Skip to main content

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

Social Psychiatry and Psychiatric Epidemiology volume 47, pages 1061–1075 (2012)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Tseng WS (2001) Handbook of cultural psychiatry. Academic Press, San Diego

  2. Wasan AD, Neufeld K, Jayaram G (2009) Practice patterns and treatment choices among psychiatrists in New Delhi, India: a qualitative and quantitative study. Soc Psychiatry Psychiatr Epidemiol 44(2):109–119

    Article  PubMed  Google Scholar 

  3. Alarcon RD (2009) Culture, cultural factors and psychiatric diagnosis: review and projections. World Psychiatry 8(3):131–139

    PubMed  Google Scholar 

  4. Ogata Y, Izumi Y, Kitaike T (2006) Mobile-phone e-mail use, social networks, and loneliness among Japanese high school students (in Japanese). Nippon Koshu Eisei Zasshi 53(7):480–492

    PubMed  Google Scholar 

  5. Saito T (1998) Social Withdrawal (Shakaiteki Hikikomori). PHP Shinsho (in Japanese), Tokyo

  6. Kaneko S (2006) Japan’s ‘socially withdrawn youths’ and time constraints in Japanese society: management and conceptualization of time in a support group for ‘hikikomori’. Time Soc 15(2–3):233–249

    Article  Google Scholar 

  7. Watts J (2002) Public health experts concerned about “hikikomori”. Lancet 359(9312):1131

    Article  PubMed  Google Scholar 

  8. Teo AR (2010) A new form of social withdrawal in Japan: a review of hikikomori. Int J Soc Psychiatry 56(2):178–185

    Article  PubMed  Google Scholar 

  9. Teo AR, Gaw AC (2010) Hikikomori, a Japanese culture-bound syndrome of social withdrawal?: A proposal for DSM-5. J Nerv Ment Dis 198(6):444–449

    Article  PubMed  Google Scholar 

  10. Borovoy A (2008) Japan’s hidden youths: mainstreaming the emotionally distressed in Japan. Cult Med Psychiatry 32(4):552–576

    Article  PubMed  Google Scholar 

  11. Garcia-Campayo J, Alda M, Sobradiel N, Sanz Abos B (2007) A case report of hikikomori in Spain. Med Clin (Barc) 129(8):318–319

    Article  Google Scholar 

  12. Sakamoto N, Martin RG, Kumano H, Kuboki T, Al-Adawi S (2005) Hikikomori, is it a culture-reactive or culture-bound syndrome? Nidotherapy and a clinical vignette from Oman. Int J Psychiatry Med 35(2):191–198

    Article  PubMed  Google Scholar 

  13. Lee KM, Koo JG, Kim EJ, Lee SH (2001) The psychosocial characteristics of oiettolie adolescents (in Korean). Korean J Counsel Psychother 13(1):147–162

    Google Scholar 

  14. Koyama A, Miyake Y, Kawakami N, Tsuchiya M, Tachimori H, Takeshima T (2010) Lifetime prevalence, psychiatric comorbidity and demographic correlates of “hikikomori” in a community population in Japan. Psychiatry Res 176(1):69–74

    Article  PubMed  Google Scholar 

  15. Kano R, Kondo N (2000) Seinen no Hikikomori (Adolescent Social Withdrawal) (in Japanese). Iwasaki gakuzyutsu shuppansha, Tokyo

    Google Scholar 

  16. Kondo N, Iwazaki H, Kobayashi M, Miyazawa H (2007) Psychiatric background of social withdrawal in adolescence (in Japanese). Seishin Shinkeigaku Zasshi 109(9):834–843

    PubMed  Google Scholar 

  17. Saito K (2010) Hikikomori No Hyouka-Shien Ni Kansuru Gaido-Rain [Guideline of Hikikomori for their evaluations and supports]. Ministry of Health, Labour and Welfare (http://www.ncgmkohnodai.go.jp/pdf/jidouseishin/22ncgm_hikikomori.pdf), Tokyo

  18. Trumpf J, Margraf J, Vriends N, Meyer AH, Becker ES (2010) Specific phobia predicts psychopathology in young women. Soc Psychiatry Psychiatr Epidemiol 45(12):1161–1166

    Article  PubMed  Google Scholar 

  19. Nolfe G, Petrella C, Zontini G, Uttieri S (2010) Association between bullying at work and mental disorders: gender differences in the Italian people. Soc Psychiatry Psychiatr Epidemiol 45(11):1037–1041

    Article  PubMed  Google Scholar 

  20. Canino G, Polanczyk G, Bauermeister JJ, Rohde LA, Frick PJ (2010) Does the prevalence of CD and ODD vary across cultures? Soc Psychiatry Psychiatr Epidemiol 45(7):695–704

    Article  PubMed  Google Scholar 

  21. Eichelsheim VI, Buist KL, Dekovic M, Wissink IB, Frijns T, van Lier PA, Koot HM, Meeus WH (2010) Associations among the parent-adolescent relationship, aggression and delinquency in different ethnic groups: a replication across two Dutch samples. Soc Psychiatry Psychiatr Epidemiol 45(3):293–300

