Diogenes Syndrome in Seniors

Diogenes syndrome can affect men and women of any age or socioeconomic background, but it most often manifests as a behavioral disorder in the elderly. According to research, it appears to be most common among people of average intelligence who are over 60 years old and live alone.

According to the US National Library of Medicine National Institutes of Health, Diogenes syndrome affects about 0.05 percent of people aged 60 and up. It's considered rare, but there's no study yet about how common it is.

What is Diogenes Syndrome? (Senile Squalor Syndrome)

Diogenes syndrome is a mental health condition marked by poor personal hygiene, hoarding, and untidy living quarters. Since it affects more older men and women, it's also known as senile squalor syndrome. Diogenes syndrome patients show no concern about self-care or maintaining a clean living atmosphere, and they seem unconcerned about their condition or how others respond to it.

Diogenes is thought to be a reaction to a late-life tragedy in some circumstances, such as the death of a lifelong partner or caregiver. Treatment is often complex because the person resents intrusions into his or her way of life, which leads to resistance and a lack of cooperation.

People and cultures have different perspectives on self-hygiene and protection. As a result, many of Diogenes syndrome's symptoms can be challenging to diagnose and treat critically. On the other hand, poor hygiene or self-neglect could put a person with this condition in danger.

Why Is It Called Diogenes Syndrome?

Diogenes was a 4th-century Greek philosopher who lived in a barrel. According to legend, Diogenes, the Greek minimalist philosopher, was the only one who did not pay his respects to Alexander the Great when he visited Corinth. Alexander found him sitting under the heat, and he inquired as to what he might do to assist him. “I would have you stop standing between me and the sun,” Diogenes answered.

Alexander was struck by Diogenes' greatness and is said to have later said that if he weren't Alexander the Great, he would prefer to be Diogenes.

On the other hand, contemporaries characterized Diogenes as having a "lack of shame" and "contempt for social organization,” thus calling this syndrome the Diogenes syndrome. However, the new Diagnostic and Statistical Manual of Mental Disorders (5th Edition, DSM V) does not mention Diogenes syndrome as a psychiatric disease because it usually occurs in conjunction with other conditions. Furthermore, there is no medical literature on it.

Types of Diogenes Syndrome

There are two types of Diogenes Syndrome: Primary and secondary.

Primary Diogenes Syndrome

The primary Diogenes syndrome is characterized by not being triggered by other existing medical conditions, which means it happened suddenly and may have a specific reason to be. 

Secondary Diogenes Syndrome

The secondary Diogenes syndrome derives from another mental health disorder. Senile or extreme social breakdown syndrome, self-neglect syndrome, senile squalor syndrome, and Messy House syndrome are other names for Diogenes syndrome.


Symptoms differ, but a cluster of common characteristics, including signs of self-neglect, may be present. Here are some of them:

  • A lack of knowledge or comprehension of personal hygiene, public health, or any protection.
  • Distrust in society and strangers.
  • Paranoia and constant suspiciousness.
  • Detachment.
  • Tendency to obsessive-compulsive behavior.
  • Social anxiety at its max.
  • Hoarding and collection of trash or household items.
  • Unsanitary living conditions.
  • Malnutrition, poor diet.
  • Unwillingness to accept help.
  • Distrust in medical treatments and professionals' advice.
  • Hostility and aggression.
  • Distorted reality.
  • Skin condition, such as dermatitis passivata.

Other Conditions With Similar Symptoms

Dermatitis passivata is a skin disease in which a horny crust forms over the skin in people with Diogenes syndrome. A lack of consistent washing generally causes this. Bad oral hygiene, which can lead to dental decay and halitosis, is another complication discovered by physicians.

Dementia can also lead to some of the same symptoms as Diogenes syndrome. According to research from the National Institutes of Health in the United States, dementia can be present in 15% of people with the disease, but it is not the only cause.

Diogenes syndrome's signs and symptoms are also difficult to differentiate from those of other medical conditions, such as:

  • Schizophrenia
  • Hoarding
  • Dementia of the frontal and temporal lobes
  • Depression
  • Obsessive-compulsive disorder (OCD) 
  • Alcoholism 

On the other hand, psychotic symptoms or extreme personality characteristics can manifest a personality disorder in certain people.

Diogenes Syndrome vs Hoarding

Diogenes syndrome—according to researchers—has been defined as a "special manifestation of hoarding disorder.

An individual’s home with Diogenes syndrome may become so filthy and unsanitary that people with a similar cultural background can feel compelled to clean and clear the room.

Since it attracts insects and rodents, hoarding can be a public health threat. In addition, the accumulation of belongings and garbage may also be a fire danger, making it difficult for the individual to escape in the event of a fire.

