Severe domestic squalor

The authors review the epidemiology, burden, course, and neuropsychological correlates of severe domestic squalor—filthy, unhygienic living conditions that necessitate immediate cleaning. Given the various terminology used in conjunction with squalor, the authors reviewed studies that focused on Diogenes syndrome, senile breakdown, and self-neglect. In addition, the authors reviewed assessment strategies in hopes of increasing clinicians’ and researchers’ systematic assessment of severe domestic squalor. Last, the authors reviewed data that have focused on the connection between squalor and hoarding. This literature review showed that, in some developed countries, at least one in every 1000 elderly persons lives in squalor and that the prevalence among younger persons is lower. Findings concerning the gender ratio have been conflicting. Squalor may be a consequence of a complex interplay of medical and psychiatric conditions, particularly those associated with frontal lobe dysfunction, including hoarding disorder. As one-sixth to one-third of patients who meet criteria for hoarding disorder may live in squalor, treatments for hoarding disorder may need to be tailored to address the specific underlying causes of squalor.