Filthy house mental illness

Recognizing Diogenes syndrome: a case report

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BMC Res Notes
v.7; 2014
PMC4016666

BMC Res Notes. 2014; 7: 276.

Published online 2014 May 2. doi: 10.1186/1756-0500-7-276

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Background

Diogenes syndrome is a behavioural disorder characterized by domestic squalor, extreme self-neglect, hoarding, and lack of shame regarding one’s living condition. Patients may present due to a range of reasons. Recognizing these will allow for earlier management of this high-mortality condition.

Case presentation

61-year Caucasian female known with bipolar 1 disorder presented with manic symptoms. She was very unkempt and foul smelling. After being admitted involuntarily, she requested that someone go to her home to feed her pets. Her house was filled with garbage, rotting food, and animal feces. She had no insight into any personal hygiene or public health problems.

Conclusions

Patients with Diogenes syndrome may be difficult to identify. Knowledge of the characteristics of Diogenes syndrome can aid in earlier recognition of such individuals, in order to decrease morbidity and mortality, and to improve public health.

Keywords: Diogenes syndrome, Self-neglect, Hording, Senile squalor, Mental health

Diogenes syndrome (DS) is a behavioural disorder characterized by domestic filth, or squalor, extreme self-neglect, hoarding, and lack of shame regarding one’s living condition [1]. The approximate annual incidence of Diogenes is 0. 05% in people over the age of 60 [2]. Affected individuals come from any socioeconomic status, but are usually of average or above-average intelligence [3]. It is often associated with other mental illnesses, such as schizophrenia, mania, and frontotemporal dementia [4]. While no clear etiology exists, it is hypothesized that it may be due to a stress reaction in people with certain pre-morbid personality traits, such as being aloof, or certain personality disorders, such as schizotypal or obsessive compulsive personality disorder [5,6]. There are suggestions that an orbitofrontal brain lesion may lead to such behaviours [7], while others state that chronic mania symptoms, such as poor insight, can lead to such a condition [4].

Although DS is not uniquely recognized in the Diagnostic and Statistical Manual (DSM) of Mental Disorders, the fifth version of the manual now identifies hoarding (syllogomania), as a psychiatric diagnosis [8]. Syllogomania is differentiated from Diogenes in that other characteristics such as the squalor and neglect are present in DS [9]. Mortality is increased in these patients, with a 46% five-year death rate [1], which is commonly due to physical illnesses such as pneumonia. This is subsequent to self-neglect, poor infection control practices, nutritional deficiency, and lack of presentation to medical care. These individuals self-isolate, and therefore may not be found until much later post-mortem. This can make specific causes of death difficult to determine [10]. This paper identifies that these patients can present due to a variety of reasons, and sometimes only by chance. Keeping this constellation of symptoms in mind will allow for a more prompt diagnosis and initiation of management of these clients.

A 61-year-old obese Caucasian female with a previous history of bipolar 1 disorder and hypothyroidism, presented for an out-patient psychiatric follow-up review accompanied by her Community Psychiatry Nurse. She was found to have pressured speech, elated mood, increased energy, and very poor personal hygiene. She was disheveled, unkempt, wearing dirty clothes, and was foul smelling. She was very agitated, and was verbally and physically abusive to staff. She had no insight, and refused any form of treatment. She was diagnosed with having a manic relapse secondary to non-adherence to medication, and was involuntarily admitted to the in-patient psychiatric ward. Complete blood count, electrolytes, glucose, liver function, and lipid profile were all within normal limits. Thyroid stimulating hormone was slightly elevated, although T4 was within normal limits. Vitamin B12 was on the low end of normal. She was re-started on her previous psychiatric medication, namely divalproex and clonazepam.

The following day she was adamant about having to go feed her cats and dogs, and eventually gave permission for a Community Mental Health Nurse enter her house to attend to her pets. Upon entering the house, it was found to be in complete disarray. The house was crammed with filthy clothes, garbage, dirty dishes, and rotting food. There was no kitchen sink in sight, and it looked as if some dishes were being cleaned in the toilet (see Figures and ). Any clear space of floor was strewn with cat and dog feces. An unbearable stench emanated from the entire two-story home. Upon questioning the patient regarding the state of her home and personal hygiene, the patient had no insight into any problems. At this time, a diagnosis of Diogenes syndrome was suspected.

