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Cited by 32Youth Substance Use and School AttendanceChild and Adolescent Psychosocial and Emotional DevelopmentImpact of Technology on Adolescents

Preliminary study of the social withdrawal (hikikomori) spectrum in French adolescents: focusing on the differences in pathology and related factors compared with Japanese adolescents

Open access
Hamasaki, Yukiko, Pionnié-Dax, Nancy, Dorard, Géraldine, Tajan, Nicolas, Hikida, Takatoshi·2022·BMC Psychiatry
DOI 10.1186/s12888-022-04116-6PMC PMC9287690
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Abstract

Background: Social withdrawal (hikikomori) has become an internationally recognized phenomenon, but its pathology and related factors are not yet fully known. We previously conducted a statistical case-control study on adolescent patients with hikikomori in Japan, which revealed the non-specificity of pathology in patients with hikikomori. Further, environmental factors, such as the lack of communication between parents and Internet overuse, were found to be significant predictors of hikikomori severity. Here, we aimed to conduct a similar preliminary case-control study in France and to compare the results with those from the study conducted in Japan. Methods: Parents of middle school students who underwent psychiatric outpatient treatment for hikikomori (n = 10) and control group parents (n = 115) completed the Child Behavior Checklist to evaluate their child’s psychopathological characteristics and the Parental Assessment of Environment and Hikikomori Severity Scales, as in our previous study in Japan. We compared the descriptive statistics and intergroup differences in France with those from the previous study conducted in Japan. In the multiple regression analysis to find predictors of hikikomori severity in French and also Japanese subjects, the same dependent and independent variables were chosen for the present study (both differed from the previous study). These were used in order to make accurate intercountry comparisons. Results: The comparisons revealed no differences in the pathology of hikikomori between Japan and France. Specifically, both studies found similarly increased scores for all symptom scales, with no specific bias. However, the statistical predictors of hikikomori severity in France (lack of communication between parents and child and lack of communication with the community) differed from those in Japan (lack of communication between parents). Conclusion: Hikikomori in Japan and France could be considered essentially the same phenomenon; moreover, our findings demonstrated the universal non-specificity and unbiasedness of the hikikomori pathology. This suggests that hikikomori is not a single clinical category with a specific psychopathology; instead, it is a common phenotype with various underlying pathologies. However, different strategies may be required in each country to prevent the onset and progression of hikikomori.

AI snapshot

Written from the paper’s full text.

TL;DR

This preliminary French case-control study found no difference in hikikomori psychopathology between French and Japanese adolescents: both showed broadly elevated CBCL symptom scores without a specific bias. However, predictors of hikikomori severity differed, with parent-child and community communication in France versus communication between parents in Japan.

Key findings

  • French adolescents with hikikomori (n = 10) had significantly higher hikikomori severity than controls (n = 115) (2.50 ± 0.43 vs. 0.73 ± 1.07, p < 0.001), and significantly higher scores on all eight CBCL syndrome subscales (p < 0.01), with effect sizes ranging from 0.24 to 0.44; “withdrawn” and “anxious/depressed” were slightly in the clinical range.
  • In multiple regression, only “withdrawn” was significantly associated with hikikomori severity in both samples (France: β = 0.313, p = 0.006; Japan: β = 0.332, p = 0.014), supporting non-specific pathology.
  • Environmental predictors differed by country: in France, “communication with the community” (β = −0.193, p = 0.026) and “communication between parents and child” (β = −0.188, p = 0.046) contributed most; in Japan, “communication between parents” contributed most (β = −0.287, p = 0.007).
  • Parental psychiatric disorder was significantly higher in the French hikikomori group than controls (2.20 ± 1.98 vs. 0.39 ± 1.07, p < 0.001, r = 0.34).

Methods

  • Case-control study in France: psychiatric outpatients aged 12–15 years treated primarily for hikikomori (n = 10) and healthy controls (n = 115), matched for sex and age; compared with a previous Japanese study of hikikomori patients (n = 20) and controls (n = 88).
  • Parents completed the Child Behavior Checklist (CBCL4–18) and the Parental Assessment of Environment and Hikikomori Severity Scales; hikikomori severity was assessed with two items, but because French internal consistency was low (Cronbach’s α = 0.316), only the “going out” item was used.
  • Analyses included Mann–Whitney U tests, Spearman correlations, and multiple regression with VIF checks; significance was set at p < 0.05.

Limitations

  • The paper states the sample size was small, the questionnaire was ad-hoc and based on the Japanese Cabinet Office definition, only parents completed the questionnaire, and the design was cross-sectional; future studies should use standardized validated instruments such as the HQ-25 and collect adolescent self-reports.
  • Evident from the text: the French hikikomori severity scale had low internal consistency (α = 0.316), and controls were recruited mainly via siblings of student volunteers using snowball sampling, which may limit representativeness.
  • Evident from the text: the very small French hikikomori group (n = 10) makes the between-country regression comparisons preliminary and limits generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12888-022-04116-6

Cites

62 of 62 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

26 of 56 cited sources checked · 7 supported · 3 flagged · accuracy not yet measured

  • Premisecitation

    The previous Japanese case-control study revealed non-specificity of pathology in patients with hikikomori.

