Family Features of Social Withdrawal Syndrome (Hikikomori)

Abstract

Background: Family may play an important role in the origin, maintenance, and treatment of people with social withdrawal. The aim of this study is to analyze family factors related to social withdrawal syndrome. Methods: Socio-demographic, clinical, and family data, including family psychiatric history, dysfunctional family dynamics, and history of family abuse were analyzed in 190 cases of social withdrawal with a minimum duration of 6 months that started an at-home treatment program. Data were analyzed at baseline and at 12 months. Results: In 36 cases (18%) neither the patient nor the family allowed at home evaluation and treatment by the Crisis Resolution Home Treatment (CRHT) team. Patients had high rates of dysfunctional family dynamics (n = 115, 61.5%), and family psychiatric history (n = 113, 59.3%), especially maternal affective (n = 22, 42.9%), and anxiety disorders (n = 11 20.4%). There was a non-negligible percentage of family maltreatment in childhood (n = 35, 20.7%) and single-parent families (n = 66, 37.8%). Most of the cases lived with their families (n = 135, 86%), had higher family collaboration in the therapeutic plan (n = 97, 51.9%) and families were the ones to detect patient isolation and call for help (n = 140, 73.7%). Higher social withdrawal severity (as defined by at least one of: early age of onset, no family collaboration, lack of insight, higher CGSI score, and higher Zarit score), was associated with family psychiatric history, dysfunctional family dynamics, and family abuse history. All of these predictive variables were highly correlated one to each other. Conclusions: There is a high frequency of family psychiatric history, dysfunctional family dynamics, and traumatic events in childhood (family maltreatment), and these factors are closely interrelated, highlighting the potential role of family in the development and maintenance of social withdrawal.

Home visiting support for people with hikikomori (social withdrawal) provided by experienced and effective workers

“…A French study showed nearly half of people with hikikomori had no professional assistance until they received home visit support (Chauliac et al, 2017). The first interview was conducted with the family or caregiver in over 70% of cases in a Spanish study (Malagón-Amor et al, 2020). However, the person with hikikomori who accepted and attended the initial visit had better outcomes, including decreasing problematic behaviours, and ensuring regular attendance/completed treatment, than those who refused the first visit (Imai et al, 2020; Kondo et al, 2008).…”

“…Lee et al (2013) reported that due to difficulties in meeting clients, well-trained caseworkers visited each client’s home to interview both the client and their parents using a structured manual. There are reports in which the home visitation support team consisted of mental health personnel (Lee et al, 2013; Malagón-Amor et al, 2020). Further evidence is needed regarding the training of home visiting workers for people with hikikomori.…”

Rationale, Relevance, and Limits of Stress-Induced Psychopathology in Rodents as Models for Psychiatry Research: An Introductory Overview

“…Different studies indicate, for instance, that auto-isolation, a common reaction of adolescents to certain stressful situations, including bullying, enhances psychopathological risk [ 109 ]. A pathological condition whose incidence has strongly increased in the internet era due to the rise of cyberbullying situations [ 110 ], is clinically linked to auto-isolation and has been recently proposed to be admitted into the DSM-5 [ 111 , 112 ]. Isolation-related stress supports the importance of social connections as functional to survival in mammals — the absence of a solid social network is a predisposing factor impacting emotional well-being [ 113 ].…”

The Hikikomori Phenomenon of Social Withdrawal: An Emerging Condition Involving Youth's Mental Health and Social Participation

“…6 However, increasing reports from around the world provided a better understanding of this condition and suggested that hikikomori is a global health problem, which may exist as an independent primary diagnosis. 7,8 The elemental attribute of hikikomori is the social isolation; the distinctive element is the sociospatial self-segregation of affected individuals, who are predominately adolescents and marginally young adults. 9 This form of physical isolation typically take place at home, where these persons spend most of the day avoiding exposure to any form of socialization (at school, sport centers, and similar socializing contexts) for days, weeks, or months.…”