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