Original Paper

Social Psychiatry and Psychiatric Epidemiology

, Volume 47, Issue 7, pp 1061-1075

First online:

Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation

  • Takahiro A. KatoAffiliated withDepartment of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu UniversityInnovation Center for Medical Redox Navigation, Kyushu University Email author 
  • , Masaru TatenoAffiliated withDepartment of Neuropsychiatry, Sapporo Medical University
  • , Naotaka ShinfukuAffiliated withSchool of Human Sciences, Seinan Gakuin University
  • , Daisuke FujisawaAffiliated withPsycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East
  • , Alan R. TeoAffiliated withDepartment of Psychiatry, University of California
  • , Norman SartoriusAffiliated withAssociation for the Improvement of Mental Health Programmes
  • , Tsuyoshi AkiyamaAffiliated withDepartment of Psychiatry, NTT Medical Center Tokyo
  • , Tetsuya IshidaAffiliated withGraduate School of Human-Environment Studies, Kyushu University
  • , Tae Young ChoiAffiliated withDepartment of Psychiatry, Catholic University of Daegu School of Medicine
    • , Yatan Pal Singh BalharaAffiliated withDepartment of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS)Department of Psychiatry and De-addiction, Lady Hardinge Medical College and SSK Hospital
    • , Ryohei MatsumotoAffiliated withDepartment of Psychiatry, Kyoto Prefectural University of Medicine
    • , Wakako Umene-NakanoAffiliated withDepartment of Psychiatry, University of Occupational and Environmental Health
    • , Yota FujimuraAffiliated withDepartment of Psychiatry, Teikyo University
    • , Anne WandAffiliated withConsultation-Liaison Psychiatry, Canterbury Hospital, Sydney Local Health Network, and Sydney Medical School, University of Sydney
    • , Jane Pei-Chen ChangAffiliated withDepartment of Psychiatry, China Medical University and Hospital
    • , Rita Yuan-Feng ChangAffiliated withDepartment of Psychiatry, ChiaYi Branch, Taichung General Veterans Hospital
    • , Behrang ShadlooAffiliated withDepartment of Psychiatry, Sina Hospital
    • , Helal Uddin AhmedAffiliated withDepartment of Psychiatry, Bangabundhu Sheikh Mujib Medical University
    • , Tiraya LerthattasilpAffiliated withFaculty of Medicine, Thammasart University Hospital
    • , Shigenobu KanbaAffiliated withDepartment of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University

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To explore whether the ‘hikikomori’ syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated.


Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome’s prevalence in their country, etiology, diagnosis, suicide risk, and treatment.


Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents’ felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization.


Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.


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