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Abstract: Presented here are two case reports of elderly persons with Diogenes syndrome (variously known as senile breakdown, social breakdown and senile squalor syndrome). Diogenes syndrome is often (but not always) characterized by a tendency to hoard excessively (syllogomania). The first patient was diagnosed as having both a schizotypal personality disorder and obsessive-compulsive disorders (OCD) while the second was diagnosed as having a schizoid personality disorder. Only the former demonstrated the tendency to hoard rubbish. The Diogenes syndrome in both cases can be hypothesized to be a reaction to stress in elderly people with certain personality characteristics or as the end stage of a personality disorder. The hoarding behavior that was manifested only in the first case can probably be the result of the presence of an OCD. The authors raise the possibility that OCD may be the cause of hoarding rubbish in those cases of Diogenes syndrome in which hoarding exists and cannot be explained by psychotic disorders, dementia or any other mental disorders due to a general medical condition (GMC) or substance-related disorders.
Introduction
Many members of the health, mental health and social systems are familiar with cases of elderly persons with dirty and derelict appearance, often living alone in filthy, neglected homes. These elderly demonstrate social withdrawal and lack of concern and shame about their filthy living conditions and extreme self-neglect. They often hoard rubbish excessively (syllogomania) (1). The above described condition is variously known as senile breakdown (2), social breakdown (3), senile squalor (4), gross self-neglect (5) and Diogenes syndrome (6). The term Diogenes syndrome was first suggested by Clark et al. (6), referring to Diogenes, a Greek philosopher who lived in the 4th century BC and believed in self-sufficiency, lack of shame and rejection of all luxury since he regarded the sense of happiness as not dependent upon material wealth. Some assume that he lived in a barrel in order to maintain his ideal of ascetic self-sufficiency (7). This term is rather misleading because Diogenes did not withdraw from society, but rather sought company and there is no evidence that he had lived in a state of extreme self-neglect. Clark et al. (6) did not define Diogenes syndrome operationally and there has been some uncertainty whether it includes...