Is Hikikomori a culture-bound syndrome of social withdrawal?.

Abstract

A form of severe social withdrawal, called hikikomori, has been frequently described in Japan and is characterized by adolescents and young adults who become recluses in their parents' homes, unable to work or go to school for months or years. The aim of this study was to review the evidence for hikikomori as a new psychiatric disorder. Recent empiric studies of hikikomori show that most cases are classifiable as a variety of existing DSM-IV-TR (or ICD-10) psychiatric disorders. However, a subset of cases with substantial psychopathology do not meet criteria for any existing psychiatric disorder. I review the differential diagnosis of hikikomori, suggest that it may be considered a new culture-bound syndrome, and propose standardized diagnostic criteria to standardize future international research of the condition. Finally, I will consider the types of research studies necessary to adequately evaluate whether hikikomori might be a unique psychiatric disorder. Toward the Reorganization of Concept "Hikikomori" and Consideration of its Possibilities as a New Clinical Term: Hikikomori, which is characterized with sever social withdrawal, is the concept of mental and behavior symptom proposed in Japan. The fact that a large number of teenagers, youth, and adults continue spend over several months as hikikomori grows into a serious problem in today's Japanese society and raised strong interests in Japan and the world. However, the definition and clinical characteristic of hikikomori has not been established yet for these two decades. Furthermore, unfortunately, the actual hikikomori cases were not reported by Japanese psychiatrists in international scientific journals. In this presentation, we will review the research and reports conducted in Japan and show several typical hikikomori cases with various clinical characteristics. The aims of this presentation are to let the actual hikikomori known to world widely and discuss the possibility of whether hikikomori can be a new term in the field of clinical psychiatry or not. In conclusion, hikikomori is thought to be best understood not as a specific problem but, rather, as the outcome of multiple kinds of medical, psychological, and social problems. Hikikomori state is worth being defined as new clinical term of symptom or state internationally because there are the many cases with the symptom of hikikomori seen by psychiatrists and there may be more cases never seen by psychiatrists despite necessity of psychiatric treatment. What is in a name? Is Hikikimori unique to Japan or a spectrum syndrome reflecting underlying psychopathology?: Hikikimori is a term that has emerged in Japan but no cases have been reported in Australia. Instead presentations of severe and prolonged social withdrawal would be described variably as "school refusal" or "social anxiety" and disorders underlying these presentations would include depression, social anxiety and post-traumatic stress disorder, schizoid and schizotypal personality disorders and autism spectrum disorders and even "chronic fatigue syndrome". A review of the presentation of this phenomenon is Australia will be presented with a focus on child and adolescent populations and school refusal. A case of severe social withdrawal will follow with the aim of generating discussion regarding the classification of hikikimori and the usefulness of clinical terms. The case is of a 15 year old boywith a previous history of learning difficulties and conduct disorder features, who then developed more severe depression and school refusal from the age of 12 years old in the context of significant family relationship problems and family mental health issues . Following an inpatient admission he progressively withdrew to the home environment, ceased all peer social contact, and mainly spent his time on the computer. He was not described as depressed. Comparison of Hikikomoris in Korea and Japan: Hikikomori is a word originated from Japanese language. In Korea, the hikikomori phenomenon is occurring in a unique form. A number of Korean researchers have conducted studies and there are also government reports about hikikomori. According to Korean researchers, hikikomori can be defined as follows: 1) a person who is confined in a house while having no close social relationships for more than three months; 2) a person who cannot participate in education, employment or training; 3) a person who has only a single friend or no friend at all; 4) a person who feels anxious or uncomfortable about social isolation; and 5) if a person has significant psychiatric disorders or is mentally retarded, the person is not regarded as a hikikomori. Although Korea and Japan share many cultural backgrounds, the two countries can also be very different. Japan is a more individualized society than Korea. In addition, every Korean male adult must complete a compulsory military service. For these reasons, there are some differences in the clinical phenotypes of hikikomori between Korea and Japan. The mean length of hermitic life is shorter and the symptoms are somewhat milder in Korea compared to Japan. This presentation reviews some papers published by Korean researchers and tries to establish essential features for future international research on the condition.