Hikikomori : Multidimensional understanding, assessment, and future international perspectives

Abstract

Hikikomori, a severe form of social withdrawal, has long been observed in Japan mainly among youth and adolescents since around the 1970s, and has been especially highlighted since the late 1990s. Moreover, hikikomori‐like cases have recently been reported in many other countries. Hikikomori negatively influences not only the individual's mental health and social participation, but also wider education and workforce stability, and as such is a novel urgent global issue. In this review, we introduce the history, definition, diagnostic evaluation, and interventions for hikikomori and also the international prevalence of hikikomori outside Japan. We propose a hypothesis regarding the globalization of hikikomori based on domestic and international perspectives. In addition, we introduce our latest assessment system for hikikomori (including the latest version of the ‘proposed diagnostic criteria of hikikomori for the future DSM/ICD diagnostic systems’) and propose therapeutic strategies, including family approaches and individualized therapies. Finally, we present future challenges that may lead to solutions for an internationalized hikikomori.

Forced social isolation due to COVID‐19 and consequent mental health problems: Lessons from hikikomori

“…7 Similarly, based on our clinical experiences, traumatic events, such as economic, social, or political crisis, can cause even previously healthy people to avoid social contact and enter a hikikomori state with psychiatric conditions. 3 Thus, we herein hypothesize that COVID-19-induced social isolation and the consequent economic crisis may be risk factors for hikikomori in the post-pandemic world.…”

“…In Japan and some Asian countries, both fears are probably deeply rooted in traditional-culture-based shame (haji) and social ostracism (murahachibu), which have, during past epidemics and economic crises, often led those sick or financially ruined to commit suicide. 3,9 Recent reports of COVID-19-related suicides might support this hypothesis. 9 Action against COVID-19 must therefore include a component addressing the prevention of stigmatization of the disease to avoid covert spread of the disease and other consequences of stigma related to the disease, such as depression and suicide.…”

“…One of the best examples of consequences of severe social isolation is the condition known as hikikomoria form of severe social withdrawal that was originally described in Japan in the late 20th century and has more recently been found worldwide. [2][3][4] In the 2010 guideline on hikikomori by the Japanese Ministry of Health, Labour, and Welfare, the definition of hikikomori was described as an avoidance of social participation, which in principle has continued under the condition of being housebound for a period of more than 6 months. 5 There are similarities and differences between hikikomori and COVID-19-related social isolation.…”

“…However, longer lasting social isolation gradually increases loneliness, which is a crucial risk factor for mental disturbances, including anxiety, depression, and addiction disorders. 3 Prolonged home confinement may lead to domestic discord, domestic violence, and in extreme cases even homicide. 2 If COVID-19-induced social isolation were to last more than several months, similar hikikomori-related problems might occur much more frequently among the huge numbers of individuals who are forced to stay at home.…”

Social status and modern‐type depression: A review

“…They are very susceptible to social defeat induced by hierarchy in the social environment and are likely to experience social defeat as trauma (Kato & Kanba, ). Hence, they easily fall into social withdrawal, and at worst, hikikomori (Kato Kanba, & Teo, , ). Their personality traits are characterized by avoidance and narcissism (Kato, Hashimoto, et al, ; Tarumi, ).…”