Diogenes Syndrome

Diogenes syndrome, also termed senile squalor syndrome, was named after the Greek Cynic philosopher Diogenes. Although symptoms of Diogenes syndrome are not currently a strong focus of scientific interest, the syndrome has received considerable coverage in the media. Symptoms include extreme self-neglect, a dirty appearance, domestic squalor, lying in excrement, social withdrawal, and compulsive hoarding of garbage. Diogenes syndrome appears to be associated with a high physical morbidity and mortality rate. As discussed in this chapter, the particular nature of Diogenes syndrome represents a particular dilemma for the mental health professions and society. The chapter also discusses hoarding disorder, a separate but overlapping concept.

Diogenes syndrome and autistic spectrum disorder

Diogenes syndrome or senile squalor syndrome has been described in the psychiatric literature with an associated mental illness in between one half and two thirds of the cases cited. The occurrence of the syndrome in the absence of a psychiatric disorder has received much attention with many hypotheses proposed. We present the case of a 72-year-old man living for many years in domestic squalor whose presentation, neuropsychological profile and history suggest an underlying autistic spectrum disorder. We are not aware of any similar case in an older adult reported in the medical literature. The co-occurrence of these two conditions is an intriguing one as certain key features of autistic spectrum disorder may predispose to Diogenes syndrome.

Senile squalor: Plyushkin's not Diogenes' syndrome

Some names appear to stick to syndromes or diseases like a proverbial glue, regardless of their total inappropriateness. Gross self-neglect in old age characterised by domestic squalor, social withdrawal, apathy, tendency to hoard rubbish (syllogomania) and a lack of shame was originally reported by Macmillan & Shaw in 1966 and subsequently ‘christened’ by Clark et al as Diogenes∗ syndrome in 1975. Post (1982) preferred the term ‘senile recluse’ and argued that this is not a syndrome but merely an end stage of personality disorder. It was usually extremely difficult to help these patients, as one's care and goodwill often met with hostility and blunt refusal to cooperate (Cybulska & Rucinski, 1986). More recent studies, however, have shown a strong association of this condition with frontal lobe dysfunction (Orrell & Sahakian, 1991), thus giving a psychiatrist of old age a somewhat firmer basis for action.