits and eat little, badly and timelessly. They can consume food in poor condition (due to poor hygiene in the house or indifference to its expiration). This as well as health problems resulting from poor hygiene and avoidance of contact with others. he may become so weak that he needs to be hospitalized, And even a high percentage of them die within a few years of the onset of the syndrome.

Possible causes

Although the cause of the cumulative behavior in Diogenes syndrome is not fixed or fully understood, most of those who suffer from it are people over 65, retired and often widowed.

So, one of the most common features is the presence of loneliness even before the accumulation begins. Whether it is due to the death of the couple or the abandonment, this loneliness can lead to the gradual disappearance of the concern for hygiene, food and contact with others, also appearing a behavioral and emotional rigidity which favors the persistence of accumulation. They feel a great insecurity and a half that they supply by accumulation. There is usually a stressful event that triggers the onset of symptoms.

A large proportion of people with Diogenes syndrome they also have a history of mental or medical conditionsIt is very common for them to be immersed in processes of addiction, dementia or major depression, often with psychotic characteristics. there is, then probable cognitive impairment which causes the person to stop worrying about their health and to maintain their health, nutrition and hygiene.

Treatment of Diogenes syndrome

Diogenes syndrome is a complex disorder that requires treatment of different approaches. People with this disorder usually do not go into therapy on their own, being referred to medical or legal services or under pressure from their families.

The multidisciplinary intervention is due to the fact that it is necessary to act both on the ideas and beliefs of the individual and on his habits, because the accumulation of waste is part of the daily life of the person and is difficult to break. dynamic. This is precisely why we must also act on the place where we live: focusing on the person alone does not work.

In many cases, the authorities, alerted by complaints from neighbors and acquaintances, go to the homes of these people and end up cleaning and disinfecting the premises. even if this can temporarily put an end to the accumulated waste, It does not solve the problem that the subject is in pain or help him to cope with situations in any other way, therefore if the outer action ends here, the subject will fall back.

Assessment and intervention

In terms of treatment, it is a priority to assess the state of health of the subject and correct complications related to lack of food and hygiene. In cases where this syndrome is produced or aggravated by other disorders such as depression or certain psychotic disorders, it is necessary to apply the most appropriate strategies to treat the disorder itself, both psychologically and pharmacologically. The use of antidepressants such as SSRIs is common to improve mood.

As for psychological treatment it would first be necessary to show the existence of a problem and the need to find a solution, because most of the people concerned ignore or do not recognize their suffering. It is also essential to be trained in the skills and guidelines of hygienic and dietary behavior.

Since in a large majority of cases there is a high level of insecurity, this aspect must be worked on in therapy, as well as the existential passivity which this type of patient shows most often. It is also necessary to restore the person’s contact with the world, through social skills training and participation in community activities. It helps fight the loneliness and anxiety it causes. The detachment of objects and waste and what the patient thinks about conservation must also be worked.

As in the vast majority of mental disorders social and family support is essential for the restoration and / or improvement of the quality of life. Psychoeducation in the immediate environment is a necessary thing to understand the patient’s condition and follow-up, it is important to monitor his activity patterns and not to return to a state of isolation.

Difference from accumulation disorder

The characteristics of Diogenes syndrome are very similar to those of another disorder with which it is often confused. the so-called accumulation disorder or palisade.

The two problems have in common the accumulation of a large number of objects and possessions which sufferers find it difficult to dispose of, as well as the fact that this accumulation poses serious problems in the use of space. . In both cases, he may present with anosognosia, or even a delusional idea that accumulation is not harmful although there is evidence to the contrary (although it is much more common not to have recognition of the existence of a disorder in Diogenes syndrome).

Also, in both disorders, problems often appear in various vital areas, especially with regard to interpersonal relationships, in many cases avoiding close contact with people.

However, in case of accumulation disorder or hoarding the accumulation is completely intentional and usually has a specific reason for wanting to maintain it. It is a disorder linked to obsessive traits.

In the case of Diogenes syndrome, the accumulation is usually due more to a process of deterioration, it is common for an ongoing dementia process to exist, and the accumulation is usually due more to unintentional passive elements (although in many cases they also collect and accumulate (waste as a mechanism of emotional protection).

In addition, while in Diogenes syndrome there is a great deterioration in personal hygiene and eating habits, in accumulation disorder these features usually do not occur, being their relatively usual behavior outside the respective harvest.

Bibliographical references:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Gómez, I., Prieto, F. (2008). Clinical forms of Diogenes syndrome. About three cases. [Versión electrónica]. Biological psychiatry, 15 (3), 97-9.
  • Marcos, M. and Gómez-Pellín, MC (2008). The story of a misnamed eponymous: Diogenes syndrome. International Journal of Geriatric Psychiatry, vol. 23, 9.
  • Saiz, D., Lozano García, M., Burguillo, F., Botillo, C. (2003). Diogenes syndrome: about two cases. [Versión electrónica]. Psychiatry. com, 7 (5).

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