Social Psychiatry and Psychiatric Epidemiology

, Volume 47, Issue 7, pp 1061–1075

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


    • Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu University
    • Innovation Center for Medical Redox NavigationKyushu University
  • Masaru Tateno
    • Department of NeuropsychiatrySapporo Medical University
  • Naotaka Shinfuku
    • School of Human SciencesSeinan Gakuin University
  • Daisuke Fujisawa
    • Psycho-Oncology Division, Research Center for Innovative OncologyNational Cancer Center Hospital East
  • Alan R. Teo
    • Department of PsychiatryUniversity of California
  • Norman Sartorius
    • Association for the Improvement of Mental Health Programmes
  • Tsuyoshi Akiyama
    • Department of PsychiatryNTT Medical Center Tokyo
  • Tetsuya Ishida
    • Graduate School of Human-Environment StudiesKyushu University
  • Tae Young Choi
    • Department of PsychiatryCatholic University of Daegu School of Medicine
  • Yatan Pal Singh Balhara
    • Department of Psychiatry and National Drug Dependence Treatment CentreAll India Institute of Medical Sciences (AIIMS)
    • Department of Psychiatry and De-addictionLady Hardinge Medical College and SSK Hospital
  • Ryohei Matsumoto
    • Department of PsychiatryKyoto Prefectural University of Medicine
  • Wakako Umene-Nakano
    • Department of PsychiatryUniversity of Occupational and Environmental Health
  • Yota Fujimura
    • Department of PsychiatryTeikyo University
  • Anne Wand
    • Consultation-Liaison Psychiatry, Canterbury Hospital, Sydney Local Health Network, and Sydney Medical SchoolUniversity of Sydney
  • Jane Pei-Chen Chang
    • Department of PsychiatryChina Medical University and Hospital
  • Rita Yuan-Feng Chang
    • Department of Psychiatry, ChiaYi BranchTaichung General Veterans Hospital
  • Behrang Shadloo
    • Department of PsychiatrySina Hospital
  • Helal Uddin Ahmed
    • Department of PsychiatryBangabundhu Sheikh Mujib Medical University
  • Tiraya Lerthattasilp
    • Faculty of MedicineThammasart University Hospital
  • Shigenobu Kanba
    • Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu University
Original Paper

DOI: 10.1007/s00127-011-0411-7

Cite this article as:
Kato, T.A., Tateno, M., Shinfuku, N. et al. Soc Psychiatry Psychiatr Epidemiol (2012) 47: 1061. doi:10.1007/s00127-011-0411-7



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.


HikikomoriSocial withdrawalTaijin kyofushoAmaeInternet addiction

Copyright information

© Springer-Verlag 2011