    “We previously conducted a statistical case-control study on adolescent patients with hikikomori in Japan, which revealed the non-specificity of pathology in patients with hikikomori.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [52] Hamasaki Y, Pionnié-Dax N, Dorard G, Tajan N, Hikida T. Identifying social withdrawal (hikikomori) factors in adolescents: understanding the hikikomori spectrum. Child Psychiatry Hum Dev. 2021;52:808–17. https://doi.org/10.1007/s10578-020-01064-8. source
  • Premisecitation

    Environmental factors, such as lack of communication between parents and Internet overuse, were significant predictors of hikikomori severity in the previous Japanese study.

    “Further, environmental factors, such as the lack of communication between parents and Internet overuse, were found to be significant predictors of hikikomori severity.”
    • Also stated in: § Background · plain
      “Furthermore, Internet overuse and lack of communication between both parents are environmental factors associated with hikikomori severity.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [52] Hamasaki Y, Pionnié-Dax N, Dorard G, Tajan N, Hikida T. Identifying social withdrawal (hikikomori) factors in adolescents: understanding the hikikomori spectrum. Child Psychiatry Hum Dev. 2021;52:808–17. https://doi.org/10.1007/s10578-020-01064-8. source
  • Premisecitation

    An absent father, a subsequent mother-child closeness and over-interference, and the inhibition of children's independence have been repeatedly mentioned in previous studies as factors in the occurrence of hikikomori in Japan.

    “An absent father, a subsequent mother-child closeness and over-interference, and the inhibition of children’s independence have been repeatedly mentioned in previous studies as factors in the occurrence of hikikomori in Japan”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [6] Kato TA, Kanba S, Teo AR. Hikikomori: experience in Japan and international relevance. World Psychiatry. 2018;17:105–6. https://doi.org/10.1002/wps.20497. source
    • cites [50] Kato TA, Hashimoto R, Hayakawa K, Kubo H, Watabe M, Teo AR, et al. Multidimensional anatomy of 'modern type depression' in Japan: a proposal for a different diagnostic approach to depression beyond the DSM-5. Psychiatry Clin Neurosci. 2016;70:7–23. https://doi.org/10.1111/pcn.12360. source

      The “MTD and hikikomori based on amae” section (page not provided) suggests that parental acceptance of a child staying home may indirectly promote hikikomori and discusses dependence on parents. It does not identify an absent father, mother–child over-closeness or over-interference, or inhibited independence as factors repeatedly mentioned in previous studies. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [56] Tajan N, Hamasaki Y, Pionnié-Dax N. Hikikomori: the Japanese cabinet Office’s 2016 survey of acute social withdrawal. Asia Pac. 2017;J15:1. source

      The Concluding remarks discuss mother–child codependency and suggest that strong parental intervention might impair youth autonomy, potentially contributing to hikikomori. They do not identify an absent father as a factor or establish that previous studies repeatedly identified this combination of factors; the proposed risk is also tentative. (LLM, conf=0.85)

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  • Premisecitation

    Family factors contribute to hikikomori severity worldwide.

    “Although family factors contribute to hikikomori severity worldwide”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [22] Colman AM. A dictionary of psychology. Oxford: Oxford University Press; 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [49] Li TM, Wong PW. Youth social withdrawal behavior (hikikomori): a systematic review of qualitative and quantitative studies. Aust N Z J Psychiatry. 2015;49:595–609. https://doi.org/10.1177/0004867415581179. source
    • cites [67] Malagón-Amor Á, Martín-López LM, Córcoles D, González A, Bellsolà M, Teo AR, et al. Family features of social withdrawal syndrome (hikikomori). Front Psychiatry 2020;11:138. https://dx.doi.org/https://doi.org/10.3389/fpsyt.2020.00138. source

      The Abstract reports that higher social-withdrawal severity was associated with family psychiatric history, dysfunctional family dynamics, and family abuse history. But the Participants section limits the study to 190 people treated in Barcelona, Spain, and the reported associations do not establish that family factors cause severity worldwide. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [70] Martinotti G, Vannini C, Di Natale C, Sociali A, Stigliano G, Santacroce R, et al. Hikikomori: psychopathology and differential diagnosis of a condition with epidemic diffusion. Int J Psychiatry Clin Pract. 2021;25:187–94. https://doi.org/10.1080/13651501.2020.1820524. source
  • Premisecitation

    Low stress tolerance and poor stress coping mechanisms in patients with hikikomori may be associated with the sum of such vulnerabilities.

