Severe domestic squalor

BACKGROUND: People who live in domestic squalor and deny help may have a condition known as severe domestic squalor, previously Diogenes syndrome. The object of this article is to provide a review of incidence, possible etiology, clinical description and management of this condition. MATERIAL AND METHODS: The article is based on literature retrieved through a non-systematic search in PubMed and the author's clinical experience. RESULTS: Severe domestic squalor may affect people of all ages, but is particularly prevalent among the elderly. Those affected live in severe squalor with garbage, rotting food, rats and mice, urine and faeces in furniture. Some tend to hoard. The annual incidence among persons above 60 years of age, referred to a specialist, is approximately 0.5 per 1000. True community prevalence is unknown. More than 50 % of cases have a concomitant diagnosis of dementia, schizophrenia or substance dependency. An association between frontal dysfunction and severe domestic squalor is sparsely, but increasingly documented. Those affected do not express concern about their situation and are unwilling to be helped. Cases are complex and very difficult to handle for general practitioners and district nurses. Respect for autonomy and a wish to help contradict each other. INTERPRETATION: It is very difficult to help persons who live in severe domestic squalor. The incidence in Norway is unknown and should be determined.