A lost screw, a shirt that no longer fits us, a wooden plank…
Many of us sometimes save objects and things that, although at that moment we know that we are not going to use them, for one reason or another (either because it brings back memories or because we believe that they may be necessary in the future) we decide to save and preserve them. .
It is something normal and in principle it does not represent any problem in our lives. But In people with Diogenes syndrome this phenomenon becomes a common and problematic tendency. product of self-abandonment, beginning to accumulate a large amount of objects and waste without any use and causing great personal and social deterioration in their lives.
Diogenes syndrome is a disorder characterized by the fact that those who suffer from it collect and store a large amount of belongings and possessions, usually junk, in their home. They have a great inability to get rid of them, so they accumulate more and more.
The objects kept by individuals with this disorder can be very diverse, from objects of great value to waste and remains, the real or symbolic value of the object not being what produces its conservation. As in hoarding disorder The person with Diogenes syndrome has great difficulty discarding their possessions, needing to keep them with them and experiencing anxiety and discomfort at the idea of ​​losing them. If asked about the reason for this conservation, people with Diogenes syndrome usually do not know how to give an explanation for it.
Some authors propose that Diogenes syndrome usually occurs in three phases. At first I would highlight the attitude of self-abandonment, beginning to generate waste that is not eliminated and begins to accumulate. Subsequently, and as the number of waste increases, the individual moves to a second phase in which the profusion of garbage and waste makes it necessary to begin organizing (not necessarily ordering) the material and space available to them, while it worsens. the deterioration of habits. In a third and final phase, the individual not only does not get rid of his waste, but begins to actively collect elements from the outside.
Leading to lack of hygiene and self-neglect
In the long run, the cumulative behavior of these people causes the collected objects to occupy a large part of the individual’s home, organizing themselves in a disorderly and expansive way throughout the entire home. This problem leads to the point that the functionality of the home is limited not being possible to access certain areas such as the bed or the kitchen. Furthermore, the disorder and lack of cleanliness caused by the accumulation causes serious hygiene problems that can compromise the health of the individual.
This syndrome produces a high level of deterioration in multiple areas, especially at a social level by causing coexistence problems. Those who suffer from it gradually withdraw from the world, isolating themselves and reducing contact with others to a minimum, due both to an increase in interpersonal conflicts due to their condition and to the time spent storing and accumulating things. They also begin to abandon some of the main hygiene habits, both household and personal.
These cases are frequently detected in advanced stages. due to complaints from neighbors and relatives due to the unhealthiness of the affected person’s home, the smell and the insects and rodents attracted to the objects.
Likewise, it is common for those who suffer from Diogenes syndrome end up having serious eating problems presenting altered eating patterns and eating little, poorly and at the wrong time. They may end up consuming food in poor condition (derived from a lack of hygiene in the home or an indifference to its expiration date). This, together with health problems derived from poor hygiene and avoidance of contact with others. It can weaken them to the point of having to be hospitalized. and even that a high percentage of them die within a few years of the onset of the syndrome.
Possible causes
Although the cause of the cumulative behavior in cases of Diogenes syndrome is not fixed or fully known, Most of those who suffer from it are people over 65 years of age, retired and often widowed.
Thus, one of the most common characteristics is the presence of loneliness before the accumulation begins. Whether due to the death of the partner or abandonment, this loneliness can lead to the progressive disappearance of concern about hygiene, food and contact with others, also appearing behavioral and emotional rigidity that favors the perseverance of accumulation. They feel great insecurity and they make up for it through accumulation. There is usually a stressful event that triggers the onset of symptoms.
A large part of the subjects with Diogenes syndrome They also have a previous mental or medical disorder and it is very common for them to be immersed in processes of substance addiction, dementia or major depression, often with psychotic characteristics. So there is probable cognitive impairment which causes the person to stop worrying about health and maintaining the state of health, nutrition and hygiene.
Diogenes syndrome is a complex disorder that requires treatment from different approaches. People with this disorder do not usually go to therapy of their own free will, being referred by medical or judicial services or pressured by their families.
The multidisciplinary intervention is due to the fact that it is necessary to act on both the ideas and beliefs of the individual as well as their habits, given that the accumulation of garbage becomes part of the person’s daily life and it is difficult to break that dynamic. Precisely for this reason we must also act on the place where we live: focusing attention only on the person is not useful.
In many cases, the authorities, alerted by complaints from neighbors and acquaintances, go to the homes of these individuals and end up cleaning and disinfecting the place. Yes ok This can temporarily eliminate the accumulated garbage does not solve the problem that the subject suffers nor does it help him or her to face the situations in another way, so if the external action ends there the subject will relapse again.
Evaluation and intervention
At the treatment level, it is a priority to evaluate the health status of the subject and correct complications derived from lack of nutrition and hygiene. In cases in which this syndrome is produced or is aggravated by other disorders such as depression or a psychotic disorder, it will be necessary to apply the most appropriate strategies to treat the disorder itself, both psychologically and pharmacologically. The use of antidepressants such as SSRIs to improve mood is common.
Regarding psychological treatment It would be necessary, first of all, to show the existence of a problem and the need to solve it, given that the majority of those affected are unaware or do not recognize their condition. It is also essential to carry out training in the skills and guidelines for hygienic and nutritional behavior.
Given that in the vast majority of cases there is a high level of insecurity, this aspect must be worked on in therapy, as well as the existential passivity that most of this type of patients display. It is also necessary to reestablish the person’s contact with the world, through training in social skills and participation in community activities. This helps combat loneliness and the anxiety it causes. The detachment of objects and waste and what the patient thinks about conservation must also be worked on.
As in the vast majority of mental disorders social and family support is an essential factor for recovery and/or improvement of quality of life. Psychoeducation of the closest environment is necessary in order to understand the patient’s condition and to monitor her, it being important to monitor her activity patterns and ensure that she does not return to a state of isolation.
Difference with hoarding disorder
The characteristics of Diogenes syndrome largely resemble another disorder with which it is frequently confused, the so-called hoarding disorder or hoarding.
Both problems have in common the accumulation of a large number of objects and possessions that are difficult for those who suffer from them to get rid of, together with the fact that this accumulation produces serious problems in the use of personal domestic space. In both cases anosognosia may occur, or even a delusional idea according to which accumulation is not harmful despite there being evidence to the contrary (although the lack of recognition of the existence of a disorder in Diogenes syndrome is much more common).
Furthermore, in both disorders problems usually appear in various vital domains, especially with regard to interpersonal relationships, in many cases avoiding close contact with people.
However, in the case of hoarding disorder or hoardingThe accumulation is totally intentional and usually has a specific reason for wanting to maintain it. It is a disorder linked to obsessive characteristics.
In the case of Diogenes syndrome, the accumulation is usually due more to a process of deterioration, it being common for there to be an ongoing dementia process, and the accumulation is usually due more to unintentional passive elements (although in many cases they also collect and accumulate waste as an emotional protection mechanism).
Furthermore, while in Diogenes syndrome a deterioration in personal hygiene and eating habits is largely present, in hoarding disorder these characteristics are not usually present, its behavior being relatively common outside of the collection.
