![]() In the case of Diogenes Syndrome, the accumulated items repair the Moi-peau and the home becomes an « exterior-proof », thus playing the role of the Moi-peau. As a result of a narcissical wound, the Moi-peau is damaged and looses its function of a container. It preserves the relationship and the cohesion « container-content ». The Moi-peau is organised as a double-wall acting both as a defence mechanism and as a filter between the psyche and the external world. The skin has three functions : the containing shell, the protective barrier of the psyche, and a medium of exchange. The Moi-peau represents a structure of the psyche founded on the following principle : any psychic function develops itself according to a bodily function from which it transposes its functioning at a mental level. A psychopathological understanding is presented here, referring to psychoanalytical theories of the Moi-peau (ego-skin) described by Anzieu. Passive type patients accumulate by default and emptiness. Active type patients fill their home to fill in the vacuum of their life, as it deteriorates and looses its narcissical appeal. Finally, the link between these pathologies and Diogenes syndrome is not yet determined : are they triggering, co-morbid or etiological factors ? Should this syndrome be considered as a true illness or as a symptom ? This paper presents Diogenes syndrome as a behavioural disorder and distinguishes 2 types : the « active type » - patients who collect from outside to clutter inside - and the « passive type » - patients who passively become invaded by their rubbish. Alcohol abuse seems to be an aggravating rather than a precipitating factor. Dementia, in particular temporo-frontal dementia, should be looked for and excluded clinically. However, psychiatric pathologies as paranoid and paranoiac psychoses, mood disorders and obsessive and compulsive disorders have been described to be associated with it in the literature. Clark and Mankikar, who named this syndrome, reckon it may represent stress-related defence mechanisms of the elderly or may be related to natural ageing process. They include the main features of the syndrome and exclude known psychiatric syndromes. There is no true consensus about diagnostic criteria. Most authors agree that this behaviour does not reflect free will and has consequently no theoretical relationship to the Greek philosopher. ![]() Although several clinical hypotheses have been suggested, the true ethiopathogeny of the syndrome remains unclear. Psychotropic treatment prescription may be necessary, depending on clinical features and the possible underlying psychiatric disease. Hospitalisation has to be avoided whenever possible and ambulatory treatment and social measures should be favoured. Moreover, 46 % of patients have a 5 year mortality rate. Management of the syndrome is difficult and ethically challenging, as the patient does not seek help. Patients suffering from Diogenes syndrome are usually discovered by chance, either because of a somatic illness, or as a result of social intervention related to their behavioural problems. ![]() The Diogenes syndrome is a fascinating object of study for the clinician who takes care of patients living in uncommon conditions, on the edge of society and unaware of the particularity of their lifestyles. Its rare occurrence contrasts with the fact that it is well-known, partly due to it being named after the Greek philosopher « Diogène de Sinope », who taught cynicism philosophy and a return to a natural way of life, and partly because of its rare characteristics. This particular geriatric syndrome has been described for the first time only quite recently, as the 2 primary descriptions by geriatricians and psychiatrists date from 19 respectively. This is accompanied by a self-imposed isolation, the refusal of external help and a tendency to accumulate heteroclite objects. Symptoms include living in extreme squalor, a neglected physical state and unhygienic conditions. Diogenes syndrome is a behavioural disorder of the elderly.
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