Diogenes Syndrome: Living in Extreme Squalor
Monday, April 14, 2008
JC Jones MA RN

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.Labels: Diogenes syndrome, extreme squalor.
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12 Comments:
At Mon Apr 14, 11:35:00 AM 2008,
Louisa Pickering said…
Thank you for the article - very insightful. I've forwarded it to several friends.
At Fri Jul 18, 12:09:00 PM 2008,
Jenny said…
I thank you too, very informative. I have lived with an elderly woman with exactly this syndrome for the last two years and it is an accurate description. Very frustrating for friends and family.
At Mon Sep 08, 01:37:00 AM 2008,
Anonymous said…
i find this subject facinating..my mom is definitely a hoarder and although not as extreme as what i see in the above picture, she has trouble throwing things away, is very controlling and tends to blame others for the lack of space in the house. i think it has been other family members who fortunately, have kept the hoarding in check. my mother grew up during the war and was deprived of even basic material goods for example wearing hand me down shoes. i wonder if material deprivation and the need to control might play a part in this illness?
At Mon Dec 15, 03:25:00 PM 2008,
Anonymous said…
THIS DESRIBES MY GRANDMOTHER COMPLETELY..ITS GOOD TO HHAVE A DIAGNOSIS.TO LIVE OR BE A LOSE RELATIVE OF A SUFFERER IS ONLY WHAT I AN CALL HELL.THESE INDIVIDUALS ARE SELFISH ,OBSTINATE,AND HAVE AN INABILITY TO SEE THE DAMAGE THAT THEY CAUSE OTHERS.IN MY EXPERIENCE THEY DO NOT AKNOWLEDGE THAT THEY HAVE APROBLEM AND SO THERE IS LITTLE HOPE FOR REHABILITATION
At Tue Dec 16, 04:50:00 AM 2008,
Anonymous said…
Thank you, this article is what I have been looking for! Very informative and very true but IS THERE A CURE or any help to be had for this dis-order ?
At Mon Dec 29, 04:58:00 PM 2008,
Anonymous said…
To Whom It May Concern:
Your web site was sent to me by my son-in-law regarding my 31 year old daughter who lives in Montana. She is visiting us for the Christmas holiday and we just found yesterday from a friend of my daughter's who lives in the same apartment as my daughter that her apartment is filthy and full of left-over food and garbage. She has a cat that a neighbor was asked to feed while she was gone and that is how they found out. She has never exhibited this kind of extreme behavior before. Some years earlier she was tentatively diagnosed with Asperger's Syndrome, but never formally. She is depressed and is reluctant to talk about what we have just found out. the neighbor, who likes my daughter very much called me. My family and I think that my daughter should remain here with us, so that we can find out what is wrong. She also has lost weight, which is good, because she has been extremely overweight, but she does not look well. We are taking her to a doctor on Wednesday. Can my daughter be suffering from this disorder, as it seems to affect people who are much older? I would appreciate any insight you can forward to me. Sincerely, Pam
At Wed Jan 14, 11:08:00 AM 2009,
Anonymous said…
Thanks for the article. However, I thought the room looked too clean. You show the junk lying everywhere, but I can still see the floors. The windows are clean and I can see out of them. There is no disgusting filth everywhere. Nothing is broken. no garbage. no piles of old papers. No mouse droppings or animal fur caked to everything. No smell of urine wafting from my computer. I dread the day I'll have to clean my in-law's home. She's too paranoid and controlling to allow us to help her while she's alive. We all feel helpless and angry because she blames us all for her plight but won't let us help. It's very, very sad for everyone involved.
