PILING UP UNTIL FALLING SICK

When we think of Diogenes syndrome, the image of a crowded apartment often comes to mind. “A woman suffering from this disease was living on the armrest of her sofa, the only uncluttered place left in her home”, says Stéphane Morandi, Head of the Mobile Psychiatric Service at CHUV. However, the disorder is not systematically expressed by the pathological accumulation of objects. Some people do not hoard; they neglect their bodies completely, which can lead to health complications such as wounds or malnutrition. Others go through withdrawal and isolation. “These people are hostile to any contact”, says Benjamin Lavigne, assistant doctor at the CHUV’s Institute of Legal Psychiatry and author of a study on the subject. 

Someone who does not seek help, despite living in untenable conditions, is a major criterion to assess whether they suffer from Diogenes syndrome. “No one affected by this disorder comes to consult on their own, explains Stéphane Morandi. The cases come to us after someone reports them, often because of unpleasant smells or litter overflowing on the landing.”

The syndrome as a symptom

This disorder does not really exist as such, insofar as it often goes hand in hand with another psychiatric disorder. “Diogenes syndrome is more a description of symptoms observed than a psychiatric diagnosis per se,” says the expert. In many cases, it is associated with other disorders such as dementia, Alzheimer’s disease, psychosis, anxiety and mood disorders or cognitive delays. 

Living alone and trauma are also risk factors. A family, marital or professional breakdown can trigger or aggravate Diogenes syndrome. The accumulation of objects can then be a way to fill a void and calm anxiety, explains Stéphane Morandi. However, a person with Diogenes syndrome is generally unable to say why they are hoarding things because they do not measure the abnormality of the situation. This alteration of judgment also means that the person can no longer maintain an objective view of their condition and the potential health hazards it entails.

The ethical issues of patient care

This lack of lucidity makes patient care, which is usually imposed, delicate. After someone reports a case, medical teams go to the person’s home. Patient care relies first on dialogue and help decluttering to ensure their safety. “We had the example of a person cooking on a wood fire next to an accumulation of flammable objects,” says Morandi. The crash team must find a balance between respecting individual autonomy and hazard management. "Throwing objects away can cause tremendous stress for those involved. Because for them, each object is important. That’s when we look for compromises." 

Medically, it is a matter of treating associated disorders such as depression or schizophrenia. “The syndrome itself is not directly treatable”, says Benjamin Lavigne. Sometimes, we have to remove individuals from their homes in order to make them healthy, which often involves hospitalisation. The hospital stay should be as short as possible, followed by close monitoring. Returning to an empty space can be a shock. Decompensation must be avoided,” he warns. Some people regain their autonomy with targeted guidance, while others require an extended follow-up or are no longer able to live alone. “The heterogeneity of profiles makes individualisation of care essential.”