    “low stress tolerance and poor stress coping mechanisms in patients with hikikomori may be associated with the sum of such vulnerabilities”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [43] Kato TA, Kanba S, Teo AR. Hikikomori: multidimensional understanding, assessment, and future international perspectives. Psychiatry Clin Neurosci. 2019;73:427–40. https://doi.org/10.1111/pcn.12895. source
    • cites [68] Nonaka S, Shimada H, Sakai M. Family behavioral repertoires and family interaction influence the adaptive behaviors of individuals with hikikomori. Front Psychiatry. 2020;10:977. https://doi.org/10.3389/fpsyt.2019.00977. source

      The Introduction (page unavailable) describes physical and psychosocial difficulties among people with hikikomori, but does not address their stress tolerance or coping mechanisms. The Methods and Limitations sections (pages unavailable) discuss family coping and family members’ stress instead. Searches for stress tolerance, patient coping, and vulnerabilities found no passage supporting the claimed association. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
    • cites [69] Nonaka S, Sakai M. Psychological factors associated with social withdrawal (hikikomori). Psychiatry Investig. 2021;18:463–70. https://doi.org/10.30773/pi.2021.0050. source

      The Discussion (page not provided) associates psychological stress, behavioral disengagement coping, and lower use of instrumental-support coping with hikikomori behaviors. It does not measure low stress tolerance or establish that these vulnerabilities have a cumulative effect. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 19
  • May combine two claims. 21
  • The quote only partly states this claim. 5

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A Japanese study found that school dropout is the most important factor in adolescent hikikomori.

    “A Japanese study found that school dropout is the most important factor in adolescent hikikomori [46].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [46] Yong R, Nomura K. Hikikomori is most associated with interpersonal relationships, followed by suicide risks: a secondary analysis of a national cross-sectional study. Front Psychiatry. 2019;10:247. https://doi.org/10.3389/fpsyt.2019.00247. source

      The Discussion says school dropout is associated with hikikomori, but identifies interpersonal relationships, followed by suicide risks, as the strongest associations—not dropout. The study also sampled people aged 15–39, rather than adolescents alone (Abstract). (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The biomarkers proposed by Hayakawa et al. for hikikomori, including oxidative stress and inflammation, are more likely to be signs of physical changes that progress with hikikomori worsening rather than hikikomori-specific markers of psychiatric vulnerability.

    “they are more likely to be signs of physical changes that progress with hikikomori worsening rather than hikikomori-specific markers of psychiatric vulnerability”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [45] Hayakawa K, Kato TA, Watabe M, Teo AR, Horikawa H, Kuwano N, et al. Blood biomarkers of hikikomori, a severe social withdrawal syndrome. Sci Rep. 2018;8:2884. https://doi.org/10.1038/s41598-018-21260-w. source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Hikikomori still has no strict definition or diagnostic criteria.

    “Hikikomori still has no strict definition or diagnostic criteria.”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [31] Ministry of Health, Labour and Welfare. Guidelines for support and evaluation of hikikomori.; 2010. https://www.mhlw.go.jp/stf/houdou/2r98520000006i6f.html. Accessed 20 October 2021.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [15] Teo AR, Fetters MD, Stufflebam K, Tateno M, Balhara Y, Choi TY, et al. Identification of the hikikomori syndrome of social withdrawal: psychosocial features and treatment preferences in four countries. Int J Soc Psychiatry. 2015;61:64–72. https://doi.org/10.1177/0020764014535758. source

      The Introduction says definitions of hikikomori have been inconsistent or insufficiently detailed and that a proposed research-grade definition had not been empirically tested. But the Method sets out specific criteria, and the Discussion describes a standardized definition and assessment tool. The paper supports a lack of settled criteria, not the unqualified claim that hikikomori has no strict definition or criteria. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [10] Kato TA, Kanba S, Teo AR. Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori. World Psychiatry. 2020;19:116–7. https://doi.org/10.1002/wps.20705. source

      In “Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori” (page not provided), the authors define hikikomori and specify three diagnostic criteria, including at least six months of social isolation. They describe these as proposed criteria, not necessarily universally adopted ones, but the categorical claim that hikikomori has no definition or diagnostic criteria is contrary to this paper. (LLM, conf=0.86)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [32] Tan MPJ, Lee W, Kato TA. International experience of hikikomori (prolonged social withdrawal) and its relevance to psychiatric research. BJPsych Int. 2021;18:34–7. https://doi.org/10.1192/bji.2020.20. source

      The “Defining hikikomori” section says studies rarely use a standardised definition and identifies unresolved differences in how hikikomori is defined. But it also presents diagnostic criteria proposed in 2020, so the claim that there are no diagnostic criteria is not supported. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In the previous Japanese study, the two hikikomori severity items had a Cronbach's alpha of 0.703, confirming internal consistency.

    “Reliability analysis between both items revealed a Cronbach’s alpha of 0.703, which confirmed internal consistency.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [52] Hamasaki Y, Pionnié-Dax N, Dorard G, Tajan N, Hikida T. Identifying social withdrawal (hikikomori) factors in adolescents: understanding the hikikomori spectrum. Child Psychiatry Hum Dev. 2021;52:808–17. https://doi.org/10.1007/s10578-020-01064-8. source

  • May combine two claims.

