Senile Squalor Syndrome

Last August we wrote a blog about hoarding and the elderly, but since we often get questions about it, we thought it would be worth revisiting.

Diogenes Syndrome

One of the challenges we sometimes face is hoarding, which for seniors is known as “Senile Squalor Syndrome” or “Diogenes Syndrome” or “Plyushkin’s Syndrome” (from Gogol’s character of that name in his novel, Dead Souls).  It’s a form of cognitive impairment characterized by:
  • Self-neglect
  • Domestic squalor
  • Social withdrawal
  • Apathy
  • Compulsive hoarding of garbage
  • Unmanageable number of pets
  • Lack of shame
  • Refusal of help
  • … and sometimes catatonia symptoms

This was first recognized as a disorder in 1966 and was named in the mid-1970’s, although the name “Diogenes Syndrome” is still applied inconsistently.  Very little is known about the underlying causes, except that it appears to be a reaction to stress and it usually occurs late in life.  The medical community generally agrees that the origin is in the frontal lobe of the brain.

Dealing with hoarding

In our experience, the most effective way to deal with this disorder is to work with the person directly.  Patience and persistence are the key characteristics required.

The television program “Hoarders” presents one strategy, which normally involves a large clean-up crew, an overwhelmed hoarder, a frustrated and emotional family, a television crew, and a professional who deals with hoarders.  In their format, the clean-up begins well but the hoarder reaches some kind of crisis and throws a monkey wrench into the process, which then grinds to a halt until the professional can intervene.  All is usually well in the end, of course.

The ETC approach

Our process is somewhat different.  We start by working with the hoarder to develop a plan for how to deal with the each type of item, usually deciding how to sort them into categories, which may themselves have sub-categories:
  • Gifts to friends and relatives
  • Donations to charity (or charities)
  • Items to take to the new home
  • Debris

We bring in a crew, but not a large one.  The client should not feel overwhelmed by the activity in the home.  We start with a single room, usually a bedroom.  Getting started is the most difficult part and so we normally begin with the easiest type of item: clothing.  We find that most people can give up at least some of their clothing without much difficulty, and doing so breaks the ice.

Once we have an item categorized, we place it in a bag or box with the destination identified.  We try to avoid removing anything from those bags or boxes once they have been placed there.  At the end of each day, we remove the bags and boxes from the premises so that the client is not tempted to rethink the designations during the night.

Mitigating the impact

On occasion we will go back and search for that white coat.  One client who was a severe hoarder had a white coat that she had destined for charity amid a mass of hundreds of sweaters and coats.  When she changed her mind and Libby retrieved it for her, she cried and told Libby that she was the only person who truly understood.

Another strategy of ours is to avoid using dumpsters.  Hoarders feel strongly that their belongings have value, and seeing a dumpster in front of the house can be upsetting.  Neighbors generally don’t like dumpsters, either.  We prefer to use more discreet hauling services, such as


In general, our process is low on drama, so would not make a good television program.  But, we like to avoid drama and we believe that our process works really well for our clients.