Treatment For Diogenes Syndrome

Diogenes syndrome does not have a specific diagnosis or treatment plan. To establish a baseline of health, some studies suggest collecting a complete medical and psychological history for the person and conducting a physical exam, blood screening, and organ function tests. Before any Diogenes treatment is necessary to rule out as many factors as possible, thus the need to do the next:

  • Apply tests to rule out other disorders that cause similar symptoms.
  • Personality tests (which can shed light on the syndrome's root cause).

Medication And Counseling

There are currently no drugs or therapies available for the treatment of Diogenes syndrome. Even so, medications for other disorders, such as paranoia or mania, can help relieve symptoms.

Psychological factors must also be considered since they can either cause or perpetuate the syndrome. Some people may benefit from intensive psychological treatment or counseling.

Social Support

There are certain therapies that are most effective in conjunction with other support services that can help treat the syndrome's underlying cause. Cleaning and personal care facilities, for example, and private caregivers can help lessen the severity of symptoms.

Hospitals and authorities are also frightening to people with Diogenes syndrome. The individual does not want or recognize the need for assistance. They have the right to deny medical treatment, which can result in ethical and legal issues.

Each case must be handled with extreme sensitivity by whoever is assisting the person. Staff in-home health or community care may be the best groups to help. It is, however, essential to be responsive to the needs and feelings of the person. For example, if an individual believes that health workers or others are attacking or punishing them, or if the intervention makes them feel uncomfortable, they are more likely to reject further assistance and revert to their previous habits.

Does It Get Better?

Diogenes syndrome is a condition that can be overcome. However, assistance and guidance from others are an integral aspect of a recovery plan. People who live in dangerous situations, on the contrary, have a poor chance of long-term survival or high quality of life.

Tips For Caregivers

Here are some guidelines and pointers to bear in mind when dealing with a Diogenes case:

  • Often consider whether care will improve the person's overall health and enjoyment of life. As distressing as it may be, the safest course of action with Diogenes is often to leave them alone because therapy may be too difficult for them or impractical without their permission.
  • Consider taking on (or hiring others to take on) simple tasks that the individual can overlook, such as ordering meals or cleaning regularly.
  • If you decide to help them declutter their house, make sure you go about it the right way. Plan ahead of time, enlist the assistance, and try to get as much done in a single trip as possible. Expect the clutter to reappearance in a matter of weeks or months.
  • Diogenes is known for making social contact with strangers uncomfortable, so try to minimize the number of people your loved one or care recipient has to communicate with at any given time and limit unfamiliar guests to just one at a time.

Diagnosing Diogenes Syndrome

Since many Diogenes sufferers live in isolation, a family member is often expected to alert medical staff to their condition. Conflict with neighbors over odors, pests, or neglected diseases, on the other hand, can result in the intervention of police or other civic officials, which may promote medical involvement, mainly if a public danger exists.

For Diogenes syndrome, medical researchers are yet to establish a recommended diagnosis or treatment plan. To rule out non-psychiatric reasons for self-neglect, hoarding, and other reported habits, a psychiatrist or mental-health professional would undoubtedly want to record symptoms, discover the individual's medical history, and perform a physical examination. This can include the use of imaging technology to determine the presence of frontal lobe brain injury.

Such behavioral-health problems, such as alcoholism and substance addiction, would be looked for by the physician or mental health provider. Diagnoses can lead to treatment for those conditions.

Possible Causes of Diogenes Syndrome

Scientists are currently investigating the cause or causes of Diogenes syndrome. As for now, the majority of what we know comes from case studies in which such trends of behavior have emerged. Some speculate that Diogenes arises from stressful or traumatic events, such as the death of a long-term spouse or partner. In a Diogenes state, a transient reduction in self-care during a time of mourning seems to be prolonged forever.

Here are some of the risk factors:

  • Old Age
  • Feeling and living alone.
  • Death of a loved one.
  • Tendency to being introverted and having social withdrawal.
  • Mental illness background.
  • Dementia.
  • Damage in the decision-making center of the brain (frontal lobe.)
  • Substance and alcohol abuse.

Alcohol and drug abuse is an especially significant factor. In addition, people with Diogenes syndrome are more likely to engage in addictive behaviors as a coping mechanism for depression, loneliness, and social isolation.

Does your loved one have Diogenes Syndrome? Is it getting hard to cope with? Please don't do it alone. Ask us all the questions you want, and let us give you options on how we can manage the situation together. At Right At Home we got the best and most professional caregivers, with certification and special care training. So contact us today and get the support you’ve been looking for.


Bruce Gropper
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