Diogenes Syndrome: Living in Extreme Squalor

Always looking for positive ways to channel my teenager's energy, I signed us up to help with a church-affiliated community rebuilding project. Hmm...Think Grey Gardens minus The Discreet Charm of the Bourgeouis. We were just along for the ride - I didn't know any of the back story, but it didn't take long for the clinician in me to assess the situation.

It was a case of three able bodied adults who disclosed psychiatric diagnoses, living in extreme squalor with a few cats and at least one dog. I've seen it before and it's always terrifying. It has a name. It is called Diogenes Syndrome or Squalor Syndrome or Messy House Syndrome.
Signs?:

• filth
• clutter
• living in isolation
• severe self-neglect
• hoarding behaviors
• compulsive hoarding is a form of obsessive-compulsive disorder (OCD)
• excessive acquisition of objects
• hoarding is different than collecting. Collecting is an organized activity and others can appreciate that which is collected.
  
• inability to discard possessions
  
• interpersonal relationships are mediated by objects
• refusal of help

Depression and dementia are risk factors for squalor syndrome. There appears to be frontal lobe involvement. Diogenes Syndrome is considered a behavioral disorder. It is highly prevalent in people aged 60-90 years who have above average intelligence with successful work histories throughout their adult lives but may have lacked significant relationships despite adequate social networks. It may represent the end stage of a personality disorder, characterized by these traits:

• aloof
• domineering
• suspicious
• aggressive
• obstinate
• lack of insight
• loss of initiative

People with Diogenes Syndrome may have had life long patterns of compulsiveness and paranoia combined with an inability to form relationships that progress into social breakdown. Persistent refusal of help, abandoning social norms and defense mechanisms of denial of need and withdrawal are distressing to family, neighbors, friends or the community who want to help. The continued refusal of help from people who are legally mentally competent presents complex ethical issues for everyone involved.

Public health hazards, fire hazards, personal health hazards are evident to the casual observer in these cases. Prognosis is poor. Management is challenging. The specter of it is chilling. It inspired me to go home and ruthlessly throw or give away bags of unneeded items and scrub everything until gleaming.

Thank you Dean Terry for use of photo, Gun Room.