Social Psychiatry and Psychiatric Epidemiology

, Volume 47, Issue 7, pp 1061–1075 | Cite as

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

  • Takahiro A. KatoEmail author
  • Masaru Tateno
  • Naotaka Shinfuku
  • Daisuke Fujisawa
  • Alan R. Teo
  • Norman Sartorius
  • Tsuyoshi Akiyama
  • Tetsuya Ishida
  • Tae Young Choi
  • Yatan Pal Singh Balhara
  • Ryohei Matsumoto
  • Wakako Umene-Nakano
  • Yota Fujimura
  • Anne Wand
  • Jane Pei-Chen Chang
  • Rita Yuan-Feng Chang
  • Behrang Shadloo
  • Helal Uddin Ahmed
  • Tiraya Lerthattasilp
  • Shigenobu Kanba
Original Paper



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.


Hikikomori Social withdrawal Taijin kyofusho Amae Internet addiction 



The present study was supported by the World Psychiatric Association (WPA) Research Fund 2010, and a grant from Japan Foundation for Neuroscience and Mental Health (both to T.A.K.). We thank the Japan Young Psychiatrists Organization (JYPO) for promoting our research activity. We are grateful to Drs. Horikawa H, Kuga H, Tanaka M and Barroilhet S for their cooperation.

Conflict of interest

All authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Takahiro A. Kato
    • 1
    • 2
    Email author
  • Masaru Tateno
    • 3
  • Naotaka Shinfuku
    • 4
  • Daisuke Fujisawa
    • 5
  • Alan R. Teo
    • 6
  • Norman Sartorius
    • 7
  • Tsuyoshi Akiyama
    • 8
  • Tetsuya Ishida
    • 9
  • Tae Young Choi
    • 10
  • Yatan Pal Singh Balhara
    • 11
    • 12
  • Ryohei Matsumoto
    • 13
  • Wakako Umene-Nakano
    • 14
  • Yota Fujimura
    • 15
  • Anne Wand
    • 16
  • Jane Pei-Chen Chang
    • 17
  • Rita Yuan-Feng Chang
    • 18
  • Behrang Shadloo
    • 19
  • Helal Uddin Ahmed
    • 20
  • Tiraya Lerthattasilp
    • 21
  • Shigenobu Kanba
    • 1
  1. 1.Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Innovation Center for Medical Redox NavigationKyushu UniversityFukuokaJapan
  3. 3.Department of NeuropsychiatrySapporo Medical UniversitySapporoJapan
  4. 4.School of Human SciencesSeinan Gakuin UniversityFukuokaJapan
  5. 5.Psycho-Oncology Division, Research Center for Innovative OncologyNational Cancer Center Hospital EastKashiwaJapan
  6. 6.Department of PsychiatryUniversity of CaliforniaSan FranciscoUSA
  7. 7.Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
  8. 8.Department of PsychiatryNTT Medical Center TokyoTokyoJapan
  9. 9.Graduate School of Human-Environment StudiesKyushu UniversityFukuokaJapan
  10. 10.Department of PsychiatryCatholic University of Daegu School of MedicineDaeguSouth Korea
  11. 11.Department of Psychiatry and National Drug Dependence Treatment CentreAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
  12. 12.Department of Psychiatry and De-addictionLady Hardinge Medical College and SSK HospitalNew DelhiIndia
  13. 13.Department of PsychiatryKyoto Prefectural University of MedicineKyotoJapan
  14. 14.Department of PsychiatryUniversity of Occupational and Environmental HealthFukuokaJapan
  15. 15.Department of PsychiatryTeikyo UniversityTokyoJapan
  16. 16.Consultation-Liaison Psychiatry, Canterbury Hospital, Sydney Local Health Network, and Sydney Medical SchoolUniversity of SydneySydneyAustralia
  17. 17.Department of PsychiatryChina Medical University and HospitalTaichungTaiwan
  18. 18.Department of Psychiatry, ChiaYi BranchTaichung General Veterans HospitalTaichungTaiwan
  19. 19.Department of PsychiatrySina HospitalKamyaranIran
  20. 20.Department of PsychiatryBangabundhu Sheikh Mujib Medical UniversityDhakaBangladesh
  21. 21.Faculty of MedicineThammasart University HospitalBangkokThailand

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