Diogenes syndrome was described by Macmillan and Shawin 1966 [1], and had the name coined by Clark et al. in1975 [2] to describe a group of 30 elderly socially with-drawn individuals who presented to hospital acutely illwith extreme self-neglect, dirty homes, and rubbishhoarding (syllogomania). These features differentiated thesyndrome from individuals who were merely social iso-lated [3]. Only half had psychiatric conditions, with manyhaving above average intelligence and previously suc-cessful professional or business lives [2]. Although the useof the name Diogenes has been criticized (as Diogenes, afourth century BC Greek philosopher did not live in iso-lated squalor or hoard rubbish) [4], over the years morecases of the syndrome have been reported in the literature.Subsequent studies have shown associations with a widerange of neurocognitive disorders including dementia,psychosis, frontal lobe damage, intellectual disability,personality disorders, substance abuse, autism, and affec-tive disorders [5, 6]. Alternative names that have beenproposed include disposophobia, or messy house, Havi-sham, and senile squallor syndromes. Miss Havisham inDicken’s novel ‘‘Great Expectations’’ was, in fact, proba-bly a better example of an individual suffering from thiscondition [6, 7].A clue to the diagnosis may be the identification ofabnormal collecting habits or ‘‘collectionism’’ during lifewhere an individual amasses a large range of items andstores them in a disorganized manner [8]. It has beenestimated that problems with hoarding may affect as manyas 1 in 20–40 individuals at some time in their lives, andthat this behavior is now being facilitated by the ease of on-line buying [7]. The hoarding of rubbish in a home is not aninsignificant problem as it can interfere with activities suchas sleeping, showering, cooking, and cleaning [7], all ofwhich contribute to a less-than-healthy life style. It mayalso foster the proliferation of rodents and insects. Hoard-ing behavior may involve the compulsive collection ofanimals which contribute to the overall level of squalor andfilth. Post mortem feeding on bodies by animals may createcertain forensic problems in a variety of circumstances, notjust Diogenes syndrome [9–11].An ongoing problem with medicolegal cases in manyjurisdictions is the lack of detailed death scene descriptionsby attending police officers if a case is considered to be notsuspicious. For this reason it is likely that the number ofcases that are identified as Diogenes syndrome afterautopsy is an underestimation. Since reviewing the forensicissues that occur in Diogenes syndrome [11], it has becomeclear that the syndrome may be involved in a wide range ofdeaths. Examples include a hypothermic death in a sociallyisolated elderly woman who fractured her hip following afall [12], and the case of fatal exsanguination from anundiagnosed rectal carcinoma in a reclusive male that hasbeen reported in this issue of the journal [13].Does it matter whether a case is identified as Diogenessyndrome or not? The answer to this question is ‘‘yes,’’ asthe syndrome has a number of characteristic and sometimesbizarre features which can potentially confuse investiga-tors. Individuals who suffer from the syndrome are isolatedand shun medical attention. For this reason they may not befound for some time after death with changes of decom-position, such as purging of fluids, raising suspicions ofinflicted injury. The lack of recent medical attendance andunusual features at the scene increase the chances of cases
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