    Premisecitation

    In the previous Japanese study, the patient group had significantly higher symptom scale scores than controls, but none fell within the clinical range, indicating no psychiatric signs specific to hikikomori.

    “We observed significantly higher symptom scale scores in the patient group than in the control group; however, none fell within the clinical range, indicating no psychiatric signs specific to hikikomori.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [52] Hamasaki Y, Pionnié-Dax N, Dorard G, Tajan N, Hikida T. Identifying social withdrawal (hikikomori) factors in adolescents: understanding the hikikomori spectrum. Child Psychiatry Hum Dev. 2021;52:808–17. https://doi.org/10.1007/s10578-020-01064-8. source

      The Results report significantly higher mean CBCL total and syndrome-subscale scores in the hikikomori group, and the Discussion says there is no distinctive psychiatric sign specific to clinical hikikomori. But the claim that none of the scores fell in the clinical range is incorrect: the total mean CBCL score was in the clinical range; only the eight syndrome subscales were subclinical. Page numbers are not provided in our copy. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The CBCL is widely used in pediatric psychiatry.

    “The CBCL was developed by Achenbach et al. for the comprehensive assessment of children’s emotional and behavioral problems [61] and is widely used in pediatric psychiatry [62–65].”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [62] Rossi A, Pollice R, Daneluzzo E, Marinangeli MG, Stratta P. Behavioral neurodevelopment abnormalities and schizophrenic disorder: a retrospective evaluation with the childhood behavior checklist (CBCL). Schizophr Res. 2000;44:121–8. https://doi.org/10.1016/S0920-9964(99)00223-6. source
    • cites [63] Welham J, Scott J, Williams G, Najman J, Bor W, O’Callaghan M, et al. Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study. Psychol Med. 2009;39:625–34. https://doi.org/10.1017/S0033291708003760. source
    • cites [64] Matheson SL, Vijayan H, Dickson H, Shepherd AM, Carr VJ, Laurens KR. Systematic meta-analysis of childhood social withdrawal in schizophrenia, and comparison with data from at-risk children aged 9–14 years. J Psychiatr Res. 2013;47:1061–8. https://doi.org/10.1016/j.jpsychires.2013.03.013. source
    • cites [65] Hamasaki Y, Nakayama T, Hikida T, Murai T. Combined pattern of childhood psycho-behavioral characteristics in patients with schizophrenia: a retrospective study in Japan. BMC Psychiatry. 2021;21–57. https://doi.org/10.1186/s12888-021-03049-w. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Hikikomori is associated with various mental disorders, including mood, anxiety, personality, developmental disorders, and the prodromal phase of schizophrenia.

    “Hikikomori is associated with various mental disorders, including mood, anxiety, personality, developmental disorders, and the prodromal phase of schizophrenia [6, 10, 33, 34].”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [6] Kato TA, Kanba S, Teo AR. Hikikomori: experience in Japan and international relevance. World Psychiatry. 2018;17:105–6. https://doi.org/10.1002/wps.20497. source
    • cites [10] Kato TA, Kanba S, Teo AR. Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori. World Psychiatry. 2020;19:116–7. https://doi.org/10.1002/wps.20705. source

      In the paper’s discussion of the revised diagnostic criteria (page not provided), the authors say hikikomori tends to co-occur with other conditions and may co-occur with a variety of psychiatric disorders. Our copy does not identify mood, anxiety, personality, or developmental disorders, or the prodromal phase of schizophrenia, as co-occurring conditions. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [33] Kondo N, Sakai M, Kuroda Y, Kiyota Y, Kitabata Y, Kurosawa M. General condition of hikikomori (prolonged social withdrawal) in Japan: psychiatric diagnosis and outcome in mental health welfare centres. Int J Soc Psychiatry. 2013;59:79–86. https://doi.org/10.1177/0020764011423611. source
    • cites [34] Hamasaki Y. Appearance of caseness: social withdrawal and the development of schizophrenia. Jpn J Clin Psychiatry. 2015;44:655–62.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In Japan, hikikomori is associated with paternal absence, close contact with the mother, and lack of independence.

    “In Japan, hikikomori is associated with paternal absence, close contact with the mother, and lack of independence [6, 50].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [6] Kato TA, Kanba S, Teo AR. Hikikomori: experience in Japan and international relevance. World Psychiatry. 2018;17:105–6. https://doi.org/10.1002/wps.20497. source
    • cites [50] Kato TA, Hashimoto R, Hayakawa K, Kubo H, Watabe M, Teo AR, et al. Multidimensional anatomy of 'modern type depression' in Japan: a proposal for a different diagnostic approach to depression beyond the DSM-5. Psychiatry Clin Neurosci. 2016;70:7–23. https://doi.org/10.1111/pcn.12360. source

      The “MTD and hikikomori based on amae” section says hikikomori may be indirectly promoted by parental acceptance of a child staying home and discusses young people’s economic dependence on parents. It does not identify paternal absence or close contact with the mother as associations, and its account of dependence is more tentative than the citing sentence. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The pathological features specific to hikikomori remain unclear and have not been described in DSM-5 or ICD-11.

