Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation

Abstract

Purpose To explore whether the ‘hikikomori’ syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated. Methods Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome's prevalence in their country, etiology, diagnosis, suicide risk, and treatment. Results Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents’ felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization. Conclusions Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.

Hikikomori: experience in Japan and international relevance

“…All of these difficulties could make war-traumatized children more challenging to manage for their parents, who, in turn, may apply more violent and coercive parenting strategies. Consistent with this hypothesis, a recent study with Tamil families in post-war Sri Lanka found that children's exposure to mass trauma and child psychopathology were the main predictors of children's self-reported victimization in their families, even after controlling for parental trauma and parental mental health 5 .…”

“…The Japanese sociocultural background has been traditionally permeated by "amae" (accepting overdependent behaviors) and shame, which may underlie the culture-bound syndrome called Taijin Kyofusho (a severe form of social phobia) as well as hikikomori 5,6 . Parent-child relationships in Japan have long been considered less oedipal than in Western societies and marked by an absent father and an extremely prolonged and close bond to the mother, which may result in difficulty to become independent 7 .…”

A Case of Hypocalcaemia Due to Vitamin D Deficiency in ‘Hikikomori’ Syndrome

“…Because of prolonged social withdrawal, patients with hikikomori syndrome may develop vitamin D deficiency due to inadequate exposure to sunlight. Nonetheless, hypocalcaemia and/or vitamin D deficiency has not previously been reported in hikikomori syndrome [1,2] and may have been overlooked. In fact, Chvostek's and/or Trousseau's signs were both negative in this case, and hypocalcaemia was found incidentally during the general laboratory investigation.…”

“…There are almost 1 million hikikomori in Japan between the ages of 20 and 40. Hikikomori syndrome [1,2] is regarded as a mental or psychiatric disorder and most probably for this reason, metabolic abnormality, in particular hypocalcaemia, associated with this condition has not been described.…”

Are culture‐bound syndromes on the verge of extinction?

“…The hikikomori syndrome appears to be especially common in urban settings. 10 While psychiatrists from diverse cultures recognise the hikikomori syndrome, management differs and there is little agreement about the underlying aetiology. Hikikomorilike phenomena are 'somewhat accepted' in Japanese society and psychiatrists tend to suggest psychotherapy, especially for teenage patients.…”