Prolonged Social Withdrawal During Adolescence: Transdiagnostic Syndrome or a New Psychiatric Entity?

The Japanese term Hikikomori is used to describe a clinical condition in which young people present a prolonged social withdrawal and isolation. Hikikomori syndrome represents an emergent worldwide phenomenon but is still poorly reported and often misdiagnosed. This study investigates and describes an Italian hikikomori adolescent group. Socio-demographic and psychopathological profiles and the relationship between hikikomori and psychopathological conditions were analyzed. No gender difference, a medium-high intellectual level, and no correlation with socioeconomic status were highlighted among the clinical group. The relationship between social withdrawal and social anxiety was significant while no correlation was found with depressive symptoms. The presence of Hikikomori syndrome was also significant in Italian adolescents, suggesting that hikikomori is not a culture-bound syndrome related to the Japanese cultural context, but rather a syndrome occurring in the upper-medium class.

The scope and nature of prolonged social withdrawal in Israel: An initial quantitative and qualitative investigation.

OBJECTIVE: Over the past few decades, prolonged social withdrawal (PSW) among young people has been recognized in several countries. Most research has been quantitative and focused on the characteristics of PSW individuals and their families. Little attention has been given to the valuable perspective of professionals providing service to this population. The purpose of the present study is to identify the characteristics of PSW in Israel, where this phenomenon has not been researched yet. For this initial investigation, the study will utilize a combination of quantitative self-report data from parents of PSW individuals, as well as qualitative data gathered from interviews with mental health professionals who work with this population. METHODS: Quantitative data were derived from records of referrals by parents of 121 PSW individuals, and later categorized into apparent characteristics of PSW. Qualitative data was collected through semi-structured interviews conducted with 19 professionals experienced in treating PSW, and later analyzed in a thematic analysis process. RESULTS: Findings from the quantitative data revealed a majority of males (70%) with an average age of 24.2, with previously diagnosed psychiatric conditions (64%). Findings from the qualitative data exposed frequently reported characteristics of PSW individuals and their families, out of which five themes emerged: Family Dynamics, Psychological Characteristics, Typical Behaviors, Past Difficulties, and Present Challenges. CONCLUSION: This study is the first to identify and report characteristics of PSW in Israel, which are consistent with previous research reported in other countries. The study is highlighting familial characteristics as well as individual ones, while also considering the broader socio-cultural context. These findings draw attention to the importance of notifying the general public, clinicians, researchers, and policymakers in Israel and beyond to the concerning problem of PSW, while contributing to the efforts to develop a map of this barely explored territory.

Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours.

BACKGROUND: Self-harm and suicidal behaviour are recognised as public health concerns. Prolonged social withdrawal behaviour, or hikikomori, is reported as a risk factor for suicidal behaviour. AIMS: To examine the occurrence and additional risk of prolonged social withdrawal behaviour on self-harm and suicidal behaviour among Chinese university students. METHOD: A cross-sectional online survey was conducted with three universities in southern China. A two-stage random sampling was adopted for recruitment, with students in different years of study, in different departments of each participating university. Hierarchical logistic regression analyses were conducted to investigate the sociodemographic and psychological correlates of self-harm and suicidal behaviours among male and female participants with hikikomori status. RESULTS: Of the students who completed the online survey, 1735 (72.23%) were included in the analysis; 11.5% (n = 200) reported self-harm behaviour and 11.8% (n = 204) reported suicidal behaviours in the past 12 months. Men showed a higher prevalence rate of self-harm than women (14.7% v. 10.8%, P = 0.048), but a similar rate of suicidal behaviours (11.9% v. 11.3%, P = 0.78). The overall prevalence rate of social withdrawal behaviour was 3.2% (7.0% for men and 2.3% for women, P < 0.001). Prolonged social withdrawal behaviour status was significantly associated with self-harm (odds ratio 2.00, 95% CI 1.22-3.29) and suicidal behaviour (odds ratio 2.35, 95% CI 1.45-3.81). However, the associations became statistically insignificant after adjustment for psychological factors in the final models in the logistic regression analyses. CONCLUSIONS: Prolonged social withdrawal behaviour appears to be associated with self-harm and suicidal behaviour, but psychological factors have stronger links with suicidality.

Similar but Different: Psychological and Psychopathological Features of Primary and Secondary Hikikomori.

Recently, there has been an increase in reports of hikikomori around the globe, and Ukraine is not an exception. The development of hikikomori is often spurred by a history of aversive or traumatic childhood experience, for example, dysfunctions between parents or between a parent and a child (ambivalent attachment) and difficulties at school (peer rejection). Previously described models of hikikomori development mostly were based on research of mixed cohorts of patients (with and without psychiatric comorbidity). To test whether there was a difference in psychological and psychopathological features between primary hikikomori (HG1, n = 13) and secondary hikikomori (HG2, n = 22) cases comorbid with neurotic, somatoform, and stress-related disorders (F40-48, ICD-10), they were compared with each other and with a healthy control group (CG, n = 28). Sociodemographic data, alexithymia [Toronto Alexithymia Scale (TAS-26)], traumatic life events [life experience questionnaire (LEQ)], hostility [Buss-Durkee Hostility Inventory (BDHI)], quality of life [Chaban Quality of Life Scale (CQLS)], and personality traits (Leonhard-Schmieschek Questionnaire) were evaluated. No relevant or statistically significant differences have been found between primary and secondary hikikomori cases, except for greater hostility in the latter. When compared with the healthy control group, the primary hikikomori cases were found to have higher frequency of alexithymia, life span traumatic events (7 ± 3.6), as well as higher levels of resentment and verbal hostility, and a bigger aggression index. In secondary hikikomori cases, higher irritability and resentment have been observed, with more dysthymia, excitability, and anxiety; and although the frequency of psychological traumas was lower (5.5 ± 4), it was still significant. Primary and secondary hikikomori had largely similar characteristics in the Ukrainian sample studied, but more studies with larger samples are needed to validate generalizability of the findings.