Content

Introduction

With Hikikomori we mean a condition that mainly concerns adolescents and young adults and which is characterized by an extreme form of social withdrawal: people lock themselves in their room and refuse any form of contact with the outside world even for long periods of time, voluntarily interrupting relationships with others and putting an end to any form of communication, even with family members.

To be defined as Hikikomori the person must manifest a state of complete social withdrawal that persists for at least six months and has an onset prior to 30 years of age. On average, the refusal of social contacts lasts from one to four years and, in some cases, is also associated with refusal to go to school, Internet addiction and reversal of the sleep-wake rhythm.

Symptoms

The condition identified as Hikikomori it is complex and controversial mainly due to the lack of a clear definition and consensus among the different studies on the criteria for ascertaining (diagnosing) it. The exact location of the condition Hikikomori in the psychiatric classification has yet to be determined. Many of the disorders (symptoms) that characterize it - such as social isolation, loss of motivation, dysphoria, sleep disturbances and reduced concentration - are in fact not specific to the condition. Hikikomori but they are common to several psychiatric and behavioral disorders.According to some authors, therefore, distinguishing Hikikomori from the signs of other disorders already present within the psychiatric classification can be very difficult and the creation of a new specific category (secondary Hikikomori) was not deemed necessary.

According to other authors, however, this syndrome should be introduced as a new disease, including it among the cultural syndromes, for those cases that do not have disorders similar to those of other psychiatric diseases (primary Hikikomori).

Hikikomori is a condition that arises and occurs mainly in Japan, although in recent years it has also spread to other countries, including the United States and Europe.

However, the proportion of cases that manifest themselves with disorders comparable to those of other psychiatric diseases seems to be high (although very variable in the various studies). The most common ailments are:

  • schizophrenia
  • social anxiety disorder
  • major depression
  • autism spectrum disorder
  • avoidant personality disorder

Causes

Studies have highlighted that "Hikikomori is a multidimensional phenomenon that derives from individual factors (for example, early traumatic experiences, introverted personality) and the context in which one lives (for example, altered family dynamics, parents who neglect or reject children or who, on the contrary, are overprotective, low academic achievement combined with high expectations). In general, family and school seem to play a decisive role. Sociocultural explanations are also possible: a break in social cohesion, urbanization, the process technological changes in the way people communicate with the advent of the Internet could all play a role in the emergence of Hikikomori.

Therapy

In general, the goal of a therapeutic intervention is to break the isolation and push the person to adopt an active role in society (attendance at school or integration into the world of work).

Taking charge of the Hikikomori must include an initial medical examination to check for psychiatric illnesses. In this case, appropriate clinical treatments are proposed, including hospitalization and drug treatment and / or psychotherapy, if necessary. it can occur in cases of severe concomitant disorders such as depression, schizophrenia and social phobia. Psychological and psychosocial interventions are needed in the case of developmental or personality disorders. Although many people described as Hikikomori have other psychiatric illnesses, recognize and treat only these disorders it may not be enough.

Listening and support services, individual or group psychotherapy (behavioral and family therapy) aimed at resolving the person's difficulties in relationships with family members, schoolmates and colleagues have shown promising results, although not yet definitive. One of the biggest difficulties lies in the fact that people tend not to respect the doctor's instructions in following treatment (low adherence to treatment). Considering that in many cases a long-lasting intervention is necessary, it is in fact difficult to obtain from the patient a continuous adherence to treatment and, therefore, the restoration of full participation in social life. Other types of services offered to young people with or at risk of Hikikomori in Japan are pet-assisted therapies, social farming and online therapies.

Prevention

Many parents of children who exclude themselves from social life do not seek the help of a doctor, thus making it difficult to take a census of people in this condition and delaying the start of treatment. Since Hikikomori derives from a malfunction of communication between society, family, school and individual, the preventive actions should concern not only the sick person but also all the life contexts in which he is inserted. Family and school above all should educate children to be socially competent, that is, in possession of those reasoning, language and emotional skills necessary to establish relationships with others and with the surrounding environment.

An educational approach (eg parenting courses, emotional intelligence training) targeting both young sick people and their parents in the early stages of withdrawal behavior is considered by some to be the key to addressing this condition. including home visits) should be provided in the case of school dropout, as well as in the sensitive transition from school to work.

Living with

To date, further studies are still needed to better distinguish between primary and secondary Hikikomori and to establish whether it is a phenomenon that requires a specific assessment (diagnosis) or whether, on the contrary, it represents a cultural or social manifestation of a pre-existing disorder. -existing. In the case of associated psychiatric diseases, the evolution over time (prognosis) may be worse than in primary hikikomori (not associated with psychiatric diseases).

It is important to keep in mind that, if the person with Hikikomori manages to reintegrate into the community after several years, he will still have to face difficulties of insertion mainly due to the lost years of school / work.It is very important, therefore, that an individual with Hikikomori seeks help from family members and / or mental health services as soon as possible.

Bibliography

Furlong A. The Japanese hikikomori phenomenon: Acute social withdrawal among young people. [Synthesis] The Sociological Review. 2008; 56: 309-325

Harding C. Hikikomori. Lancet Psychiatry. 2018; 5: 28-29

Koyama A, Miyake Y, Kawakami N, Tsuchiya M, Tachimori H, Takeshima T. Lifetime prevalence, psychiatric comorbidity and demographic correlates of Hikikomori in a community population in Japan. [Synthesis] Psychiatry Research. 2010; 176: 69-74

Stip E, Thibault A, Beauchamp-Chatel A, Kisely S. Internet addiction, Hikikomori syndrome, and the prodromal phase of psychosis. Frontiers in Psychiatry. 2016; 7: 6

Tateno M, Teo AR, Ukai W, Kanazawa J, Katsuki R, Kubo H and Kato TA. Internet Addiction, Smartphone Addiction, and Hikikomori Trait in Japanese Young Adult: Social Isolation and Social Network. Frontiers in Psychiatry. 2019; 10: 455

Teo AR. A new form of social withdrawal: A review of Hikikomori. International Journal of Social Psychiatry. 2010; 56: 178-185

Wong JCM, Wan MJS, Kroneman L, Kato TA, Lo TW, Wong PW-C, Chan GH. Hikikomori Phenomenon in East Asia: Regional Perspectives, Challenges, and Opportunities for Social Health Agencies. Frontiers in Psychiatry. 2019; 10: 512

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