Diogenes syndrome or isolated syllogomania? Four heterogeneous clinical cases

Hoarding Disorder and Diogenes Syndrome: Two Case Reports and a Narrative Review

Hoarding disorder (HD) and Diogenes syndrome (DS) are challenging and multifaceted conditions that significantly impact patients and society. These disorders are characterized by excessive hoarding behaviors, often accompanied by multiple physical and mental comorbidities, diminished quality of life, and substantial public health challenges. Through the presentation of two case reports and a narrative review, this article revisits HD and DS, highlighting the need for clinical awareness, targeted management strategies, and further research in this field. The first case report describes a 35-year-old woman with early-onset HD and comorbid obsessive-compulsive disorder, while the second details a 78-year-old woman with DS related to vascular dementia. These cases underscore the necessity of timely diagnosis, multidisciplinary interventions, and comprehensive management to prevent deterioration, address physical health issues, improve hygiene and home safety, and mitigate harm to both patients and the community. Advanced treatments such as transcranial magnetic stimulation and electroconvulsive therapy may also play a role in managing these complex conditions. The development of practical guidelines is essential for the effective assessment and care of patients with such multidimensional needs. Moreover, there is a critical need for well-designed randomized controlled trials to evaluate and compare pharmacological and non-pharmacological treatment approaches.

Diogenes Syndrome: Identification and Distinction from Hoarding Disorder

"Severe domestic squalor" or Diogenes syndrome is characterised by extreme self-neglect of environment, health, and hygiene, excessive hoarding, squalor, social withdrawal, and a distinct lack of concern or shame regarding one's living condition. This report presents a case of a 51-year-old male admitted to the hospital psychiatric ward following the police removing him from his home. Police officers attended the man's home following the alarm being raised by his stepfather that he had not been seen or heard from in 3 weeks. His home was covered in several feet of rubbish, rotting food, and debris and smelled intensely of rotting mould, urine, and faeces. He was found lying nude on top of garbage with a rug over him. Diogenes syndrome is highly comorbid with psychiatric and somatic disorders, including depression, obsessive-compulsive disorder, personality disorder, and stress. This case report provides a rare opportunity to better understand the distinction of Diogenes syndrome from the closely related condition hoarding disorder. Furthermore, creating an agreed-upon constellation of symptoms representative of Diogenes is essential to creating a formal Diagnostic and Statistical Manual of Mental Disorders (DSM) entry, which would facilitate the much-needed development of assessment measures to enable accurate diagnosis and treatment.

Diogenes Syndrome in Frontotemporal Dementia

Diogenes syndrome refers to the combination of extreme self-neglect and excessive collecting with clutter and squalor, which is often present in patients with dementia. Diogenes syndrome may be particularly common in behavioral variant frontotemporal dementia (bvFTD), and the investigation of these patients may help clarify the nature of this syndrome. We describe 5 patients with bvFTD who exhibited a decline in self-care accompanied by hoarding behaviors. These patients, and a review of the literature, suggest a combination of frontal lobe disturbances: loss of insight or self-awareness with a failure to clean up or discard, a general compulsive drive, and an innate impulse to take environmental items. This impulse may be part of the environmental dependency syndrome in frontal disease, with specific involvement of a right frontolimbic-striatal system. Further investigation of the similarities and mechanisms of these symptoms in bvFTD could help in understanding Diogenes syndrome and lead to potential treatment options.

Recognizing Diogenes syndrome: a case report

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.