The patient did not have a history of current or prior excessive alcohol use or any recreational drug use. He had some demoralization related to his cancer diagnoses but did not have hopelessness and wanted to take it “one day at a time.”
The impairment was apparent only to his family members who were concerned about his safety at home. Moreover, the patient lacked insight into his situation at home and did not report distress. He did not have symptoms of psychosis, and he did not meet criteria for hoarding disorder, as there was no sentimental attachment to possessions in the house nor a perceived need to necessarily keep “waste” at home. He did not meet DSM-5 criteria, currently or in the past, for major depressive disorder, adjustment disorder, bipolar disorder, generalized anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder ( 7). The patient was seen and evaluated by the psychiatric consultation-liaison team. Social work was consulted to determine whether there were any safety concerns if the patient was discharged back home, and a psychiatric consultation was requested for evaluation for a psychiatric disorder and assessment of cognitive functioning.
F lived alone, and there had been accumulation of “waste” congesting and cluttering the living area. F’s son shared his concerns with the primary team about his father’s hoarding garbage, spoiled food, and excreta at home since the cancer diagnosis. He was admitted to the oncology floor for evaluation and management of his symptoms. He had been started on carboplatin chemotherapy infusion 1 month prior. He was brought into the hospital for concerns with regard to worsening dysphagia, fatigue, and serosanguinous drainage from his nose. F” is a 78-year-old widowed, Caucasian man with a past medical history of hypertension and coronary artery disease who was diagnosed with carcinoma of the paranasal sinus with leptomingeal carcinomatosis 6 weeks prior. The present case report is of a patient with sudden-onset hoarding of garbage, spoiled food, and excreta in his house after a life-threatening diagnosis. Both these descriptors refer to a person’s home becoming so unclean, unhygienic, and repulsive that individuals of similar culture and background would consider extensive clearing and cleaning to be essential ( 4, 5). In the present case report, Diogenes syndrome and severe domestic squalor are used interchangeably to describe the same psychopathological phenomenon.
There has been a proposal for use of the term “severe domestic squalor” as a better descriptor of this syndrome ( 4). However, many authors have argued that there was not much discussion of why the eponym is appropriate and have argued that the term is a misnomer ( 4– 6). The syndrome was named after Diogenes, as the ancient Greek philosopher showed “lack of shame” and “contempt for social organization” ( 3). The term Diogenes syndrome was later coined by Clark et al. Macmillan and Shaw first described the syndrome in 1966 ( 2). A depiction of Diogenes, by French painter Jean-Leon Gerome ( 1), is shown in Figure 1. The onset of extreme self-neglect in elderly individuals where there is a temporal relationship to the news of a life-threatening illness has been reported in literature and referred to as Diogenes syndrome, named after the ancient Greek philosopher who lived in a barrel in the 4th-century BCE.
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