Diogenes syndrome is a behavioral disorder that affects older adults. It occurs in both men and women. The main symptoms are excessive hoarding, dirty homes, and poor personal hygiene. People with Diogenes syndrome also withdraw from life and society.

They often live alone and are unaware that anything is wrong with the condition of their home and lack of self-care. These conditions often lead to illnesses like pneumonia, or accidents like falls or fires. It is often through these situations that the person’s condition first becomes known.

Diogenes syndrome is often linked to mental illnesses that include:

  • schizophrenia
  • obsessive-compulsive disorder (OCD)
  • depression
  • dementia
  • addiction, especially to alcohol

This condition can be difficult to treat. It can also be hard to care for people who have it.

Diogenes syndrome is sometimes diagnosed in people who are middle aged. But it usually occurs in people over 60 years of age. Symptoms usually appear over time.

Early symptoms often include withdrawing from social situations and an avoidance of others. People may also start to display poor judgment, changes in personality, and inappropriate behaviors.

You can have this condition for a long time before it’s diagnosed. That’s partly due to the intense isolation that’s a symptom of Diogenes syndrome.

Warning symptoms in an undiagnosed person may include:

  • skin rashes caused by poor hygiene, fleas, or lice
  • matted, unkempt hair
  • overgrown toenails and fingernails
  • body odor
  • unkempt appearance
  • unexplained injuries
  • malnutrition
  • dehydration

The person’s home will most likely also exhibit signs of neglect and decay. Some examples include:

  • rodent infestation
  • overwhelming amounts of garbage in and around the home
  • an intense, unpleasant smell

A person diagnosed with Diogenes syndrome typically exhibits some, or all, of these symptoms:

  • extreme self-neglect
  • filthy surroundings
  • excessive hoarding
  • denial about their situation
  • no embarrassment or shame about their surroundings or lack of cleanliness
  • refusal of support or help

Having one or more risk factors for this condition doesn’t mean it will occur. Often, a specific incident becomes a trigger for the onset of symptoms. This can be something like the death of a spouse or other close relative, retirement, or divorce. Medical conditions may also trigger symptom onset. These can include:

  • stroke
  • loss of mobility due to arthritis or broken bones
  • congestive heart failure
  • dementia
  • vision problems
  • increasing frailty
  • depression

Other risk factors include:

  • loss of a trusted companion or caregiver
  • history of mental illness
  • history of substance abuse
  • history of abuse
  • character traits, such as being introverted
  • personality traits, such as suspiciousness, unfriendliness, or an overall detachment from others

People with Diogenes syndrome rarely reach out for help. They are often diagnosed after a family member reaches out for help on the person’s behalf. A diagnosis may also come as a result of complaints from neighbors. Diogenes syndrome isn’t classified as a disease. Many other diagnoses also include these symptoms. These may include:

  • compulsive hoarding
  • schizophrenia
  • dementia

There are two types of Diogenes syndrome. They are:

Primary Diogenes syndrome: This diagnosis is given when no additional mental illness has been diagnosed.

Secondary Diogenes syndrome: This diagnosis is given when an additional mental illness is part of the overall diagnosis.

Each group accounts for approximately 50 percent of all diagnosed cases.

To make a diagnosis, a doctor will look for clues in the person’s behavioral and social history. A social worker may be able to help with this. This is especially true if the individual has a history of complaints against them from neighbors or others.

A physical exam and brain imaging tests, like an MRI or PET scan, will help a doctor identify any underlying cause that may be treatable.

Diogenes syndrome may be hard to treat in some people, but ongoing care is important. People with the disorder may be at risk for life-threatening illness or injury if untreated. Their condition may also cause environmental risks to those around them.

A doctor will look for underlying factors to help determine the best treatment. Determining the person’s competency is an important first step. If the person is able to take part in their own treatment, behavioral therapies like those used for compulsive hoarding, may help.

Treatments may include medications used to treat anxiety, obsessive-compulsive disorder (OCD), depression, or psychosis.

Support groups or other types of support networking can also help if the person is willing to take part in them.

A person with this condition may need to receive inpatient treatment. Other times, they may just need to have a caregiver come to their home to check up on them. Their doctor will decide how to work with the individual and their family to help come up with a treatment plan.

It’s possible to recover from Diogenes syndrome. The help and support of others is an important part of a treatment plan. People who remain in unsafe conditions do not usually have a good outlook for long-term survival or quality of life.

Caring for someone with this condition can feel overwhelming. The person you knew may have all but vanished. You may need to pursue legal or medical support if they are unable to care for themselves. Or there may need to be involuntary commitment. This occurs if they’re unable to make appropriate decisions on their own behalf.

Read more: The fight to become my parents’ caregiver »

Involuntary commitment laws vary from state to state. To pursue involuntary commitment, you will need to prove that the individual is at risk of harming themselves or others. While the situation may be clear to you, it may be less clear to the court. Having good records will help you justify the need to have the person removed from their home to a facility. Keep in mind that involuntary commitment doesn’t guarantee involuntary treatment. You will need to remain involved in determining ongoing care and appropriate therapies.