Sunday, April 27, 2014

Living in filth: Diogenes syndrome

Have you ever wondered what happens when someone doesn't wash or bathe for months and months? Well, the result is not pretty. Dirt, dust, bacterial, fungal, and parasitic debris conglomerate to form thick, stinking crusts and scales over various parts of the body.

You might think that one sees such epic levels of uncleanliness mostly in the homeless population - well, not necessarily. Some mental disorders lead to extreme neglect of personal hygiene. This can be perplexing and baffling when the sufferer is, apparently, quite lucid and maintains contact with reality, yet does not register the truth of his/her condition (or doesn't care). An example of such a disorder is Diogenes syndrome, named for the philosopher Diogenes of Sinope, who pursued an unconventional lifestyle characterized by deliberate poverty and self-neglect (he is said to have lived in a large ceramic wine jar). Characteristic symptoms of Diogenes syndrome include social withdrawal, apathy, a filthy home, extreme self-neglect and compulsive hoarding of rubbish, coupled with a shameless attitude and stubborn refusal of help.

Living alone for long periods of time without appropriate social interaction, a lack of cognitive stimulation, as well as a genetic predisposition to the condition, can all be a catalyst for Diogenes syndrome. In predisposed individuals, the disorder may be precipitated by some deeply traumatic event such as the death of a loved one. Sufferers frequently have above average intelligence. Incidentally, "Diogenes syndrome" is a misnomer, since the philosopher Diogenes did not hoard - on the contrary, he tried to reduce the number of his possessions to a minimum - and was not socially withdrawn.

Diogenes syndrome usually affects the elderly; however, occasionally it occurs in younger individuals with some form of mental illness, such as a 34-year old man from Kolkata, India, described in a recent article by Biswas et al. (2013). This man was coaxed by his neighbors to come to the hospital because of numerous brown crusts and pimply lesions on his body, mostly on the trunk. He had been suffering from this condition for more than six months.

The patient was alert and cooperative but was severely depressed. He had no relatives to visit him and had been stubbornly refusing help from neighbors, who reported that he had not taken a bath for longer than 2 years. They also described his home as filthy and crowded with furniture, old books, and scraps of papers in huge heaps.

In the photo below, many dark brown lesions are visible on the man's chest and arms. These thick crusts are composed of dirt, sebum and dead skin cells, with a reddened, inflamed base. Ewww. The patient also looks quite frail and malnourished. According to the article, his scalp, groin, and face were almost spared. There were also no signs of parasites such as scabies or lice.

Here you can see more disgusting lesions on his back, along with lots of acne.

The best part? This man was an university graduate and was actually earning a living - as a computer programmer!

Doctors diagnosed the patient with schizophrenia. He was admitted to a psychiatric ward and treated with antipsychotics, as well as antibiotics for his skin lesions - and washed from head to toe, of course (I wonder how he tolerated this). According to the article, his condition improved, but the authors don't say whether he was ultimately able to live independently again.


Biswas P, Ganguly A, Bala S, Nag F, Choudhary N, Sen S. (2013) Diogenes Syndrome: A Case Report. Case Rep Dermatol Med. 2013; 2013: 595192.


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