    Article  PubMed  Google Scholar 

  22. Coid J, Yang M (2010) Violence and delayed social independence among young adult British men. Soc Psychiatry Psychiatr Epidemiol 45(3):301–308

    Article  PubMed  Google Scholar 

  23. Rydell AM (2010) Family factors and children’s disruptive behaviour: an investigation of links between demographic characteristics, negative life events and symptoms of ODD and ADHD. Soc Psychiatry Psychiatr Epidemiol 45(2):233–244

    Article  PubMed  Google Scholar 

  24. Kitayama O, Saito T, Watanabe T, Muto S (2001) Zadankai Hikikomori Ni Tsuite (Forum Hikikomori)(in Japanese). In: Watanabe T, Muto S (eds) Gendai No Esprit 403-Hikikomori-. Shibundo, Tokyo, pp 5–34

  25. Doi T (1973) The anatomy of dependence. Kodensha International, Tokyo

    Google Scholar 

  26. Kato T (2008) The significance of communicating with neighbors for young psychiatrists. World Cult Psychiatr Res Rev 3(4):219–225. http://www.wcprr.org/pdf/03-04/2008.04.219225.pdf

  27. Niiya Y, Ellsworth PC, Yamaguchi S (2006) Amae in Japan and the United States: an exploration of a “culturally unique” emotion. Emotion 6(2):279–295

    Article  PubMed  Google Scholar 

  28. Malagon A, Alvaro P, Corcoles D, Martin-Lopez LM, Bulbena A (2010) ‘hikikomori’: a new diagnosis or a syndrome associated with a psychiatric diagnosis? Int J Soc Psychiatry 56(5):558–559

    Article  PubMed  Google Scholar 

  29. Kinugasa T (1998) Young Adults and withdrawal (Yangu Adaruto No Hikikomori) (in Japanese). Rinsho Shinkeigaku 27:147–152

    Google Scholar 

  30. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, Hegerl U, Lonnqvist J, Malone K, Marusic A, Mehlum L, Patton G, Phillips M, Rutz W, Rihmer Z, Schmidtke A, Shaffer D, Silverman M, Takahashi Y, Varnik A, Wasserman D, Yip P, Hendin H (2005) Suicide prevention strategies: a systematic review. JAMA 294(16):2064–2074

    Article  PubMed  CAS  Google Scholar 

  31. Hsu LK, Lee S (1993) Is weight phobia always necessary for a diagnosis of anorexia nervosa? Am J Psychiatry 150(10):1466–1471

    PubMed  CAS  Google Scholar 

  32. Pavlova B, Uher R, Dragomirecka E, Papezova H (2010) Trends in hospital admissions for eating disorders in a country undergoing a socio-cultural transition, the Czech Republic 1981–2005. Soc Psychiatry Psychiatr Epidemiol 45(5):541–550

    Article  PubMed  Google Scholar 

  33. Miller MN, Pumariega AJ (2001) Culture and eating disorders: a historical and cross-cultural review. Psychiatry 64(2):93–110

    Article  PubMed  CAS  Google Scholar 

  34. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th edn). American Psychiatric Association, Washington (DC)

  35. Russell JG (1989) Anxiety disorders in Japan: a review of the Japanese literature on shinkeishitsu and taijinkyofusho. Culture Med Psychiatry 13(4):391–403

    Article  CAS  Google Scholar 

  36. Nakamura K, Shioji R (1997) Taijin kyoufushou to hikikomori (in Japanese). Rinshou Seishin Igaku (Clin Psychiatry) 26:1169–1176

    Google Scholar 

  37. Kirmayer LJ (1991) The place of culture in psychiatric nosology: Taijin kyofusho and DSM-III-R. J Nerv Ment Dis 179(1):19–28

    Article  PubMed  CAS  Google Scholar 

  38. Simons RC (1980) The resolution of the Latah paradox. J Nerv Ment Dis 168(4):195–206

    Article  PubMed  CAS  Google Scholar 

  39. Kenny MG (1983) Paradox lost. The latah problem revisited. J Nerv Ment Dis 171(3):159–167

    Google Scholar 

  40. Aboujaoude E (2010) Problematic Internet use: an overview. World Psychiatry 9(2):85–90

    PubMed  Google Scholar 

  41. Young K (2010) Internet addiction over the decade: a personal look back. World Psychiatry 9(2):91

    PubMed  Google Scholar 

  42. Ha JH, Yoo HJ, Cho IH, Chin B, Shin D, Kim JH (2006) Psychiatric comorbidity assessed in Korean children and adolescents who screen positive for Internet addiction. J Clin Psychiatry 67(5):821–826

    Article  PubMed  Google Scholar 

  43. Yen CF, Yen JY, Ko CH (2010) Internet addiction: ongoing research in Asia. World Psychiatry 9(2):97

    PubMed  Google Scholar 

  44. Jeon HJ, Lee JY, Lee YM, Hong JP, Won SH, Cho SJ, Kim JY, Chang SM, Lee D, Lee HW, Cho MJ (2010) Lifetime prevalence and correlates of suicidal ideation, plan, and single and multiple attempts in a Korean nationwide study. J Nerv Ment Dis 198(9):643–646