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Bathroom. This is the state in which the bathroom was found in the patient’s house. The patient had been using the toilet for both toileting and periodically washing her dishes.

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Living room. The patient’s living room was filled with dirty clothing, old newspaper, and animal feces.

Diagnosis of DS can be difficult as no one constellation of symptoms has been established. Hoarding, which can occur in DS, can also be found in many psychiatric conditions such as obsessive-compulsive disorder (OCD), schizophrenia, dementia, and others [11]. The act of accumulation in DS is more likely ego-syntonic however, in contrast to the anxiety and intrusive thoughts that accompany collection in OCD [12]. DS can be distinguished from personality disorders in that the personality in DS deteriorates, while the true personality disorder does not [13]. Self-neglect can also be a part of dementia, schizophrenia, OCD, and affective disorders [11]. Frontal lobe dementia tends to occur approximately 10 years prior to the typical age that DS patients are affected though [13]. A diagnosis of schizophrenia can include delusions, hallucinations, and disorganized speech [14], which are not classical characteristics of DS. Clearer delineations between disorders need to exist however. An alterative suggestion was that DS “may be a final common pathway of different psychiatric disorders” [15].

Management of DS can be difficult, as patients often deny that there is a problem, may refuse any help, and can present late to medical attention [16], often in crisis. Ethical and legal issues can then arise, such as finding a balance between autonomy and beneficence [17]. For example, a patient’s notion of self-neglect can be quite different than the view of their healthcare provider [13]. Public Health issues may also arise concerning the patient’s housing. Fire, mould, and biological material can pollute the surrounding environment, so the health of nearby residents needs to be considered.

Establishing good rapport is vital in order to decrease the patient’s resistance to aid. A physical exam should be completed. Blood tests may include potassium, calcium, vitamin B12, iron, thyroid stimulating hormone, folate, and albumin [11]. Functional inquiries and cognitive testing may be useful. Treatment usually begins by looking at any other possible psychiatric issues such as mania or psychosis. Risperidone has been suggested for use in DS even when there are no underlying psychotic features [11]. Other pharmaceuticals that may be of benefit include zolpidem for sleep, paroxetine for hoarding, and sodium valproate or quetiapine for secondary bipolar disorders [11]. Flexible outpatient treatment through community care providers is preferable if there is little risk to the patient or to others [2]. This can include counseling and cleaning services, and individualized case management [18]. The mental health act can be used if difficulties are experienced in managing higher-risk patients. If management is not conducted in a sensitive manner, patients will simply return to the same living condition, with much more resistance to support and follow-up.

The prognosis of affected individuals depends on their capability of re-integrating into society, and often relies on the patients making small changes away from unhealthy living conditions [19]. Other poor prognostic factors include poor physical health, which may already be advanced due to neglect, and early age at onset.

As time progressed as an in-patient, the patient’s mood settled, although she remained guarded, with little insight into her self-care. The patient required persistent and gentle pressure in order to even start thinking about de-cluttering and improving her personal hygiene. She was eventually persuaded to allow a company to help her clean her home, at a cost of $8,073. The patient was present at the clean up. The sink was eventually found under a large pile of debris. The patient is now living at home, and receiving close follow-up with her Community Psychiatry Nurse and Psychiatrist. It remains to be seen whether these interventions will make any long-term impact to her living condition and health.

This case illustrates the importance of suspecting Diogenes syndrome when elderly patients present with certain non-specific symptoms that may otherwise be disregarded. These include patients who are unkempt and malodorous, with personality traits of being unfriendly, detached, or suspicious. Such characteristics can also be related to multiple other psychiatric conditions. Timely diagnosis and respectful management may reduce both acute and chronic physical illness, increase personal and home hygiene and safety, and improve public health outcomes.

Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

The authors have nothing to declare.

JDCI – Contributed to design, carried out acquisition of data, drafted the manuscript, and gave final approval of the version to be published. KN – Contributed to conception and design, revised the manuscript critically for important intellectual content, and gave final approval of the version to be published. All authors read and approved the final manuscript.

JDCI is in the second year of a rural family medicine residency training program at the University of Saskatchewan, Canada.

KN is a consultant psychiatrist in North Battleford, Saskatchewan, Canada, and faculty at the University of Saskatchewan, Canada.

We wish to thank Dr Stephanie Young for her assistance in revising the manuscript. Dr Young does not have any sources of funding to disclose. The authors received no external funding for this study.

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Articles from BMC Research Notes are provided here courtesy of BioMed Central

Diogenes Syndrome: Symptoms, Caregiving, and More

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Medically reviewed by Timothy J. Legg, PhD, PsyD — By Corey Whelan — Updated on March 22, 2017

Overview

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.

Last medically reviewed on November 4, 2016

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Cipriani, G., Lucetti, C., Vedovello, M., & Nuti, A. (2012, December). Diogenes syndrome in patients suffering from dementia. Dialogues in Clinical Neuroscience, 14(4), 455-460
ncbi.nlm.nih.gov/pubmed/23393422
Jaffe, D. J. (n.d.). Involuntary treatment and involuntary commitment laws: Basis in law and history
mentalillnesspolicy.org/ivc/involuntary-commitment-concepts.html
Lavigne, B. , Hamdan, M., Faure, B., Merveille, H., Pareaud, M., Tallon, E., … Calvet, B. (2016, March 23). Diogenes syndrome and hoarding disorder: Same or different? [Abstract]. L’Encephale
ncbi.nlm.nih.gov/pubmed/27017316
Irvine, J. D. C., & Nwachukwu, K. (2014, May 2). Recognizing diogenes syndrome: A case report. BMC Research Notes, 7, 276
ncbi.nlm.nih.gov/pmc/articles/PMC4016666/

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Medically reviewed by Timothy J. Legg, PhD, PsyD — By Corey Whelan — Updated on March 22, 2017

"These are sick people." How to deal with neighbors who have turned the house into a dump

https://ria.ru/20180602/1521766448.html

"These are sick people." How to deal with neighbors who have turned the house into a dump

"These are sick people." How to deal with neighbors who turned the house into a garbage dump - RIA Novosti, 06/02/2018

"These are sick people." How to deal with neighbors who turned the house into a garbage dump

Cockroaches, stink and tons of garbage - some neighbors can turn life into hell. Some endure, others turn to the district police officer, the Ministry of Emergency Situations and even Rospotrebnadzor ... RIA Novosti, 06/02/2018

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Society, Krasnoyarsk, Samara Region, Moscow

90352 Moscow , Jun 2 - RIA Novosti, Irina Khaletskaya. Cockroaches, stench and tons of garbage - some neighbors can turn life into hell. Some tolerate it, others turn to the district police, the Ministry of Emergency Situations and even Rospotrebnadzor. However, according to the law, it is not forbidden to carry rubbish to the apartment, and it is useless to conflict with the "scavengers". After all, as a rule, these people suffer from a mental disorder - "Plyushkin's syndrome". How to protect yourself from uncontrolled hoarding in the neighborhood - in the material of RIA Novosti.

Apartment spread. A pensioner from Karelia was asked to demolish an emergency house

May 31, 2018, 08:00

KAMAZ trucks with rubbish

Residents of a nine-story building in Novokuibyshevsk, Samara region, have long forgotten what cleanliness and comfort are. This is because one of the neighbors has been turning her apartment into a dump for several years. At first, the residents recall, she simply left things that she felt she needed. Further - more: the pensioner began to carry trash directly from the trash cans in the yard.

