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Identification of the hikikomori syndrome of social withdrawal: Psychosocial features and treatment preferences in four countries
Open accessAbstract
Background: Hikikomori, a form of social withdrawal first reported in Japan, may exist globally but cross-national studies of cases of hikikomori are lacking. Aims: To identify individuals with hikikomori in multiple countries and describe features of the condition. Method: Participants were recruited from sites in India, Japan, Korea and the United States. Hikikomori was defined as a 6-month or longer period of spending almost all time at home and avoiding social situations and social relationships, associated with significant distress/impairment. Additional measures included the University of California, Los Angeles (UCLA) Loneliness Scale, Lubben Social Network Scale (LSNS-6), Sheehan Disability Scale (SDS) and modified Cornell Treatment Preferences Index. Results: A total of 36 participants with hikikomori were identified, with cases detected in all four countries. These individuals had high levels of loneliness (UCLA Loneliness Scale M = 55.4, SD = 10.5), limited social networks (LSNS-6 M = 9.7, SD = 5.5) and moderate functional impairment (SDS M = 16.5, SD = 7.9). Of them 28 (78%) desired treatment for their social withdrawal, with a significantly higher preference for psychotherapy over pharmacotherapy, in-person over telepsychiatry treatment and mental health specialists over primary care providers. Across countries, participants with hikikomori had similar generally treatment preferences and psychosocial features. Conclusion: Hikikomori exists cross-nationally and can be assessed with a standardized assessment tool. Individuals with hikikomori have substantial psychosocial impairment and disability, and some may desire treatment.
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“Hikikomori still has no strict definition or diagnostic criteria.”
From Preliminary study of the social withdrawal (hikikomori) spectrum in French adolescents: focusing on the differences in pathology and related factors compared with Japanese adolescents (2022) · cites this paper as [15]
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Cites
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Internet addiction in adolescence: neurobiological, psychosocial and clinical issues
Cerniglia, L., Zoratto, F., Cimino, S., Laviola, G., Ammaniti, M., & Adriani, W. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.12.024 · Cited by 371
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Self-citationHikikomori : Multidimensional understanding, assessment, and future international perspectives
Kato, T. A., Kanba, S., & Teo, A. R. (2019) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12895 · Cited by 335
Self-citationDevelopment and validation of the 25‐item Hikikomori Questionnaire (HQ‐25)
Teo, A. R., Chen, J. I., Kubo, H., Katsuki, R., Sato‐Kasai, M., Shimokawa, N., Hayakawa, K., Umene‐Nakano, W., Aikens, J. E., Kanba, S., et al. (2018) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12691 · Cited by 209
Self-citationDefining pathological social withdrawal: proposed diagnostic criteria for hikikomori
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Metadata
- Authors
- Teo, A. R., Fetters, M. D., Stufflebam, K., Tateno, M., Balhara, Y., Choi, T. Y., Kanba, S., Mathews, C. A., & Kato, T. A.
- Affiliations
- Portland VA Medical Center (US)
- University of Michigan (US)
- Sapporo Medical University (JP)
- All India Institute of Medical Sciences (IN)
- Daegu Catholic University (KR)
- Kyushu University (JP)
- University of California, San Francisco (US)
- ORCID
- Venue
- International Journal of Social Psychiatry
- Publisher
- SAGE Publications
- Published
- 2014-05-27
- Volume
- 61
- Issue
- 1
- Pages
- 64-72
- ISSN
- 0020-7640 (ISSN-L)
- 1741-2854
- PMC
- PMC5573567
- OpenAlex
- W2118458816
- Cited by
- 229
- References
- 32
- Citations by year
- 2026: 23 · 2025: 24 · 2024: 21 · 2023: 32 · 2022: 19 · 2021: 17 · 2020: 27 · 2019: 20 · 2018: 17 · 2017: 9 · 2016: 11 · 2015: 7 · 2014: 2
- FWCI
- 49.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Social Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK2 HX001789)
- Robert Wood Johnson Foundation
- Pfizer Health Research Foundation
- Japan Society for the Promotion of Science (26713039, 24650227, 24591724)
- Topics
- Social Sciences › Education › Youth Substance Use and School Attendance
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- hikikomori, social withdrawal, loneliness, functional disability, treatment preferences, psychotherapy versus pharmacotherapy, telepsychiatry, cross-national comparison, psychosocial impairment
- MeSH terms
- Adolescent, Adult, Mental Disorders, Demography, Drug Therapy, Female, Humans, India, Japan, Male, Middle Aged, Psychotherapy, Surveys and Questionnaires, Regression Analysis, Social Isolation, United States, Multivariate Analysis, Treatment Outcome, Young Adult, Republic of Korea, Self Report
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