Early Adolescence in Social Withdrawal: Two Hikikomori in Treatment

Abstract

IntroductionSocial withdrawal is a potential signals of distress and mental illness such as psychosis, mood disorders, anxiety (Kirkcaldy & Siefen, 2012). The term 'hikikomori” defines a particular form of social withdrawal recognized in Japan at the end of the last century (Saito, 1998). At the moment in all the west world (United States, France, United Kingdom, Spain, Italy) there is an increasing frequency of adolescents and young people who show symptoms of hikikomori like a life style centered on the own home and refusal of the school.Objectives and AimsRequests to take care of social withdrawal teenagers (hikikomori) are increasing. This work describes two cases in treatment of early adolescents.MethodsAuthors analyse the terapeutic steps of the clinical treatment of two very young teenegers arrived to the Public Health Service because their extreme social withdrawal. The work focusses the attention on the relationship with the patients, the families and the social context.ResultsThe two cases show that the treatment of hikikomori sindrome is complex. A single type of approach (e.g. individual psychoterapy or family therapy) is not sufficient. Combining different patterns it is possible to create a network of treatments able to promote the resources of subject and of his/her familiar and social context.ConclusionsResults underline the necessity of increasing the clinical knowledges on the social withdrawal sindrome and creating new protocols useful for the treatment.

Hikikomori: debating a XXI century phenomenon from a clinical point of view

“…This case is representative of the UFSMIA's clinical approach. Other similar cases are reported in previous articles (42,46,33).…”

“…On the basis of its own clinical experience, the UFSMIA of Arezzo has articulated an approach based on several interventions, fine-tuned for each case and each individual moment. No rigid protocol was defined, rather therapeutic programs are organized following a careful assessment of the degree and the typology of social withdrawal, its comorbidity with other clinical conditions, the existence of withdrawal-based psychopathological symptoms, and the personal and family resources that can be activated (49,50). The actions of different professionals (child neuropsychiatrists, psychologists, teachers, social, and community workers) must be combined and arranged according to the concept of modularity (51), which should aim each single intervention at welldefined and specific objectives within a wide-ranging clinical project.…”