As a result, the neighbors were forced to seek cleaning in the apartment through all possible instances - otherwise the unpleasant smell and cockroaches would not give rest. "We have been at war with this pensioner for a long time. The woman is non-contact, does not understand persuasion, probably because she is out of her mind. Yes, and I don’t want to come to visit her to talk. I have to write statements, call everyone - from the sanitary epidemiological station to the police ", - Svetlana Bakunina (name changed at her request) told RIA Novosti correspondent.

According to the residents, the fact that the apartment has an owner, a grandmother's relative, saves. She organizes cleaning from time to time, but order is restored there for a short time. The pensioner manages to quickly litter everything so that the front door barely opens.

"Besides, there are few people who want to clean up this garbage dump. Private companies don't undertake this, the neighbors are physically incapable of it, and the grandmother herself fights with us to the last. When she you start explaining, she keeps repeating the same thing: “These are my things, I bought them, there are receipts for everything,” Bakunina says. fires through mountains of garbage. "While we were extinguishing, all the cockroaches and mice from her apartment ran into ours," she complains.0003

The last time the management company "Promzhilservis" cleaned the ill-fated apartment. According to the press service, employees in respirators took out the garbage for two days. They called for a loader and a dump truck. As a result, several KamAZ trucks of waste accumulated.

© Photo: courtesy of Novogradservis Managing Company Insects from Plushkin's houses subsequently move to neighboring apartments to the premises, so the problem can only be solved through the courts," the management company said.

Risk group

A retired woman from Novokuybyshevsk suffering from "Plyushkin's syndrome" is observed in a neuropsychiatric dispensary. However, much more often people who cannot control the craving for collecting junk do not undergo treatment, because they do not see any deviations in their behavior. Neighbors are trying to deal with sluts in conventional ways - complaints and lawsuits, not always realizing that they are facing a sick person.

Meanwhile, psychoanalysts believe that a tendency to uncontrolled hoarding can be inherent in a person, never noticed in this, and at any moment take on an acute form.

Psychotherapist Alexander Pyatnitsky told a RIA Novosti correspondent that the illness at first looks like a character trait. Thriftiness, frugality or stinginess in youth can develop into a disease in adulthood due to senile changes in the brain. However, this process can be controlled.

Signs of "Plyushkin's syndrome" appear gradually: for example, a person buys all cheap things without missing a single sale. The main message, Pyatnitsky explains, is "it will definitely come in handy for me. " At the same time, nothing is thrown out of the house. A person does not notice that the home is already littered with unnecessary items. “At these stages, there is still a chance to reason with him, but when hoarding takes asocial forms, the house has turned into a dump, its owner has become a hermit, you can’t do without psychiatrists and treatment,” Pyatnitsky explains.

No longer a tenant. What horrors do owners face when renting an apartment? attachment to things.

According to Pyatnitsky, the problem of people with such deviations is that they live alone and simply do not hear criticism addressed to them. Severe stress, prolonged depression or other experiences can lead to schizophrenia and, as a result, to the "Plyushkin syndrome".

I can store, I can not store

At the beginning of May, a video spread around the social networks, in which a resident of Krasnoyarsk tried to talk to a certain Vasya from a neighboring apartment, more like a dump. A shaggy, bearded grandfather goes down the mountain of rubbish to the door. In the pile you can see not only household garbage, but also teapots, bags, clothes, books. After a skirmish, the author of the video tries to pour water on the stinking mountain, but Vasya takes the bottle and leaves.

"We lived nearby. Eternal stench, cockroaches, bugs, flies and all that. I remember five years ago they took out a whole KamAZ truck from him, and he dragged it in again." "It's a Beard! I was scared of him when I lived in a hostel, and I always remember him like that," they note in the comments to the entry.

Grandfather brings some things every day, but he only puts them in his room and is generally peaceful. Therefore, it is extremely difficult to bring him to any responsibility. According to the law, the dwelling is inviolable, and the owner has every right to do whatever he wants there, if it does not endanger others.

Sergey Prikhodin, a lawyer in the field of housing and communal disputes, explained to RIA Novosti that it is difficult to hold the Plushkins accountable because there is no direct law against warehousing things. Creating unsanitary conditions is a violation of the interests and rights of other people. However, for evidence, you will have to provide the court with a huge package of documents.

