Beyond Pack-Rat: Hoarding Disorder and Diogenes syndrome

By Tina Richardson


Compulsive hoarding, aka Diogenes syndrome, is a pathological anxiety disorder that hampers a person’s general ability to disassociate value from objects.

Typically this manifests in an accumulation of unnecessary items over a period of months, or even years. Although this trend remains controllable in a majority of individuals with the disorder, compulsive hoarding can evolve into a life-changing disorder. We all know pack-rats who function normally.  You’ll notice some of the extreme hoarding behaviours have similar symptoms as a with a well-adjusted pack-rat.

The name Diogenes derives from a philosopher in ancient in Sinope, Greece.  He was a Cynic and an extreme minimalist, who legend has it lived in a huge jar in Athens.

Many people aren’t obsessed with neatness and cleanliness, and we’ve all found our homes in a state of chaos at one time or another. Dishes piling up in the sink, hanging linens everywhere, half-opened moving boxes in every corner with various trinkets strewn across the floor and so on. However in the vast majority of individuals, these situations don’t go on to cause an actual disorder and – after some time – they manage to restore order in their environment. They may get teased from time to time about being a pack-rat (sounds a lot more harmless then be told he or she likes to hoard!)

house with hoarded items

So how do we recognize this disorder in our loved ones? And how do we avoid making it worse?

Symptoms of Compulsive Hoarding

Compulsive behaviors often come and go as phases in young adults, but sometimes hoarding can serve as a serious sign of Diogenes syndrome.

Schizophrenic Child
Schizophrenia in a child may be marked by abnormal behavior, including strange speech and limited ability to comprehend reality. Other cross-over symptoms between the two disorders include pulling away from social engagement, false beliefs, and anxiety.

Anyone can suffer from Diogenes syndrome, regardless of age or gender. When subjects are young, the disorder is almost always accompanied by a psychiatric illness, such as schizophrenia. This disorder can also affect elderly people who have just experienced bereavement ( e.g. the loss of a long-term spouse). In almost everyone, the syndrome is either rooted in childhood experience or appears after a significant emotional shock.

Common Symptoms of Diogenes Syndrome:

  • Neglect of personal hygiene
  • Neglect of personal living space
  • An unhealthy accumulation of useless objects (magazines, trinkets, boxes, plastic bags, clothes, etc.). Objects occupy the subject’s entire living space, blocking even the exits.
  • Compulsive accumulation of garbage and even excrement in some cases (theirs or those of their pets)
  • Social isolation and/or refusal to receive people at home
  • A state of denial: subjects are typically unaware of the state of the environment in which they live, and believe everything is normal
  • Anger, resentment or delusions of persecution when encouraged to clean up by their peers or loved ones

    Animal Hoarding

In the most severe cases of Diogenes syndrome, disorder and lack of hygiene almost always result in the proliferation of insects, allergens and moulds in the living space. This very often results in the “breaking point” that ultimately leads to official diagnosis, as it pushes neighbours and loved ones to contact professionals for an intervention. Note also that some of the more serious effects are completely missing from what we see with pack-rat behavior.

Factors That Typify Hoarding Disorder

Diogenes syndrome occurs equally between men and women. The onset of this behavioral disorder is uninfluenced by hereditary factors or socioeconomics, but research shows that it is most common in adults over the age of 60 who live alone.

Diogenes syndrome can be primary, meaning not triggered by existing medical conditions, or secondary – which means occurring as a result of other medical conditions.

What do hoarders typically accumulate?
Compulsive hoarders can accumulate a wide variety of objects based on their individual sensibilities. The most common items are clothes, books, flyers, bills, boxes, food and electronics.

Book Hoarding
Book hoarding: a pack-rat doesn’t let the pages become a home for small animals.

In combination with one another, these accumulated items can begin to pose health risks over time.

collecting and storing shirts
Compulsive collecting and storing shirts

What are typical health risks?
There are a multitude of risks that can materialize even after a short period of compulsive hoarding. Many of these are influenced directly by the conditions and materials that make up the subject’s living space. The most common are the risks of fire, respiratory health problems, feelings of isolation, claustrophobia, moulds and the emergence of vermin such as flies or rats.

Is there a typical cause for Diogenes syndrome?
As it is with the majority of mental health disorders, Diogenes syndrome hasn’t been traced to a single or direct cause as of this writing. The study of mental health is quite different from virology, where specific bacterium or cellular activity can explain an infection.

However, there are accompanying factors that occur with Diogenes syndrome. In over 50% of cases, people with the tendency to hoard were noted even in childhood as indecisive individuals, with an unusual attachment to objects and a penchant for collecting.

anxious woman on couch

Identifying Diogenes Syndrome in Family Members & Loved Ones

It’s often difficult to realize that a person suffers from Diogenes syndrome, as they often come off as harmlessly aloof at first. Their issues are usually brushed off as pack-rat behaviour. In the majority of cases, Diogenes syndrome is discovered by chance – when a neighbor complains of odors to the landlord or during routine inspections by the fire department, for example.

When a person is diagnosed, they are very often in a state of denial about the problematic nature of their disorder. Most often, specialized counsellors and professionals will be needed to even begin to get rid of accumulated, stockpiled objects. The subject is often treated in a psychiatric facility with the goal of changing key habits, but as of this writing, there is no definitive treatment against Diogenes syndrome.

It’s necessary to employ tact and gentleness when helping a person with Diogenes syndrome. A brusque or forceful intervention can sink these people into depression, substance abuse or neurotic behavior.

Helping Family Members & Loved Ones Avoid Diogenes Syndrome

Obviously, not everyone with a slight tendency to be messy can be diagnosed as a compulsive hoarder. As we’ve seen, most behavioral disorders normally require a trigger. Oftentimes, we can get ahead of Diogenes syndrome in family members and loved ones by instilling simple behavioral best practices in them from a young age.

  1. Unclutter your home in phases: one room at a time, one closet at a time.
  2. Proceed in small periods of 20-30 minutes each day rather than procrastinating until the end of the week, when it’s more likely to feel like a single massive chore.
  3. Get rid of all clothes, shoes and personal items you haven’t worn for a year or more.
  4. For utensils and dishes, a good idea is to put everything in a big box before putting them back in the cupboard individually. In 2-3 weeks, you’ll be able to identify what is really useful to you, while the rest is already sitting in a box and ready for disposal.
  5. Sort your bills and documents as you receive them; avoid letting anything pile up on tables and desks.
  6. Put things away after using them.