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Diogenes' syndrome

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    A behavioural disorder usually observed in the elderly, characterized by gross self-neglect, lack of self-consciousness about personal habits, untidiness, and compulsive hoarding of rubbish. This is accompanied by a self-imposed isolation and the refusal of external help. The person is often aloof, suspicious, emotionally labile, aggressive, group dependent, and reality distorting. Persons from all social groups can suffer from this condition. 46% of patients have a 5 year mortality rate.

    Havisham syndrome is named for Miss Havisham, a figure in Charles Dickens' (1812-1870) Great Expectations.
    Plyushkin's syndrome is named for Plyushkin, Russian aristocrat in Nikolai Vasilievich Gogol's (1809-1852) novel Dead Souls.


    • N. Gogol:
      Dead Souls. London : Penguin, 1961: 120-128. First published in Russian in 1852.
    • Charles Dickens:
      Great Expectations.
      First serialised in All Year Round from December 1, 1860 to August 1861.
    • D. Macmillan and P. Shaw:
      Senile breakdown in standards of personal and environmental cleanliness.
      British Medical Journal, October 29, 1966, 2 (5521): 1032-1037.
    • A. N. G. Clark, G. D. Manikar, I. Gray:
      The Diogenes syndrome. A clinical study of gross neglect in old age.
      The Lancet, London, February 15, 1975, I (7903): 366-368.
      Abstract: A study of elderly patients (fourteen men, sixteen women) who were admitted to hospital with acute illness and extreme self-neglect revealed common features which might be called Diogenes syndrome. All had dirty, untidy homes and a filthy personal appearance about which they showed no shame. Hoarding of rubbish (syllogomania) was sometimes seen. All except two lived alone, but poverty and poor housing standards were not a serious problem. All were known to the social-services departments and a third had persistently refused offers of help. An acute presentation with falls or collapse was common, and several physical diagnoses could be made. Multiple deficiency states were found--including iron, folate, vitamin B12, vitamin C, calcium and vitamin D, serum proteins and albumin, water, and potassium. The mortality, especially for women, was high (46%); most of the survivors responded well and were discharged. Half showed no evidence of psychiatric disorder and possessed higher than average intelligence. Many had led successful professional and business lives, with good family backgrounds and upbringing. Personality characteristics showed them to tend to be aloff, suspicious, emotionally labile, aggressive, group-dependent, and reality-distorting individuals. It is suggested that this syndrome may be a reaction late in life to stress in a certain type of personality.
    • A. Cybulska and J. Rucinski:
      Gross self-neglect in old age. British Journal of Hospital Medicine, 1986, 36: 21-23.
    • Stanley Jablonski:
      Jablonski’s Dictionary of Syndromes & Eponymic diseases.
      Krieger Publishing Company, Malabar, Florida, 1991.
    • Bernfried Leiber, editor:
      Die klinischen Syndrome. Syndrome, Sequenzen und Symptomenkomplexe.
      Urban & Schwarzenberg, München-Wien-Baltimore, 1990. 8th edition, München 1997.
    • E. Cybulska:
      Senile squalor: Plyushkin's not Diogenes' syndrome.
      Psychiatric Bulletin, London, 1998, 22: 319-320.

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