History of Self-Neglect

Ancient Greece

Diogenes is probably the first recorded case of self-neglect

In the 4th century BCE, Diogenes of Sinope was a Greek Cynic philosopher. He is best known for holding a lantern to the faces of the citizens of Athens, claiming he was searching for an honest man (Mark, 2014). When Alexander the Great asked if there was anything he could do for Diogenes, he replied “could you stand a little out of my sun” (Mark, 2014). Diogenes’ behavior was strongly influenced by his belief that if an act is not shameful in private then it should not be shameful in public. According to him, manners and etiquette should not be observed. He rejected social norms (Pavlou & Lachs, 2008). Diogenes’ ideals were “life according to nature,” “self-sufficiency,” “freedom from emotion,” “lack of shame,” “outspokenness,” and “contempt for social organization” (Cipriani, Lucetti, Vedovello, & Nuti, 2012). Diogenes is an example of intentional self-neglect because of an extreme philosophical belief.

Modern

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 An APS caseworker using a self-neglect survey in the field

“Senile Breakdown” was the term initially used to describe what is currently known as self-neglect (Macmillan & Shaw, 1966). The condition described 50 years ago is still accurate today: “She, her garments, her possessions, and her house are filthy. She may be verminous and there may be feces and pools of urine on the floor” (Macmillan & Shaw, 1966, p. 1032). Over the following years, the terminology became confusing, with the condition variously being called:

  • 1966: Senile breakdown — (Macmillan & Shaw, 1966)
  • 1975: Diogenes syndrome — (Clark, Mankikar, & Gray, 1975)
  • 1977: Elder self-neglect — (Roe, 1977)
  • 1991: Social breakdown — (Ungvari & Hantz, 1991)
  • 1998: Senile squalor syndrome — (Clark, 1998)
  • 2000: Litter hoarding syndrome — (Jürgens, 2000)
  • 2004: Messy house syndrome — (Barocka, Seehuber, & Schone, 2004)
  • 2006: Intentional and nonintentional subtypes of self-neglect — (Gibbons, Lauder, & Ludwick, 2006)
  • 2014: Four subtypes of elder self-neglect described: Physical and medical, environmental, global, and financial — (Burnett et al., 2014)

Despite these terminologies, health care providers have been aware since at least 1966 that most, but not all, who suffer from self-neglect are elderly. In 1966, it was believed that there was a strong association with senile psychosis, present in 23 of the 38 cases studied (Macmillan & Shaw, 1966). However, by 1977, it was shown that half had no evidence of a psychiatric disorder and instead possessed higher than average intelligence (Clark et al., 1975). By 1977, it also became clear that the condition was commonly seen among individuals with adequate financial resources; poverty is not a characteristic of self-neglect (Clark et al., 1975).  

Did You Know!
Diogenes is an example of intentional self-neglect. He was of sound mind and made a decision to live in that manner

There is still not a complete understanding of self-neglect after more than 50 years of study,  It remains unclear whether self-neglect is a distinct syndrome or represents a collection of mental illnesses that have overlapping signs and symptoms (Esposito, Corruble, & Hardy, 2006; Halliday, Banerjee, Philpot, & Macdonald, 2000). Previously, each case of possible SN had to be assessed by a doctor (Clark et. al., 1975). Beginning in the mid-2000’s, screening tools for self-neglect starting to be developed (Naik, Pickens, Burnett, Lai, & Dyer, 2007). Today, self-neglect screening tools are actively used in the field by health care providers (Torbay Safeguarding Adults, 2016). Validation of these screening tools is ongoing (Day, Leahy-Warren, & McCarthy, 2016; Day & McCarthy, 2016).

References

Barocka, A., Seehuber, D., & Schone, D. (2004). Messy house syndrome. MMW Fortschritte der Medizin146(45), 36-39.

Burnett, J., Dyer, C. B., Halphen, J. M., Achenbaum, W. A., Green, C. E., Booker, J. G., & Diamond, P. M. (2014). Four subtypes of self‐neglect in older adults: Results of a latent class analysis. Journal of the American Geriatrics Society62(6), 1127-1132.

Cipriani, G., Lucetti, C., Vedovello, M., & Nuti, A. (2012). Diogenes syndrome in patients suffering from dementia. Dialogues in Clinical Neuroscience, 14(4), 455–460

Clark, J. (1998). The challenge of senile squalor syndrome. Geriatric Medicine-London, 28, 41-46.

Clark, A. N. G., Mankikar, G. D., & Gray, I. (1975). Diogenes syndrome: a clinical study of gross neglect in old age. The Lancet, 305(7903), 366-368.

Day, M. R., Leahy-Warren, P., & McCarthy, G. (2016). Self-neglect: Ethical considerations. Annual Review of Nursing Research34(1), 89-107.

Day, M. R., & McCarthy, G. (2016). Self-neglect: Development and evaluation of a self-neglect (SN-37) measurement instrument. Archives of Psychiatric Nursing, 30(4), 480-485.

Esposito, D., Corruble, E., & Hardy, P. (2006). Could self‐neglect in older adults be a geriatric syndrome?. Journal of the American Geriatrics Society, 54(12), 1946-1946.

Gibbons, S., Lauder, W., & Ludwick, R. (2006). Self‐Neglect: A proposed new NANDA diagnosis. International Journal of Nursing Terminologies and Classifications, 17(1), 10-18.

Halliday, G., Banerjee, S., Philpot, M., & Macdonald, A. (2000). Community study of people who live in squalor. The Lancet355(9207), 882-886.

Jürgens, A. (2000). Refuse hoarding syndrome. Psychiatrische Praxis27(1), 42-46.

Macmillan, D., & Shaw, P. (1966). Senile breakdown in standards of personal and environmental cleanliness. British Medical Journal, 2(5521), 1032–1037.

Mark, J. (2014). Diogenes of Sinope. Retrieved from http://www.ancient.eu/Diogenes_of_Sinope/

Naik, A. D., Pickens, S., Burnett, J., Lai, J. M., & Dyer, C. B. (2007). Assessing capacity in the setting of self-neglect: Development of a novel screening tool for decision-making capacity. Journal of elder Abuse & Neglect18(4), 79-91.

Pavlou, M. P., & Lachs, M. S. (2008). Self-neglect in older adults: A primer for clinicians. Journal of General Internal Medicine, 23(11), 1841-1846.

Roe, P. F (1977). Self-neglect. Age Ageing, 6(3), 192-194.

Torbay Safeguarding Adults (March 16, 2016). Self-neglect screening tool. Retrieved from http://www.torbayandsouthdevon.nhs.uk/uploads/adults-journey-self-neglect-initial-screening-tool.pdf

Ungvari, G. S., & Hantz, P. M. (1991). Social breakdown in the elderly, II. Sociodemographic data and psychopathology. Comprehensive Psychiatry, 32(5), 445-449.


Last updated: by
I. M. Abumaria, AGPCNP-BC
Version 1.00