At Thu Jan 29, 05:19:00 AM 2009,
Anonymous said…
My mother in law has had this problem for many years - certainly all the 38 years since I have known her. She has always been very controlling of her three sons who have never challenged her because she would stop speaking to them. The problem got very much worse after my father in law died because he used to keep the hoarding in check a bit. Even so, we were never allowed to visit and we would have to meet her at the garden gate at a pre-arranged time if we wanted to take her out of the house for any occasion. But, there is hope. A couple of years ago I talked to her about moving out of the house. She immediately dismissed the idea because obviously someone would have to deal with the filth and rubbish in the house. But I persisisted, in a very non-judgmental way (I kept saying that the house was obviously too big for her to cope with and this wasn't her fault) and finally we got her to move into a rented flat. She stayed there for eighteen months while we all cleared the house out and redecorated it and then we moved her back in. She hasn't changed though - she had started to do the same thing to the rented flat to the extent we had to let the landlord keep the deposit because the carpets had been ruined by her dog. But, we are now on the top of the situation because it meant that we can now go back into the house regularly to help keep it clean. She is slowly filling it back up but at least we are now able to have a nurse round to help her with her various ailments and she is 85 so I doubt whether she will have the time left to fill the house up with rubbish again. We are lucky, we had the money to be able to do this but the important thing was to gently insist that something had to be done and keep insisting until she had no other choice. We made it clear that we would not continue to take her shopping etc if she dod not co-operate. This was hard to do and I feel for everybody who has to look after a family member with this problem.
At Sat Feb 07, 07:12:00 AM 2009,
Anonymous said…
I am a social welfare worker with older people and have come across this issue many times. The people behave exactly as described and are very difficult to work with, flouting authority when they are causing problems with their neighbours...smells,blocking fire escapes etc. We have found that having a guardian appointed has helped in one case as she saw a psychogeriatrician who diagnosed a mental health problem.We had to remove her using the gentle pesuasion of police officers as her unit also had ten cats deficating in it. The rubbish was piled high up all the walls and there was no floor to be seen. She could not use the bathroom or kitchen and was going to the toilet in cans and buckets. She had not allowed anyone in for over 10 years. She is in hospital at the moment while being assessed and is comfortable though a bit cranky. We will find her new housing and services to help keep her new place clean. It took one year to get to this point as she did not respond to our negotiations. It can be done with local servies all working together in what we call a hoarding task force. Good luck everyone.
At Tue Feb 17, 04:12:00 PM 2009,
Anonymous said…
Diogenes Syndrome is not limited to the elderly... I have been whitness to more than one circumstance of this sort of filthy lifestyle in people under the age of 30 who have seen no problems with living in rooms with animal feces on the floor and moldy plates throughout.
At Thu May 21, 09:49:00 AM 2009,
Lisa said…
Thank you for the information. My sister and I have been dealing with our mother who suffers from this. It is very difficult. One thing we have learned is that to her, the items she has are of value. The STUFF is her stuff. Mom is nearing 80 and we are thinking that a bull dozer would be great! We are going to try to convince her to donate to the less fortunate.
At Sat May 30, 09:01:00 AM 2009,
Anonymous said…
I notice that no one comments who has this syndrome. I only just heard the name for it today and looked at your site. I have it. I am an artist. I hoard stuff that is sometimes made into art and sometimes not. It is getting worse as I age... I am 51 and female. I really would like to have it all clean and organized in my home - it used to be when my kids were young. But if you think it is hard having a relative with this problem, I am here to tell you that it is horrible and painful beyond words to have it yourself. Let's try to be more understanding. Those of us who have this issue are not necessarily senile. The judgmentalism we know we will encounter is why no one can come into our homes and we feel invaded when someone does unless it is a trusted friend or family member. And at the bottom of it all is that those of us whose trust has been betrayed early in life and who learn over and over again as we grow older and patterns tend to repeat themselves that we can't trust anyone (why a lot of animals is sometimes a factor because an animal does not judge about superficial things) Some of the sweetest, most intelligent, loving people I know have been hoarders. We all work hard on getting over it, because it is painful to be in this but a monumental task to overcome. And outside help is no good because people "let" you keep stuff that you could care a less about because they would value it.... but the one thing you love, the most expensive Japanese ink roller, the hemp paper from Thailand. but all those other people who know best... they burn my stuff, they throw it out in the rain, let it get moldy and they use my house to hoard their own stuff too, so there is never any room for my own things.... what I'm saying is, there is rarely just one individual, just the identified person that everyone dumps on, sometimes in a very concrete way. Yet the identified hoarder is the one who is called "controlling" or "obstinate" for not letting others "control" them. There is a big desire for some of us to make order from chaos. That is my definition of the art making process. Keeping people away.... is my definition of a neurosis that is still working for me. Sigh...
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