    “The pathological features specific to hikikomori remain unclear and have not been described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [40] or the International Classification of Diseases (ICD-11) [41].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [40] American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). Amer Psychiatric Pub Inc. 2013. source

      The supplied passages (section labeled 11 September 2026; no page given) discuss depression, not hikikomori or DSM-5's coverage of it. Searches for hikikomori and its diagnostic classification returned no relevant passage, so our copy does not establish whether DSM-5 describes its specific pathological features. The ICD-11 portion is attributed to a different citation. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [41] WHO. ICD-11 for mortality and morbidity statistics; 2019. https://icd.who.int/browse11/l-m/en. Accessed 4 September 2021.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Previous studies have reported complications with various psychiatric disorders, including anxiety and mood disorders, and the prodromal phase of schizophrenia.

    “Contrarily, previous studies [6, 10, 33–35] have reported complications with various psychiatric disorders, including anxiety and mood disorders, and the prodromal phase of schizophrenia.”
    Quote in the paperSubstantial claim1 of 5 sources checked
    • cites [6] Kato TA, Kanba S, Teo AR. Hikikomori: experience in Japan and international relevance. World Psychiatry. 2018;17:105–6. https://doi.org/10.1002/wps.20497. source
    • cites [10] Kato TA, Kanba S, Teo AR. Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori. World Psychiatry. 2020;19:116–7. https://doi.org/10.1002/wps.20705. source

      In “Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori” (page not provided), the paper says hikikomori tends to co-occur with other psychiatric conditions. It does not identify anxiety disorders, mood disorders, or the prodromal phase of schizophrenia as those conditions. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [33] Kondo N, Sakai M, Kuroda Y, Kiyota Y, Kitabata Y, Kurosawa M. General condition of hikikomori (prolonged social withdrawal) in Japan: psychiatric diagnosis and outcome in mental health welfare centres. Int J Soc Psychiatry. 2013;59:79–86. https://doi.org/10.1177/0020764011423611. source
    • cites [34] Hamasaki Y. Appearance of caseness: social withdrawal and the development of schizophrenia. Jpn J Clin Psychiatry. 2015;44:655–62.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [35] Teo AR, Stufflebam K, Saha S, Fetters MD, Tateno M, Kanba S, et al. Psychopathology associated with social withdrawal: idiopathic and comorbid presentations. Psychiatry Res. 2015;228:182–3. https://doi.org/10.1016/j.psychres.2015.04.033. source

  • May combine two claims.

    Premisecitation

    In the between-group comparisons of the Japanese sample in the previous survey, the patient group showed significantly high parental psychiatric disorders, overuse of Internet, and low communication between parents; the patient group showed significantly higher scores for all CBCL syndrome subscales than the control group, which were all in the subclinical range.

    “In the between-group comparisons of the Japanese sample in our previous survey, the patient group showed significantly high “parental psychiatric disorders”, “overuse of Internet”, and low “communication between parents”; the patient group showed significantly higher scores for all CBCL syndrome subscales than the control group, which were all in the subclinical range.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [52] Hamasaki Y, Pionnié-Dax N, Dorard G, Tajan N, Hikida T. Identifying social withdrawal (hikikomori) factors in adolescents: understanding the hikikomori spectrum. Child Psychiatry Hum Dev. 2021;52:808–17. https://doi.org/10.1007/s10578-020-01064-8. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Stip et al. reported overuse of Internet games, social media, and YouTube in Asian countries, including Japan, South Korea, China, and Hong Kong, but not in other countries.

    “Stip et al. reported overuse of Internet games, social media (Instagram, Facebook, etc.), and YouTube in Asian countries, including Japan, South Korea, China, and Hong Kong, but not in other countries”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [28] Stip E, Thibault A, Beauchamp-Chatel A, Kisely S. Internet addiction, hikikomori syndrome, and the prodromal phase of psychosis. Front Psychiatry. 2016;7:6. https://doi.org/10.3389/fpsyt.2016.00006. source

      The Literature Review’s “Differential Diagnosis of Hikikomori” section reports widespread social-media and YouTube use and gives Internet-addiction figures for adolescents in Hong Kong and Korea. It does not report overuse of all three activities in Japan, South Korea, China, and Hong Kong, or say that such overuse does not occur elsewhere. The paper says Asian countries are at the forefront of research, not that the problem is confined to them. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    The authors' previous Japanese study indicated an association of excessive Internet use with hikikomori severity, but the present study did not.

    “Our previous Japanese study [52], but not the present study, indicated an association of excessive Internet use with hikikomori severity.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [52] Hamasaki Y, Pionnié-Dax N, Dorard G, Tajan N, Hikida T. Identifying social withdrawal (hikikomori) factors in adolescents: understanding the hikikomori spectrum. Child Psychiatry Hum Dev. 2021;52:808–17. https://doi.org/10.1007/s10578-020-01064-8. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Dysfunctional family relationships have been identified in other countries, including Hong Kong, Spain, Italy, and France.

