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

Abstract

The term hikikomori describes a specific form of social withdrawal that can be observed in children, adolescents, and young adults. Epidemiological research studies have shown that this condition is comorbid with a psychopathological disorder only in 50% of all cases. Many young people in a state of withdrawal do not show symptoms ascribable to already known diagnostic parameters. The authors, psychologist, and psychiatrist at the UFSMIA (Functional Mental Health Unit for Children and Adolescents) in Arezzo, illustrate the current debate on the hikikomori phenomenon from a number of viewpoints: psychiatric, sociological, anthropological, and psychological. On the basis of a clinical case discussed at length in this paper, the authors define their viewpoints and the strategies initiated at the Mental Health Unit in the presence of a patient displaying a state of acute social withdrawal. The multiple actions taken by the UFSMIA are combined according to the concept of modularity. Clinical experiences collected allow the definition of therapeutic protocols useful for the treatment of hikikomori adolescents. The overall objective is to promote the autonomy of the adolescent, as well as the reinforcement of his/her identity and personal resources, as well as the non-traumatic re-entry into the social context.

Psychoanalytic Psychotherapy for Hikikomori Young Adults and Adolescents

“…A series of developmental events and factors, already described, facilitate this choice. My clinical perspective is that confused adolescents going through a transitional period can see social withdrawal as a form of psychological moratorium in order to regain control over the environment and gradually re‐establish direction, and reconstruct identity (Ranieri & Luccherino, ). Unfortunately the decision to become a recluse is a trap for the young person, who is rapidly imprisoned in complex psychic mechanisms which curb and restrict independence and personal autonomy.…”

Working with social withdrawal, or hikikomori, in Japan: From shame to pride

“…A regional survey of records from public health services reports that over half of those identified as socially withdrawn had untreated psychological conditions: approximately one‐third having schizophrenic disorders and mood disorders requiring medication, another third having personality disorders and adjustment disorders requiring psychotherapy, and the final third having developmental disorders (such as Asperger syndrome) and mental retardation requiring long‐term occupational therapy to develop life and social skills (OECD, 2015). Social withdrawal has been a major social problem in Japan for the past three decades and is now recognized in other Asian countries as well as in Europe (Ranieri & Luccherino, 2018).…”

The <i>Hikikomori</i> Phenomenon: Could Loneliness Be a Choice of Self-Restriction from Society?

“…Although an inclusion of diagnostic criteria of hikikomori in international classifications of mental disorders, as DSM-5 or ICD-11, has recently been claimed, the claim remains controversial [17]. Several authors consider hikikomori an underground subculture for coping with societal issues such as bullying and discrimination [8]. Others identify hikikomori as a new form of depression [9].…”

“…A growing body of research shows that hikikomori occurs not only in Japan, but also in neighbouring South Korea and China, as well as in countries as diverse as Oman, India, Spain, France, Italy, the United Kingdom, Canada, Australia and the United States [8]- [14]. Its occurrence may be due to the presence of social conditions similar to those in Japan, such as growing employment uncertainty and rapidly shifting social values [15].…”

“…With its complex causes and worldwide distribution, hikikomori appears today as a transversal phenomenon, so widespread that cannot be assimilated to a specific sociocultural context nor confined to the field of mental health [8]. Rather, it is a disorder that reaches deeply into all aspects of society, intersecting with anthropology, medicine, sociology, politics, economics, culture and education.…”