Creativity, hyperesthesia, and mental illness

A Psychoanalytical Approach to Diogenes Syndrome

This article is an attempt at a psychoanalytic understanding of Diogenes syndrome, or hoarding disorder syndrome, by way of a clinical case. This syndrome is characterized by a failure to attend to proper housing habits, including the hoarding of rubbish that may, in fact, create unsuitable, even dangerous, living conditions. The clinical case used suggests that Diogenes syndrome or hoarding disorder reflects or indicates an extreme form of obsessive neurosis involving libidinal regressions to anal fixations designed, paradoxically, to satisfy both a passion for dirty and for order. However, this pathological hoarding may also function to protect the subject against fears associated with meeting people, thereby avoiding any possible intimacy and promoting self-exclusion in an anti-object aim. Finally, the case under discussion helps us to understand the particular psychological aspects or relevance that the actual items and rubbish accumulated have in this syndrome.

Diogenes syndrome in patients suffering from dementia

Diogenes syndrome (DS) is a behavioral disorder of the elderly. Symptoms include living in extreme squalor, a neglected physical state, and unhygienic conditions. This is accompanied by a self-imposed isolation, the refusal of external help, and a tendency to accumulate unusual objects. To explore the phenomenon of DS in dementia we searched for the terms: “Diogenes syndrome, self-neglect, dementia. ” It has long been understood that individuals with dementia often become shut-ins, living in squalor, in the Eastern Baltimore study, dementia was present in 15% of the elderly cases with moderate and severe social breakdown syndrome; twice as many as in the general population of the same age group. Researchers have underlined the frequent presence of DS (36%) in frontotemporal dementia (FTD): different neuropsychological modifications in FTD may contribute to symptoms of DS. The initial treatment should be a behavioral program, but there is not sufficient information regarding pharmacological treatment of the syndrome.

Is collectionism a diagnostic clue for Diogenes syndrome?

BACKGROUND

Diogenes syndrome (DS) is characterized by extreme self-neglect, domestic squalor, and social withdrawal. Despite having been described decades ago, it is still difficult to persue a correct diagnosis in primary care clinics.

METHODS

This paper reports a case of an elderly man with extreme self neglect and an abnormal collecting pattern whose condition remained undetected for many years. His collectionism was manifested with a tendency to store items in an organized manner but without a clear purpose.

CONCLUSION

The authors suggest that the presence of collectionism could be a helpful clue towards diagnosis of DS in similar cases.

On phenomenology and classification of hoarding: a review

OBJECTIVE

Hoarding is a behavioural abnormity characterized by the excessive collection of poorly usable objects. It is described mainly in association with obsessive-compulsive disorders (OCDs) and in geriatric populations. Yet the literature on the phenomenon is heterogeneous and the notion obviously lacks a consistent definition. This review attempts to describe the psychopathological and clinical spectrum of hoarding and may contribute to clarify its classification.

METHOD

Systematic review and discussion of the literature on hoarding.

RESULTS

Hoarding is a complex behavioural phenomenon associated with different mental disorders. The psychopathological structure is variously composed of elements of OCDs, impulse-control disorders, and ritualistic behaviour. Severe self-neglect is a possible consequence of hoarding.

CONCLUSION

Without further specifications the term hoarding is of limited heuristic value and cannot guide therapeutic interventions satisfactorily. The condition needs to be evaluated carefully in every particular case in relation to the aforementioned psychopathological concepts.

Diogenes syndrome: the self-neglect elderly

Diogenes syndrome (DS) is characterized by severe self-neglect, domestic squalor, social withdrawal, syllogomania, and refusal of help that may be precipitated by stressful events. Secondary DS is related to mental disorders. Its management includes day care center and community care.