Walled up, demons! A court in Yakutia forced a family to block the windows with bricks

January 12, 2018, 08:00

describe the situation in detail: mention smells, cockroaches and other troubles. The document will come in handy during the process. Next, you need to call an independent company that will take measurements for smells, noises, insects. Then invite Rospotrebnadzor, the housing inspectorate, the Ministry of Emergency Situations (if the garbage is on the stairwell) . Attach all these protocols to the case and go to court," recommends Prikhodin.

According to him, the judge will decide to eliminate the violations and impose a fine for non-pecuniary damage. Particular attention, the lawyer clarifies, should be paid to neighbors who collect not only things, but also cats or dogs - then they can be held criminally liable for careless handling of animals.

However, as practice shows, if a person is mentally ill, no court will force him to throw out the garbage. This can be done by the management company, which will then issue an invoice to Plushkin. “You just have to put up with it and carry out the same procedure year after year,” admits Prikhodin.

Pyatnitsky, a psychiatrist, has a different opinion: instead of tormenting oneself with lawsuits and scandals, which, in fact, do not produce results, it is easier for neighbors to try to help a person. In particular, he suggests calling the psychiatric service and calling a specialist. If a neighbor registers, starts treatment and is supervised, it is likely that he will stop dragging garbage from the street.

What psychological problems does the mess in the house speak of

Marina Muravyova (@murmaripari), an experienced psychologist, coach and blogger, will help you figure out what internal problems the space signals, falling on you with a chaotic flow of information, things and events.

It may seem that the house is just a space for rest, so if there is a mess in it, then it's okay, other areas of life look like separate examples of success and growth. Only there is also confusion: the work has not been happy for a long time, you communicate with those who are not interesting to you, there is always not enough money, a bright future does not come. All this speaks of the habit of man to surround himself with chaos and disorder. He is so used to it, he is “normal”, even likes it sometimes. Of course, he made such a choice - to live surrounded by chaos - not just like that, but for certain reasons.

Fear of change

If we exclude the clinical and psychiatric component, then the first thing that this way of life speaks about is the fear of novelty in a person. The littering of space in this case is a kind of attempt to stop time, to create the illusion of security. Buried in a mass of unnecessary things, attitudes and attitudes, a person thus deprives himself of the opportunity to encounter something new, freely moving, alive. He clings to the past, in everyday terms he “attaches” himself to old things (even if it is unnecessary trash), simply because their energy is already familiar to him. And to let something new into your own life is, firstly, scary, and secondly, hard. First, you will have to clear the rubble of the accumulated "junk", and this is an effort on yourself, the expenditure of your own emotions, time and effort. It's not easy, in general. Once again, running in circles begins in an atmosphere of familiar routine, and the changes are shifted to the next month or year ( see also: "6 questions to ask yourself if you want to start from scratch").

The trick is that for real changes in life, “decluttering” is necessary. It is not for nothing that all reboot courses begin with the recommendation to “free up space and make room for something new.” In the mess there is no place for the “new”, but there is an understandable “old”, among which, perhaps, it is uncomfortable, but understandable and predictable. And do not console yourself with the thought that this is the desired stability. It will be much more effective to admit to yourself that the disorder is your response, the protective shell that you use to hide behind the fear of change. Try not to lie to yourself: and after honesty will come a clear understanding of your needs, and you will be able to afford the desired changes.

Draw a border

Chaotically scattered things is also a story about personal boundaries. In this way, a person tries to remind himself and others that he exists, and that he is something ( read also: "4 sure ways to increase self-esteem"). “At least, I created this chaos,” such an explanation for oneself in this situation would be quite logical.

Disorder at home and in life is also a form of protest: against strict parental rules or partner's restrictions. “This is my space and it will be the way I decided, and not the way my parents demanded.” If a person has long passed the age of majority and does not live with his parents, the craving for littering may be a consequence of being “stuck” in adolescence, when the protest was not shown and still requires a way out.

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