A 12-month study of the hikikomori syndrome of social withdrawal: Clinical characterization and different subtypes proposal

Abstract

Social withdrawal is a new mental health problem increasingly common, present in different cultures, whose psychopathology and treatment is not yet established. This study aims to determine the socio-demographic and clinical features and possible clinical subtypes that predict the 12-month outcomes of cases with hikikomori syndrome, a severe form of social withdrawal. Socio-demographic and clinical data at baseline were analysed as well as data obtained for 12 months after at-home treatment in 190 cases. The inclusion criteria were: spending all time at home, avoiding social situations and relationships, significant deterioration due to social isolation, with a minimum duration of 6 months. Six major diagnostic groups were identified: affective, anxiety, psychotic, drug use, personality and other Axis I disorders. The anxiety-affective subgroup demonstrated lower clinical severity, but worse evolution. Less than half of the cases were available for medical follow-up at 12-months. Subjects undergoing intensive treatment had a higher medical follow-up rate and better social networks at 12-months. Therefore, our findings provide data to reach consensus on the specific characteristics of social isolation hikikomori syndrome. The analysis demonstrated the fragility and tendency to relapse and have disengagement, particularly relevant in the anxiety-affective subgroup, suggesting that intensive treatments are more effective.

Hikikomori : Multidimensional understanding, assessment, and future international perspectives

“…In 2010, we conducted the first international hikikomori survey targeting psychiatrists in Australia, Bangladesh, Iran, India, Japan, South Korea, Taiwan, Thailand, and the USA using two case vignettes in a self‐reporting format and showed the possibility of a hikikomori ‐like phenomenon in all the countries surveyed . Thereafter, the cases of hikikomori sufferers in countries including France, Spain, Italy and Brazil were reported . Epidemiological surveys of hikikomori outside Japan are very limited.…”

“…9,18 Thereafter, the cases of hikikomori sufferers in countries including France, Spain, Italy and Brazil were reported. [38][39][40][41][42][43][44] Epidemiological surveys of hikikomori outside Japan are very limited. In Hong Kong, a telephone-based epidemiological survey has revealed that hikikomori sufferers (duration 6 months and over) account for 1.9% of the population.…”

Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori

“…Fourth, we have removed other psychiatric disorders as an exclusion criterion for hikikomori. It is clear that this disorder tends to co‐occur with other conditions. In our view, the frequency of co‐occurring conditions increases the importance of addressing social withdrawal as a health issue.…”

Family Features of Social Withdrawal Syndrome (Hikikomori)

“…Social withdrawal syndrome was first described in Japan as hikikomori, and defined as the state of confining oneself to one's house for more than 6 months and strictly limiting communication with others (1). In recent years its existence has been described in other countries and cultures, noting that other factors besides Japanese culture may also influence its origin and development (2)(3)(4).…”

“…We have previously assessed which factors determine withdrawal relapse or persistence (3). Among them, some factors, such as age or comorbid diagnostics, may result in being difficult to modify.…”