The Broadway musical "Grey Gardens" -- headed for Tony nominations and a Hollywood movie -- highlights the fall of socialite Edie Bouvier Beale and her mother, Edith, who lived in a squalid 28-room mansion among scores of flea-infested cats and raccoons, and towers of dirty cans.
But the hit show also highlights Diogenes syndrome, a disorder characterized by self-neglect, domestic squalor and social withdrawal.
The eccentric Beale pair -- the first cousin and aunt of Jacqueline Kennedy Onassis -- is a classic example of what has also been called squalor disorder, which especially affects the elderly.
The syndrome was named for Diogenes, a Greek philosopher of the fourth century B.C., who advanced the principles of self-sufficiency and contentment unrelated to material possessions -- a misnomer -- given the nature of the disorder, which causes people to hoard animals and belongings.
Hoarding occurs in about 1 to 2 percent of the population, according to Randy Frost, a psychology professor at Smith College who wrote "Buried Treasures," a self-help book for hoarders.
About 10 percent of hoarders display the rarer Diogenes syndrome.
Those who live with the syndrome manifest personality traits like reclusiveness, suspiciousness, obstinacy and other isolating tendencies. There are often precipitating events -- such as physical illness, deafness, blindness and bereavement -- that make the syndrome worse.
Research shows a relationship between the syndrome and anxiety and depression, and anecdotal studies suggest the disorder may be triggered by a significant emotional or relationship loss, said Frost.
Hoarding -- which is also seen in dementia and mental retardation -- is also associated with obsessive-compulsive disorder, and that can start as early as the teenage years, Frost said.
"When you ask people about their lives, they've been hoarding for years, but they don't get serious about it for another decade," said Frost. "By 65, the community around them starts to pay more attention.
A Web site devoted to this disorder -- Squalors.com -- cites numerous cases of Diogenes syndrome through history, including Beethoven and the English writer and raconteur Quentin Crisp.
Another case was Eliza Emily Donnithorne, the possible inspiration for the Miss Havisham character in Charles Dickens' "Great Expectations." Left on the altar in mid-19th century Australia, the 26-year-old reportedly shut herself in the dining room with the wedding feast, where she remained with the cockroaches and the mice, waiting for her fiancé to return.
He never did.
Those with the condition are often exploited by others. Last year, Milwaukee city health officials cracked down on landlords -- some paid by the city -- who were renting squalid homes to the mentally ill after the local newspaper exposed abuses.
The Journal Sentinel showed images of people living amid rats and roaches in deadly conditions.
"When you go around to these rooming houses, it's horrifying," said Meg Kissinger, who reported the story. "The woman who we started the series with was lying on a mattress, drenched in urine, with piles of spent toilet paper around the room. There was a rash running up and down her legs and she was eating moldy food that the landlady had retrieved from the garbage cans and was serving people."