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The Hikikomori syndrome: voluntary social isolation

The phenomenon of voluntary social isolation emerged in the 1990s in Japan, in response to the heavy psychological pressures of Japanese society and resulting in an increase of Japanese boys locked away in voluntary withdrawal.

This social isolation syndrome has been termed Hikikomori syndrome, a Japanese term for 'staying away' (from hiku 'to pull' and komoru 'to withdraw'). Hikikomori was first defined by psychiatrist T. Saito who, in his book Hikikomori: Adolescence Without End, explains the meaning of the term Hikikomori:

"those who withdraw completely from society and remain in their homes for more than six months, with onset in their late twenties, and for whom other psychiatric disorders do not better explain the primary causes of this condition."

What is a Hikikomori? Or rather, who are Hikikomori? What does it mean to be Hikikomori? What are the characteristics of Hikikomori syndrome? Why does one become Hikikomori?

There are many questions regarding this phenomenon of voluntary social isolation, especially in relation to the psychological reasons why children do not leave home and the possible cure for Hikikomori.

In this article, we will try to shed some light on the phenomenon by unravelling the causes of Hikikomori syndrome, its symptoms and consequences, with a look also at Italian Hikikomori. Finally, we will try to understand how to help a Hikikomori and what are the intervention strategies to overcome Hikikomori syndrome.

Hikikomori: from Japanese syndrome to global problem

As we have mentioned, the translation of the term Hikikomori indicates those 'people affected by a syndrome that causes them to lock themselves in their rooms and never come out'. The definition of Hikikomori began to emerge in Japan in the 1980s and 1990s.

In 2010, research was published that found 1.2% of the Japanese population to be Hikikomori. Six years later, the estimate was "about 541,000 in the 15-39 age group."

The same year, the Japanese Ministry of Health, Labour and Welfare published guidelines on the Hikikomori syndrome. The document, which mainly emphasised how to recognise a Hikikomori and possible treatments, underlined the diagnostic criteria of the social isolation syndrome identified by the Japanese government:

  • home-centred lifestyle

  • no interest or willingness to attend school or work

  • persistence of symptoms beyond six months.

Initially, the Hikikomori syndrome was thought to be limited exclusively to the geographical area of Japan, as if it were a kind of 'culturally related syndrome'. Interesting in this regard is the article Hikikomori: cultural internalising syndrome or voluntary withdrawal.

Thanks to increased attention to this phenomenon, it was found to be a difficulty shared by all economically developed civilisations in the Western world.

Who are Hikikomori children

A Hikikomori is a person who experiences voluntary social isolation to escape all the social dynamics that cause pressure.

What is superficially referred to as the 'disease of those who do not leave home' occurs mainly from the age of 14 onwards, although it easily tends to become chronic and, for this reason, there are also cases of adult Hikikomori.

Various studies also show that boys are more likely to shut themselves in and 'isolate themselves from the world' than girls, with a ratio of up to 4:1.

Possible causes of Hikikomori syndrome

As we have seen, Hikikomori and adolescence is the main combination that characterises the phenomenon of voluntary social isolation. But what is the cause of Hikikomori distress?

Hikikomori syndrome has a number of causes that we can, for simplicity's sake, divide into three categories:

  • individual

  • family

  • social.

With regard to individual aspects, hikikomoris seem to be people with a marked introversion, who in social relationships may experience shame and fear of not feeling up to standard, conditions that may be among the causes of low self-esteem.

Family factors that stand out among the causes of voluntary withdrawal are varied. In adolescence, the conflictual relationship with parents may be frequent but, in the case of a Hikikomori, the causes may be related to, for example

  • the type of attachment (in most cases it is ambivalent insecure attachment)

  • familiarity with mental disorders

  • dysfunctional family dynamics, such as poor communication or a lack of empathy on the part of parents towards their child

  • family mistreatment or abuse.

In addition to the difficulties arising from these elements, there are those caused by the social context, including:

  • economic changes

  • increased collective loneliness caused by the massive spread of social media and digital life (which, in turn, can cause internet addiction in adolescence)

  • traumatic experiences caused by bullying at school (Hikikomori syndrome is often linked to situations of school discomfort).

What are the alarm bells for Hikikomori episodes? How to recognise the symptoms?

What do Hikikomori do and what are the symptoms of social withdrawal? Hikikomoris may shut themselves in out of fear, their withdrawal is voluntary and they are determined not to want to see anyone.

Although Hikikomori may experience anxiety attacks and feel lonely because they avoid any social relationships, they may also be prone to anger attacks and violent behaviour.

This isolating oneself from everyone, not wanting to leave the house (and sometimes not even one's own room) is often accompanied by apathy, refusal to attend school, and internet addiction, as emphasised by research conducted by a team of Japanese scholars in which they point out that:

"As social media applications are becoming more popular, users are more closely connected to the Internet and their time spent with others in the real world continues to decrease. Males often isolate themselves from the social community to engage in online gaming while females use the Internet to avoid being excluded from their online communications."

The consequences of voluntary social isolation

The consequences of Hikikomori can greatly affect the life of the adolescent who is experiencing social marginalisation through self-exclusion.

Not wanting to leave home can result in:

  • reversal of the sleep-wake rhythm and sleep disturbances

  • depression

  • social phobia or other anxiety disorders

  • the development of pathological dependence, such as social network addiction.

Internet addiction and social isolation are closely linked, because digital platforms are used by the Hikikomori as their only contact with the outside world, but also simply to pass the time.

It must be remembered, however, that Internet addiction is a pathology in its own right and not all people who suffer from it then become Hikikomori.

The pathology of Hikikomori: the differential diagnosis

In psychology, the Hikikomori syndrome is still studied and has some doubts about its classification. From the review conducted by psychiatrist A. R. Teo, who has analysed numerous studies on the subject, some interesting elements emerge, such as the differential diagnosis for voluntary isolation syndrome:

"The main characteristic of hikikomori is social withdrawal or isolation. This, in itself, obviously has a wide differential diagnosis: psychotic illness such as schizophrenia; anxiety disorders such as post-traumatic stress disorder or social anxiety disorder; major depressive disorder or other mood disorders; and personality disorders, such as schizoid personality disorder or avoidant personality disorder, are among the many considerations."

Social withdrawal and Covid-19: what relationship?

The social anxiety caused by lockdown has caused numerous consequences on people's psychological well-being and, in some cases, may have fostered depression and social isolation.

But, the isolation we experienced in order to stem the spread of the coronavirus and the symptoms of Hikikomori present a difference that should not be forgotten: that between forced isolation, due to force majeure, and isolation that is desired, sought after, and maintained.

Those who have found themselves locked in because of lockdown have often experienced covid anxiety along with an admittedly unpleasant sense of physical loneliness; but the condition of social withdrawal in the Hikikomori is rather that of psychological isolation: not feeling, that is, recognised or accepted by the outside world for who one is.

Hikikomori syndrome and psychological therapy

Hikikomori syndrome does not have a specific classification in the DSM-5. How then is a Hikikomori treated? What are the remedies for social isolation? And how can a Hikikomori be helped?

Psychology comes to the rescue whether it is a first-hand experience (although a Hikikomori rarely turns spontaneously to a therapist) or support is needed for parents and family who often do not know how to deal with a child diagnosed with hikikomori.

Psychologists who are experts in Hikikomori syndrome can work to investigate the causes, assessing the symptoms and analysing the person's behaviour, the social and family context in which he or she lives, and the possible discomforts they may cause.

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