    “Dysfunctional family relationships have been identified in other countries, including Hong Kong, Spain, Italy, and France”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [22] Colman AM. A dictionary of psychology. Oxford: Oxford University Press; 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [49] Li TM, Wong PW. Youth social withdrawal behavior (hikikomori): a systematic review of qualitative and quantitative studies. Aust N Z J Psychiatry. 2015;49:595–609. https://doi.org/10.1177/0004867415581179. source
    • cites [67] Malagón-Amor Á, Martín-López LM, Córcoles D, González A, Bellsolà M, Teo AR, et al. Family features of social withdrawal syndrome (hikikomori). Front Psychiatry 2020;11:138. https://dx.doi.org/https://doi.org/10.3389/fpsyt.2020.00138. source

      The Materials and Methods (Participants; page unavailable) locate the study in Barcelona, Spain, and the Results report dysfunctional family dynamics among its social-withdrawal cases. The paper does not establish the claim for Hong Kong, Italy, or France. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [70] Martinotti G, Vannini C, Di Natale C, Sociali A, Stigliano G, Santacroce R, et al. Hikikomori: psychopathology and differential diagnosis of a condition with epidemic diffusion. Int J Psychiatry Clin Pract. 2021;25:187–94. https://doi.org/10.1080/13651501.2020.1820524. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Previous Japanese studies have reported an association of hikikomori with paternal absence, close contact with the mother, and lack of independence.

    “Previous Japanese studies have reported an association of hikikomori with paternal absence, close contact with the mother, and lack of independence”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [6] Kato TA, Kanba S, Teo AR. Hikikomori: experience in Japan and international relevance. World Psychiatry. 2018;17:105–6. https://doi.org/10.1002/wps.20497. source
    • cites [50] Kato TA, Hashimoto R, Hayakawa K, Kubo H, Watabe M, Teo AR, et al. Multidimensional anatomy of 'modern type depression' in Japan: a proposal for a different diagnostic approach to depression beyond the DSM-5. Psychiatry Clin Neurosci. 2016;70:7–23. https://doi.org/10.1111/pcn.12360. source

      The “MTD and hikikomori based on amae” section (page unavailable) suggests that parental acceptance and continued dependence may contribute to hikikomori, which partly supports the lack-of-independence component. It does not report an association with paternal absence or specifically close contact with the mother, and presents the dependence link as a possibility rather than an established association. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [68] Nonaka S, Shimada H, Sakai M. Family behavioral repertoires and family interaction influence the adaptive behaviors of individuals with hikikomori. Front Psychiatry. 2020;10:977. https://doi.org/10.3389/fpsyt.2019.00977. source

      The Introduction discusses family relationships and reports that childrearing styles did not significantly differ between hikikomori and non-hikikomori groups, but it does not address the three specific associations claimed. Searches for paternal absence, maternal closeness, and lack of independence found no passage reporting those associations; the Methods instead describe measures of parents’ relationship to the child and adaptive behaviors. Page numbers are unavailable in our copy. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the French hikikomori patient group, parental physical disorder was significantly higher than in the control group (p < 0.05), but with a small effect size (r < 0.3).

    “in the hikikomori patient group, “parental psychiatric disorder” (p < 0.001), “parental physical disorder” (p < 0.05), and “conflict between parents and child” (p < 0.05) were significantly higher than in the control group”
    • Also stated in: § Descriptive statistics and between-group comparisons of hikikomori severity, environmental factors, and CBCL scores · plain
      “However, the effect sizes of “parental physical disorder”, “communication between parents”, and “conflict between parents and child” were small (r < 0.3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no between-study difference in the pathology of hikikomori; both studies showed similarly increased scores for all symptom scales with no specific bias.

    “There was no between-study difference in the pathology of hikikomori. Both studies showed similarly increased scores for all symptom scales; moreover, there was no specific bias in the appearance of symptoms.”
    • Also stated in: § Results · plain
      “The comparisons revealed no differences in the pathology of hikikomori between Japan and France. Specifically, both studies found similarly increased scores for all symptom scales, with no specific bias.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In the French sample, communication with the community and communication between parents and child were significant predictors of hikikomori severity in multiple regression (p < 0.05).

    “In the French sample, “communication with the community” and “communication between parents and child” showed the highest contribution to hikikomori severity.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the French hikikomori patient group, conflict between parents and child was significantly higher than in the control group (p < 0.05), but with a small effect size (r < 0.3).

    “in the hikikomori patient group, “parental psychiatric disorder” (p < 0.001), “parental physical disorder” (p < 0.05), and “conflict between parents and child” (p < 0.05) were significantly higher than in the control group”
    • Also stated in: § Descriptive statistics and between-group comparisons of hikikomori severity, environmental factors, and CBCL scores · plain
      “However, the effect sizes of “parental physical disorder”, “communication between parents”, and “conflict between parents and child” were small (r < 0.3).”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the French hikikomori patient group, communication between parents was significantly lower than in the control group (p < 0.01), but with a small effect size (r < 0.3).

