We live in a world where mental health conditions aren’t fully accepted or understood. Efforts are being made by celebrities, media houses, and social organisations to have open and honest discussions around mental health. But, we still have a long way to go before we get to a point where people who go through these conditions aren’t looked down upon.
One very underrated mental health condition is social withdrawal. Research indicates that this condition might lead to a lot of negative impact on the lives of most young adults.1 And, a good example of this condition is Hikikomori.
What Is Hikikomori?
The word “Hikikomori” roughly translates to pulling inward or being confined. And, true to its name, the condition is a severe form of social withdrawal which was first discussed in the 1970s, Japan. It involves a complete withdrawal from society for 6 months or more. It is most common in adolescent males.2
These adolescents and young adults tend to become recluses in their parents’ homes. Additionally, they are unable to work, go to school, or step outside the house for months or years. They also don’t make or maintain any personal relationships outside their families.
Anxiety and personality disorders are often the differential diagnosis of this condition. But, most other mental disorders such as schizophrenia and mental retardation are not associated with it. Although the condition hasn’t been reviewed in English medical literature, it is believed to be a silent epidemic with almost thousands of cases being estimated in Japan.3 4
What Causes Hikikomori?
Considering the fact that it isn’t a recognized mental disorder, it is difficult to state what exactly causes it. Any research available has drawn from case studies of young adults who’ve been diagnosed with the condition.5 Having stated that, some factors that might lead to hikikomori include
- Traumatic childhood experiences: This includes experiencing social exclusion, peer rejection, or being victims of bullying.
- Introverted personality traits: This includes temperamental shyness as well as an ambivalent or avoidant attachment style.
- Familial problems: Dysfunctional family dynamics, parental rejection, overprotectiveness, and parental psychopathy might contribute to hikikomori.
- Academic pressure: Poor academic achievement, high expectations, and rejection might lead to the development of social withdrawal.
- Sociocultural conditions: This includes a breakdown of social cohesion, urbanization, technological progress, globalization, and downward social mobility. These factors might lead to disengagement and disassociation from the society.
- Technology: A preference for online communication might play a huge role in social withdrawal in a few individuals.
Besides this, choosing to work despite job availability, lack of self-competence, and having unclear ambitions for the future might contribute to social withdrawal. Often, those with Hikikomori have a sense of apathy that is believed to border on nihilism. They might be disillusioned by the society in general and have a lack of motivation to engage with anyone. They might also have difficulty expressing their emotions.6 7
How Is Hikikomori Treated?
Like most other psychiatric conditions, treatment for Hikikomori involves a combination of psychotherapy and psychopharmacology. A few things that might be involved in the treatment include
- Family therapy sessions
- Gradual exposure to social contact
- Psychotherapy focused on childhood trauma
- Vocational rehabilitation
For patients who are complete recluses, clinicians might first make repeated home visits in order to draw them out of their rooms. Although this might seem counter-intuitive, non-individual approaches have shown the most benefits when it comes to treating this condition. In it, therapists moderate a group where individuals suffering from social withdrawal can talk about their issues.
Antidepressants might also be prescribed, but there isn’t enough research to support its use. The biggest challenge in treating this condition, however, is the fact that there isn’t a concrete cause-effect diagnosis available for it at the moment.8
Although most studies claim that Hikikomori is endemic to Japan, cases have been reported in Oman, UK, Korea, Italy, Spain, and France.9 10 Currently, researchers have called for further studies and investigation into the syndrome. But, meanwhile, if you suspect that someone you know might be going through this syndrome, do reach out to them.
|↑1||Luster, Stephanie Shea. Social Withdrawal and Internalizing Problems in Emerging Adulthood: Does Parenting Matter?. Brigham Young University, 2015.|
|↑2, ↑7, ↑8, ↑10||Teo, Alan R. “A new form of social withdrawal in Japan: a review of hikikomori.” International journal of social psychiatry 56, no. 2 (2010): 178-185.|
|↑3||Tateno, Masaru, Tae Woo Park, Takahiro A. Kato, Wakako Umene-Nakano, and Toshikazu Saito. “Hikikomori as a possible clinical term in psychiatry: a questionnaire survey.” BMC psychiatry 12, no. 1 (2012): 169.|
|↑4||Teo, Alan Robert, and Albert C. Gaw. “Hikikomori, A Japanese Culture-Bound Syndrome of Social Withdrawal? A Proposal for DSM-V.” The Journal of nervous and mental disease 198, no. 6 (2010): 444.|
|↑5||Stip, Emmanuel, Alexis Thibault, Alexis Beauchamp-Chatel, and Steve Kisely. “Internet addiction, hikikomori syndrome, and the prodromal phase of psychosis.” Frontiers in psychiatry 7 (2016).|
|↑6||Uchida, Yukiko, and Vinai Norasakkunkit. “The NEET and Hikikomori spectrum: Assessing the risks and consequences of becoming culturally marginalized.” Frontiers in psychology 6 (2015).|
|↑9||Sakamoto, Noriyuki, Rodger G. Martin, Hiroaki Kumano, Tomifusa Kuboki, and Samir Al-Adawi. “Hikikomori, is it a culture-reactive or culture-bound syndrome? Nidotherapy and a clinical vignette from Oman.” The International Journal of Psychiatry in Medicine 35, no. 2 (2005): 191-198.|