I want it, I take it, it doesn’t work for me, I see it, I keep it, I accumulate it but I don’t throw it away; I leave it, I forget but I don’t throw it away because I want it; papers or newspapers, broken dolls or tin boxes, used clothes, unused clothes or garbage clothes, offal and waste for some, treasures for people who suffer from the Diogenes syndrome or hoarding disorder.
“Basically the Diogenes syndrome or hoarding disorder It occurs in people who have great difficulty getting rid of or parting with their property and possessions, They don’t matter the real value they have, for them they are very important even if they don’t seem so to the rest of us,” explains Ana Belén Santos-Olmo, a psychologist at the Psychological Support Service for the Elderly in Social Isolation.
Madrid is a forerunner in the care of this syndrome through the Psychological Support Service for Fragile Elderly with Social Isolation (SAP), a unit that provides assistance that goes beyond simple care for the elderly, since it deals with people in extreme situations such as functional dependency, in a deficient socio-family situation, with cognitive disorders, and, in general, situations that lead to social seclusion.
From the SAP, a service that is part of the Collaboration Agreement between the Family and Social Services Government Area, which depends on the Madrid City Council, and the Official College of Psychologists of Madrid, has been analyzed in an investigation the situation of elderly patients with this disorder, with the aim of improving care for these people who suffer the consequences of social exclusion, and, on the other hand, the accumulation of garbage.
Within the population served by the SAP, the study shows that 21% had accumulation in their homes, being women the most affected (65.4%) and the average age 80 years. The profile shows that the majority do not have children (77%) and live alone (92%). Regarding marital status, 54% are single, 27% are widowed and 19% are separated or divorced. “It is curious that there is no married person within the group of people with accumulation, although they may have been married,” Santos-Olmo explains to Europa Press.
Regarding cognitive impairment, 85% of the population studied has no impairment or is mildly impaired, versus 15 percent who are moderately to severely impaired. Regarding the presence of a mental disorder, 61% of the population presents some serious mental disorder, the most frequent being the presence of psychotic symptoms (24%), alcohol abuse (19%) and symptoms corresponding to mental disorders. personality (16%).
However, it is difficult to know approximately the population affected by Diogenes syndrome and hoarding disorders in Spain; it is said that he Diogenes could affect up to 6 percent of the populationwhile the hoarding disorder would have a prevalence of 4%, however there are no studies that certify these data.
Diogenes vs hoarding disorder
Clinicians are beginning to give hoarding disorder its own entity more closely related to obsessive-compulsive disorder (OCD). Although the characteristics of one and the other are similar, the truth is that in Diogenes the accumulation is not only due to what the person has bought, but rather to the fact that they do not throw away or get rid of anything, accumulating rubbish, rubbish , leftover food, etc.
Besides, Diogenes syndrome would be more related to older people and the appearance of cognitive deterioration, resulting in greater physical deterioration and social isolation. Likewise, adds Eva Velázquez, another of the psychologists who are part of the SAP, “the person has zero awareness of the problem and denies their situation despite being pointed out.”
“More than what they accumulate, the difference would be in the awareness of the disease they have“, warns Santos-Olmo, who, simplifying, summarizes that the hoarding disorder would have to do with something more anxious or compulsive, while the Diogenes syndrome is more related to cognitive deterioration.
Precisely, this year the American Psychiatric Association reissued one of its clinical guidelines on mental disorders which includes Hoarding Disorder as a new diagnostic category. From their experience, the psychologists point out that in these cases people can accumulate clean things or buy things, while others do not throw away and, therefore, also accumulate.
field work
Velázquez recalls that when talking about Diogenes, within the work they do, they are talking about an “extreme profile”, and, therefore, about a small part of the population with which they work, however, he emphasizes that the isolation of people who accumulate causes great difficulties for those affected and their environment.
Among other consequences, it is common to see habitability problems in the house which causes falls due to obstacles in the ambulation; increased risk of fire, and inability to use the furniture in the home. Situations that lead them to not being able to sleep in bed or cook in the kitchen; and that, by living in an unhealthy environment, they can even be surrounded by pests of insects or rodents.
But, despite the consequences that this way of living has for social relationships or health, they do not recognize that they have a problem. “They have given us the most varied excuses: that it is not theirs, that their grandchildren have left it or that we have caught them when they are picking it up because they are going to paint or are doing construction; even a woman denied seeing the cockroach that was walking around the table,” he explains.
In addition, create discomfort within the community of neighborsdue to bad smells, possible insect infestations, fire risk, etc., and, on occasions, this discomfort translates into complaints by the community of neighbors in Social Services, in the Department of Environmental Health of the City Council of Madrid or in other official organizations.
When this happens or is suspected, the Environmental Health Department of the Madrid City Council must be notified, often the Social Services are already aware of it. The work that is carried out from SAP consists of help people recognize the problem so that cleaning is the least traumatic possible and prevent it from happening again..
“The user often signs the consent to enter the cleaning, otherwise more time is required; once the cleaning is done we work towards the acceptance of that cleaning so that it is as less traumatic as possible and lives it in a way positive, we work in the line of managing negative emotions, always keeping in mind that what for them are treasures for us is rubbish and that they have the feeling that valuable things have been thrown at them”, affirms Velázquez.
At the same time, they work trying to prevent this behavior from repeating itself in the future. For them, the SAP offers them the help they need, and it is about making them aware of the problem and the risks it can cause to their health. “We also work in the environment of the personsometimes with family or friends and other times, also, with the community of neighbors”, explains Velázquez, who recalls that it often helps to reduce the stress that this situation generates and, on the other hand, de-estimates the user by avoiding situations of rejection in your closest environment.
Despite everything, Santos-Olmo admits that these are people who relapse into these behaviors and, despite working on re-education from the awareness of the disease, “they act in the same way again.”