    “while “communication between parents and child” (p < 0.001) and “communication between parents” (p < 0.01) were significantly lower.”
    • Also stated in: § Descriptive statistics and between-group comparisons of hikikomori severity, environmental factors, and CBCL scores · plain
      “However, the effect sizes of “parental physical disorder”, “communication between parents”, and “conflict between parents and child” were small (r < 0.3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Although scores for withdrawn and anxious/depressed were slightly in the clinical range, no CBCL item had a large effect size (range 0.24-0.44).

    “Although the scores for “withdrawn” and “anxious/depressed” were slightly in the clinical range, no item had a large effect size (range, 0.24–0.44).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the Japanese sample, communication with the community and communication between parents and child did not contribute to hikikomori severity, while communication between parents had the highest contribution.

    “Contrastingly, these variables did not contribute to hikikomori severity in the Japanese sample, and “communication between parents” had the highest contribution.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In both samples, among the eight CBCL syndrome subscales, only 'withdrawn' was significantly associated with hikikomori severity.

    “Among the eight independent variables, only “withdrawn” was significantly associated with hikikomori severity.”
    • Also stated in: § Associations between hikikomori severity and CBCL subscale scores · plain
      “The analysis results for both samples were similar.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The middle-school age is crucial for the early detection and intervention of hikikomori.

    “The middle-school age is crucial for the early detection and intervention of hikikomori from the perspective of neurodevelopmental plasticity and malleability [51]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] Drabick DAG, Steinberg L. Developmental psychopathology. Encyclopedia adolescence. London: Elsevier; 2011.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    Hikikomori is not a single clinical category with a specific psychopathology; rather, it is a common phenotype with various underlying pathologies.

    “This suggests that hikikomori is not a single clinical category with a specific psychopathology; rather, it is a common phenotype with various underlying pathologies.”
    • Also stated in: § Conclusion · hedged
      “This suggests that hikikomori is not a single clinical category with a specific psychopathology; instead, it is a common phenotype with various underlying pathologies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The findings demonstrate the universal non-specificity and unbiasedness of the hikikomori pathology.

    “our findings demonstrated the universal non-specificity and unbiasedness of the hikikomori pathology”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Various factors, including the family's economic situation, contribute to absenteeism in France, which differs from Japan.

    “Specifically, various factors, including the family’s economic situation, contribute to absenteeism in France [58], which differs from the situation in Japan.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] Becquemin M, Couronné J, Mardon A. Absentéismes scolaires. Soc jeunesses difficulté. 2013;13 http://journals.openedition.org/sejed/7407.

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The pathology of hikikomori is non-specific and diverse.

    “the pathology of hikikomori is non-specific and diverse”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Compared to other countries, Japanese fathers' participation in the home is lower, and cooperation between parents in child rearing is also relatively low.

    “Compared to other countries, Japanese fathers’ participation in the home is lower, and cooperation between parents in child rearing is also relatively low.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Gender Equality Bureau, Cabinet Office, Government of Japan. Women and men in Japan; 2020:12. Pamphlet available at https://www.gender.go.jp/english_contents/pr_act/pub/pamphlet/women-and-men20/index.html

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Only the parents completed the questionnaire.

    “Only the parents completed the questionnaire.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: When the investigation started, the HQ-25 had not yet been validated.

  • May combine two claims.

    Interpretationreasoning

    A lack of communication with the community is considered a problem in France, but not in Japan.

    “while a lack of communication with the community is considered a problem in France, it is not the case in Japan.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Double hikikomori situations predict hikikomori severity in France, but not in Japan.

    “it would mean that double hikikomori situations predict hikikomori severity in France, but not in Japan.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The sample size of this study was small.

    “the sample size was small”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The study used an ad-hoc questionnaire based on the definition of the Japanese Cabinet Office, which is a major limitation.

    “we developed an ad-hoc questionnaire based on the definition of the Japanese Cabinet Office, which is a major limitation of our study”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: During the development of the study methodology, few studies on hikikomori had been conducted.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The fact that 'lack of communication between parents' is a predictor of hikikomori severity only in Japan may be explained by differences in parental roles between the two countries.

    “the fact that “lack of communication between parents” is a predictor of hikikomori severity only in Japan may be explained by differences in parental roles between the two countries.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    All patients were screened using SCID-I and Kid-SCID.

    “All patients were screened using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) [53] and the Structured Clinical Interview for DSM-IV Childhood Diagnoses (Kid-SCID) [54, 55].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [53] First MB, Spitzer RL, Gibbon M, Williams JB. Structured clinical interview for DSM-IV-TR axis I disorders: patient edition (SCID-I/P). New York: New York State Psychiatric Institute; 2001.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [54] Hien D, Matzner FJ, First MB, Sptizer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV-child edition (version 1.0). New York: Columbia University; 1994.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [55] Roelofs J, Muris P, Braet C, Arntz A, Beelen I. The structured clinical interview for DSM-IV childhood diagnoses (kid-SCID): first psychometric evaluation in a Dutch sample of clinically referred youths. Child Psychiatry Hum Dev. 2015;46(3):367–75. https://doi.org/10.1007/s10578-014-0477-z. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Kato et al. suggested the coexistence of several general psychopathological mechanisms underlying shut-in behavior.

