Psychiatrie clinique, biologique et thérapeutique

Syndrome de Diogène et Hoarding disorder : une même entité ?

Mis à jour le jeudi 8 février 2018

Diogenes syndrome and Hoarding disorder: Same or different?

B. Lavignea, M. Hamdana, B. Faurea, H. Merveilleb, M. Pareaudc, E. Tallonc, A. Bouthiera, J.-P. Clémentd, B. Calvetc

aPôle universitaire de psychiatrie de l’adulte et de la personne âgée, centre hospitalier Esquirol, 15, rue du Docteur-Marcland, 87000 Limoges, France
bÉquipe mobile d’évaluation et de suivi de la personne âgée, pôle universitaire de psychiatrie de l’adulte et de la personne âgée, centre hospitalier Esquirol, 87000 Limoges, France
cPôle universitaire de psychiatrie de l’adulte et de la personne âgée, centre Jean-Marie-Léger, centre hospitalier Esquirol, 87000 Limoges, France
dPôle universitaire de psychiatrie de l’adulte et de la personne âgée, centre hospitalier Esquirol, 87000 Limoges, France

Résumé

En 2013, le DSM-5 a proposé la création d’une nouvelle maladie mentale, le Hoarding disorder (HD), qu’on pourrait traduire par le syndrome d’entassement. La séméiologie française décrit depuis plusieurs années un syndrome dans lequel l’entassement est un point important, il s’agit du syndrome de Diogène. Cet article pose les questions de leurs différences et de leurs points communs. Issu des troubles anxieux, et en particulier des troubles obsessionnels compulsifs, le HD s’en est progressivement détaché, pour devenir un trouble anxieux individualisé. Il se manifeste entre autres par une difficulté majeure à se séparer de possessions, qui s’accumulent ainsi, parfois jusqu’à rendre invivable, voire insalubre, le domicile. L’insight dans ce trouble est variable et certains patients peuvent ainsi présenter les critères diagnostiques du syndrome de Diogène, à savoir l’absence d’appel à l’aide, et un trouble du rapport aux objets, la syllogomanie. Au total, le syndrome de Diogène et le Hoarding disorder pourraient être deux dimensions d’une même entité, l’un représentant la dimension de saleté (squalor) et l’autre la dimension d’entassement (hoarding). Des études cliniques sont indispensables pour avancer dans la compréhension de ces troubles et les soins à apporter aux patients.
© L’Encéphale, Paris, 2016.

Abstract

Introduction. – In 2013, the American Psychiatric Association published the DSM-5. In this new version, new diagnoses were proposed including the Hoarding disorder. In the French semeiology, the Diogenes syndrome is described, among other symptoms, by a pathological tendency to accumulate objects called syllogomania which is very close to hoarding. This paper explores the similarities and differences between the two syndromes.
Description. – The Diogenes syndrome was first described in 1966 but was officially named for the ancient Greek philosopher in 1975 by Clark. Its frequency is around five for 100,000 persons. Many aetiologies have been known to be associated with the Diogenes syndrome: schizophrenia, dementia – especially frontotemporal type, anxiety disorders, mood disorders, and substance abuse – especially alcohol abuse. 
The diagnostic requires one major criterion, the inability to ask for medical or social help, and one of three minor criteria: a pathological relationship to the body, which leads to somatic illness; a pathological relationship to the society, which leads to a progressive exclusion from it; and finally, a pathological link with objects. This last criterion is very interesting because it is closely related to the Hoarding syndrome: indeed, patients with syllogamania, as also named, have a tendency to hoard every object they find. At the end, their homes are full of useless objects, and some living places can be unusable because they are cluttered and congested. This last point is similar to the definition given in the DSM-5 for the Hoarding disorder which describes a persistent difficulty parting with possessions; distress associated with discarding possessions; and accumulations that congest and clutter active living areas. 
The Hoarding disorder was first part of the Obsessive and compulsive disorders, but it has progressively appeared that it could be individualized with its own prevalence of 2.3% to 14% lifetime. Genetical studies have shown that at least 50% of patients suffering from excessive hoarding had a relative with a dimension of hoarding. 
Finally, Mattaix-Cols et al. decided to create a new syndrome in the DSM-5, and the Hoarding disorder was born.
Discussion. – The discussion begins with relationships between the Hoarding disorder and the Diogenes syndrome. A patient with hoarding, and a poor insight, could be very isolated, and could persist in a lack of calling for help, because of not being aware of his pathology. Thus, it could be diagnosed as a Hoarding syndrome with a poor insight, or as a Diogenes syndrome, with the first major criterion (lack of calling for help) and one of the three minor criteria, the syllogomania, or hoarding. 
Moreover, some authors have described old people living for many years with a tendency to hoard. Progressively, some of them had a congested and cluttered home, and a few were living in squalor, a description very close to the Diogenes syndrome. Finally, we discuss the comorbidity of Hoarding disorder and Diogenes syndrome. In particular, the first one is associated with Attention deficit and hyperactivity disorders; and some authors also described the links between ADHD, bipolar disorder and frontotemporal dementia which is one of the aetiologies of the Diogenes syndrome. 
A psychodynamic model in which ADHD, Hoarding disorder and Diogenes syndrome are linked can be imagined, and the last one could be an overlooked evolution of the two first syndromes.
Conclusion. – In conclusion, we can imagine a dimensional model, based on two dimensions: hoarding and squalor. Hoarding disorder is the major expression of the first dimension, and Diogenes syndrome the major expression of the second. Both of them could be a different expression of one central aetiology. More studies are needed to complete this vision.
© L’Encéphale, Paris, 2016.

 

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