    Article  PubMed  Google Scholar 

  45. Hagihara A, Miyazaki S, Tarumi K (2010) Internet use and suicide among younger age groups between 1989 and 2008 in Japan. Acta Psychiatr Scand 121(6):485; author reply 485–486

    Google Scholar 

  46. Naito A (2007) Internet suicide in Japan: implications for child and adolescent mental health. Clin Child Psychol Psychiatry 12(4):583–597

    Article  PubMed  Google Scholar 

  47. Ozawa-de Silva C (2008) Too lonely to die alone: internet suicide pacts and existential suffering in Japan. Cult Med Psychiatry 32(4):516–551

    Article  PubMed  Google Scholar 

  48. Kondo N, Sakai M, Ishikawa S, Niimuras J, Tanoue M (2008) Home visits for social withdrawal cases in community mental health and child welfare services (in Japanese). Seishin Shinkeigaku Zasshi 110(7):536–545

    PubMed  Google Scholar 

  49. Kato TA, Tateno M, Umene-Nakano W, Balhara YP, Teo AR, Fujisawa D, Sasaki R, Ishida T, Kanba S (2010) Impact of biopsychosocial factors on psychiatric training in Japan and overseas: are psychiatrists oriented to mind, brain, or sociocultural issues? Psychiatry Clin Neurosci 64(5):520–530

    Article  PubMed  Google Scholar 

  50. Tanaka-Matsumi J (1979) Taijin Kyofusho: diagnostic and cultural issues in Japanese psychiatry. Cult Med Psychiatry 3(3):231–245

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The present study was supported by the World Psychiatric Association (WPA) Research Fund 2010, and a grant from Japan Foundation for Neuroscience and Mental Health (both to T.A.K.). We thank the Japan Young Psychiatrists Organization (JYPO) for promoting our research activity. We are grateful to Drs. Horikawa H, Kuga H, Tanaka M and Barroilhet S for their cooperation.

Conflict of interest

All authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan

    Takahiro A. Kato & Shigenobu Kanba

  2. Innovation Center for Medical Redox Navigation, Kyushu University, Fukuoka, Japan

    Takahiro A. Kato

  3. Department of Neuropsychiatry, Sapporo Medical University, Sapporo, Japan

    Masaru Tateno

  4. School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan

    Naotaka Shinfuku

  5. Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan

    Daisuke Fujisawa

  6. Department of Psychiatry, University of California, San Francisco, CA, USA

    Alan R. Teo

  7. Association for the Improvement of Mental Health Programmes, Geneva, Switzerland

    Norman Sartorius

  8. Department of Psychiatry, NTT Medical Center Tokyo, Tokyo, Japan

    Tsuyoshi Akiyama

  9. Graduate School of Human-Environment Studies, Kyushu University, Fukuoka, Japan

    Tetsuya Ishida

  10. Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, South Korea

    Tae Young Choi

  11. Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Yatan Pal Singh Balhara

  12. Department of Psychiatry and De-addiction, Lady Hardinge Medical College and SSK Hospital, New Delhi, India

    Yatan Pal Singh Balhara

  13. Department of Psychiatry, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Ryohei Matsumoto

  14. Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan

    Wakako Umene-Nakano

  15. Department of Psychiatry, Teikyo University, Tokyo, Japan

    Yota Fujimura

  16. Consultation-Liaison Psychiatry, Canterbury Hospital, Sydney Local Health Network, and Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    Anne Wand

  17. Department of Psychiatry, China Medical University and Hospital, Taichung, Taiwan

    Jane Pei-Chen Chang

  18. Department of Psychiatry, ChiaYi Branch, Taichung General Veterans Hospital, Taichung, Taiwan

    Rita Yuan-Feng Chang

  19. Department of Psychiatry, Sina Hospital, Kamyaran, Iran

    Behrang Shadloo

  20. Department of Psychiatry, Bangabundhu Sheikh Mujib Medical University, Dhaka, Bangladesh

    Helal Uddin Ahmed

  21. Faculty of Medicine, Thammasart University Hospital, Bangkok, Thailand

    Tiraya Lerthattasilp

Authors
  1. Takahiro A. Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masaru Tateno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naotaka Shinfuku
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daisuke Fujisawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alan R. Teo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Norman Sartorius
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tsuyoshi Akiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tetsuya Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tae Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yatan Pal Singh Balhara
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ryohei Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Wakako Umene-Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yota Fujimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Anne Wand
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Jane Pei-Chen Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Rita Yuan-Feng Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Behrang Shadloo
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Helal Uddin Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Tiraya Lerthattasilp
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Shigenobu Kanba
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takahiro A. Kato.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kato, T.A., Tateno, M., Shinfuku, N. et al. Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation. Soc Psychiatry Psychiatr Epidemiol 47, 1061–1075 (2012). https://doi.org/10.1007/s00127-011-0411-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-011-0411-7

Keywords

  • Hikikomori
  • Social withdrawal
  • Taijin kyofusho
  • Amae
  • Internet addiction