Multimodal treatment for a Brazilian case of hikikomori

Abstract

the twins continued to live with their father, and psychotherapy was recommended to all evaluees. These cases demonstrate that the assessment of parental alienation demands attentive study of the legal process, multiple evaluations carried out with different family members, and collateral sources of information. In a context of conjugal disputes and possible psychiatric disorders (in parents or children), it is mandatory to characterize the child behavior as consistent in rejecting one parent due to manipulation and indoctrination performed by the othertherefore, identifying incorporation of the alienating parent's speech. It is also important to identify in the child a phenomenon known as the ''independent thinker'': the child consistently claims that his resistance to the unfavored parent is due to his own independent thought, and not the result of the other parent's influence. 3 Additional challenges are listed in Box 1. 4 Moreover, the distinction between parental alienation and estrangement (justified rejection of one parent following a real history of neglect, physical and sexual abuse, or domestic violence) 3 must be made. Finally, the most important factor according to expert recommendations refers to a ''potential harm to the child'' criterion, related to developmental and psychological maladaptation. 5

Understanding the experiences of hikikomori through the lens of the CHIME framework: connectedness, hope and optimism, identity, meaning in life, and empowerment; systematic review

“…In contrast, some reported feeling freed from restraints and timelines and enjoying their seclusion [ 53 ]. Poor hygiene behaviors were reported in a minority of hikikomori [ 38 , 49 , 72 ], with one person defecating and urinating in jars or bottles in his room [ 49 ].…”

“… ✓ ✓ ✓ Matsuguma et al [ 77 ] ✓ ✓ ✓ ✓ ? ✓ X ✓ Silić et al (2019) ✓ ✓ ✓ ✓ ✓ ✓ X ✓ Roza et al [ 72 ] X ✓ ✓ ✓ ✓ ✓ X ✓ JBI for Qualitative Study Is there congruity between the stated philosophical perspective and the research methodology? Is there congruity between the research methodology and the research question or objectives?…”

Hikikomori and the COVID-19 pandemic: not leaving behind the socially withdrawn

“…4,6 Family interventions, comorbidity treatment, online interventions, physical activity, multiple psychotherapeutic approaches, social skills training, etc., have been indicated as potentially useful strategies for hikikomori cases. 3,[7][8][9][10][11] Nevertheless, the evidence to support these treatment approaches is weak, mainly due to a lack of studies on the topic. 3,6 In 2020, updated diagnostic criteria 4 were proposed for hikikomori, with the inclusion of a severity classification based on the weekly frequency the individual leaves his home or room.…”

“…4,10 The prevalence of hikikomori in Brazil is unknown due to a lack of empirical research on the phenomenon; however, the syndrome has been reported three times in Brazilian patients. 9,12,13 Recently, our group described the complete treatment program for one of these cases. The patient reported substantial clinical improvement after a multimodal intervention strategy, including pharmacological treatment of comorbidities, family psychoeducation, and the use of different psychotherapy techniques.…”

“…The patient reported substantial clinical improvement after a multimodal intervention strategy, including pharmacological treatment of comorbidities, family psychoeducation, and the use of different psychotherapy techniques. 9 Considering this scenario, we hypothesized that strict confinement measures may have relevant negative consequences on hikikomori cases, and the syndrome is likely to grow in prevalence. Young people, not only those with pathological social withdrawal, may increase the time spent gaming or on the Internet, factors potentially associated with the syndrome.…”