Diogenes syndrome is considered as a behavioral disorder and its caracteristics are: an unusual relationship to objects (accumulation of it – syllogomania) that leads to an unsanitary home, an unusual relationship to others that seems like self-exclusion (social breakdown syndrome) and an unusual relationship to the body (body and clothes are neglicted). There can be deny of trouble, no shame feeling and refusal of help. Diogenes syndrome was called this way because of the greek philosopher Diogène of Sinope (413-327 B.C.) who would have lived alone with extreme lack of personal and domestic hygiene and careless for the social rules.
The clinical diagnosis is mostly based on the home visit. There can be two types: the active Diogenes syndrome (patients fulfill their home with objects from the outside as a way to fill their existence and rebuild their narcissism) and the passive one (people that get passively invade by their garbage and cannot prevent the accumulation of it). This syndrome is often concerning old people (more than 60 years old) living in the urban area. There would be more women suffering from it than men. They mainly live alone, all social-categories are concerned: it does not come from a financial issue.
Half of the persons with Diogenes Syndrome would have a psychiatric pathology. The most frequent are: dementia (frontotemporal dementia), OCD (keeping objects would be compulsive), mood disorders (depression and manic episodes can lead to self negligence), alcoholism (which is more an aggravating factor than a comorbidity) and psychosis (schizophrenia and paranoid psychosis).
They are often hospitalized for behavioral disorder with an enforced hospitalization by the decision of the public prosecutor because they don’t have any consciousness of their problems.
The article is about a case study of a woman with Diogenes Syndrome and a chronic delusional psychosis. Up to 40% of people with Diogenes syndrome would have a psychosis too. Object loss, grief and narcissistic failures would have led to an unefficiency of the « Moi-Peau » as contenant according to the authors. Objects collection and rubbish accumulation would be ways to rebuild this. The psychosis, with its partition delusion, add more to this object accumulation in order to avoid the loss. It is an exterior way to fill in their interior. The most famous case of Diogenes syndrome is Camille Claudel, a sculptor of the XXth century .
In the end, when a person is living in such lack of hygiene and uncleaned home, medical evaluation can be important in order to investigate Diogenes syndrome and psychiatric disorder. We can see similar aspect between Diogene syndrome and homelessness through the same questions of life events, evolution or psychiatric pathology. Diogene syndrome would be a kind of « homelessness at home ».
Vocabulary : social breakdown syndrome = syndrome de l’effondrement social ; enforced hospitalization = hospitalisation sous contrainte ; public prosecutor = procureur de la République ; partition delusion = angoisse de morcellement.
Bibliography : Ducasse D, Alezrah C, Benayed J, Arbault D, Bardou H, Meniai M, Ferrer I. Réflexions autour d’un cas clinique de syndrome de Diogène et ses liens avec la psychose. L’Information psychiatrique 2011 ; 87 : 733-9 doi:10.1684/ipe.2011.0854
Written by Anaëlle Vadon, Albane Doucet and Emma Foirest.