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Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation

Abstract

Purpose  

To explore whether the ‘hikikomori’ syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are
diagnosed and treated.

Methods  

Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA.
Participants rated the syndrome’s prevalence in their country, etiology, diagnosis, suicide risk, and treatment.

Results  

Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis.
Respondents’ felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors
were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and
some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment
such as hospitalization.

Conclusions  

Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide
a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.

  • Content Type Journal Article
  • Category Original Paper
  • Pages 1-15
  • DOI 10.1007/s00127-011-0411-7
  • Authors
    • Takahiro A. Kato, Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582 Japan
    • Masaru Tateno, Department of Neuropsychiatry, Sapporo Medical University, Sapporo, Japan
    • Naotaka Shinfuku, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
    • Daisuke Fujisawa, Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan
    • Alan R. Teo, Department of Psychiatry, University of California, San Francisco, CA, USA
    • Norman Sartorius, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
    • Tsuyoshi Akiyama, Department of Psychiatry, NTT Medical Center Tokyo, Tokyo, Japan
    • Tetsuya Ishida, Graduate School of Human-Environment Studies, Kyushu University, Fukuoka, Japan
    • Tae Young Choi, Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, South Korea
    • Yatan Pal Singh Balhara, Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
    • Ryohei Matsumoto, Department of Psychiatry, Kyoto Prefectural University of Medicine, Kyoto, Japan
    • Wakako Umene-Nakano, Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
    • Yota Fujimura, Department of Psychiatry, Teikyo University, Tokyo, Japan
    • Anne Wand, Consultation-Liaison Psychiatry, Canterbury Hospital, Sydney Local Health Network, and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
    • Jane Pei-Chen Chang, Department of Psychiatry, China Medical University and Hospital, Taichung, Taiwan
    • Rita Yuan-Feng Chang, Department of Psychiatry, ChiaYi Branch, Taichung General Veterans Hospital, Taichung, Taiwan
    • Behrang Shadloo, Department of Psychiatry, Sina Hospital, Kamyaran, Iran
    • Helal Uddin Ahmed, Department of Psychiatry, Bangabundhu Sheikh Mujib Medical University, Dhaka, Bangladesh
    • Tiraya Lerthattasilp, Faculty of Medicine, Thammasart University Hospital, Bangkok, Thailand
    • Shigenobu Kanba, Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582 Japan