    “Consistent with our findings, Kato et al. suggested the coexistence of several general psychopathological mechanisms underlying shut-in behavior [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Kato TA, Kanba S, Teo AR. Hikikomori: experience in Japan and international relevance. World Psychiatry. 2018;17:105–6. https://doi.org/10.1002/wps.20497. source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The present study was cross-sectional.

    “the present study was cross-sectional”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    No multicollinearity was observed in any of the variables in the multiple regression analyses.

    “There was no multicollinearity in any of the variables.”
    • Also stated in: § Associations between hikikomori severity and CBCL subscale scores · plain
      “No multicollinearity was observed in any of the variables.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The control and patient groups were matched for sex and age.

    “The control and patient groups were matched for sex and age (Table 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Hikikomori is not a single clinical category with a specific psychopathology; instead, it is a common phenotype with various underlying pathologies.

    “Our findings suggest that hikikomori is not a single clinical category with a specific psychopathology; instead, it is a common phenotype with various underlying pathologies.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The epidemic of hikikomori has emerged from various pathological bases in the backdrop of socio-familial systems that are rapidly changing due to the influence of the information technology revolution and other factors.
41 of 41

  • The paper relies on this without support.

    Factors related to the onset and severity of hikikomori in adolescents remain unclear due to a lack of epidemiological studies.

    “Given the lack of epidemiological studies, factors related to the onset and severity of hikikomori in adolescents remain unclear.”

  • The authors state this as an assumption.

    The epidemic of hikikomori has emerged from various pathological bases in the backdrop of socio-familial systems that are rapidly changing due to the influence of the information technology revolution and other factors.

    “it may be reasonable to assume that the epidemic of hikikomori has emerged from various pathological bases in the backdrop of socio-familial systems that are rapidly changing due to the influence of the information technology revolution and other factors”

  • The paper relies on this without support.

    During the development of the study methodology, few studies on hikikomori had been conducted.

    “During the development of the study methodology, few studies on hikikomori had been conducted.”

  • The paper relies on this without support.

    When the investigation started, the HQ-25 had not yet been validated.

    “When we started our investigation, the HQ-25 had not yet been validated.”
4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. Saito T. Shakaiteki hikikomori: owaranai shisyunki. Tokyo: PHP Shinsho; 1998.
  2. Oxford dictionary of English. 3rd ed. Oxford: Oxford University Press; 2010.
  3. Hamasaki Y. Appearance of caseness: social withdrawal and the development of schizophrenia. Jpn J Clin Psychiatry. 2015;44:655–62.
  4. First MB, Spitzer RL, Gibbon M, Williams JB. Structured clinical interview for DSM-IV-TR axis I disorders: patient edition (SCID-I/P). New York: New York State Psychiatric Institute; 2001.
  5. Hien D, Matzner FJ, First MB, Sptizer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV-child edition (version 1.0). New York: Columbia University; 1994.
  6. Hamasaki Y, Pionnié-Dax N, Tajan N. Rapport de recherches sur le hikikomori. Synthèse des résultats publiés en septembre 2016 par le bureau du cabinet du Japon. Inf Psychiatr. 2017(93):289–96.
  7. Gender Equality Bureau, Cabinet Office, Government of Japan. Women and men in Japan; 2020:12. Pamphlet available at https://www.gender.go.jp/english_contents/pr_act/pub/pamphlet/women-and-men20/index.html

Cited by

Sorted by citations

Related

Authors
Hamasaki, Y., Pionnié-Dax, N., Dorard, G., Tajan, N., & Hikida, T.
Affiliations
  • Kyoto Women's University (JP)
  • Université Paris Cité (FR)
  • Kyoto University (JP)
  • The University of Osaka (JP)
Corresponding author
Hamasaki, Yukiko
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2022-07-16
Volume
22
Issue
1
Pages
477-477
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-022-04116-6
PMC
PMC9287690
OpenAlex
W4285588531
Cited by
32
References
60
Citations by year
2026: 3 · 2025: 8 · 2024: 6 · 2023: 14 · 2022: 1
FWCI
15.29
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • HAL (Le Centre pour la Communication Scientifique Directe) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Japan Agency for Medical Research and Development (JP21wm0425010)
  • Japan Society for the Promotion of Science (18H00999 and 18KK0068)
Topics
  • Social Sciences › Education › Youth Substance Use and School Attendance
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
Keywords
hikikomori, social withdrawal, adolescents, psychopathology, parental communication, community communication, internet overuse, cross-cultural comparison, Japan, France, Child Behavior Checklist
MeSH terms
Phobia, Social, Mental Disorders, France, Humans, Japan, Shame, Social Isolation, Case-Control Studies

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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