|Tamaki Saitō, a Japanese psychologist who specializes in puberty and adolescence, believes hikikomori was already evident among a large proportion of teens and young adults in Japan by the late 20th century / Photo by: Francesco Jodice via Wikimedia Commons|
Japan is keeping a close eye on people's extreme desire to be alone, a condition known as hikikomori. Tamaki Saitō, a Japanese psychologist who specializes in puberty and adolescence, believes hikikomori was already evident among a large proportion of teens and young adults in Japan by the late 20th century.
However, the severe withdrawal from the outside world, common among young adults, is more widespread than previously believed—prompting experts to provide a clear and consistent definition to improve treatment.
A paper recently published in the journal World Psychiatry proposes a new definition for hikikomori, one that has more consistent international diagnostic criteria for the growing phenomenon.
The proposed definition aims to provide a clearer understanding of what hikikomori to better identify if a person has this condition. A simplified and clearer definition also seeks to improve subsequent treatment, the authors said.
"There is a cultural issue within the house of medicine whereby we don't pay attention to [extreme social withdrawal] and don't think it is in our lane to deal with," Alan Teo, one of the authors from the Oregon Health & Science University School of Medicine, said in a statement.
Teo noted that spending time online may result in negative implications for face-to-face interactions with other people, which are crucial for mental health.
"Your social life is critical to your quality of life—yet in health care, we often forget to think about that. A person's day-to-day social life is really what brings them meaning and value."
In the paper, Teo and his co-authors highlight four key aspects that would identify hikikomori:
• Staying at home: The proposed definition provides the frequency of time spent outside the home. People who occasionally leave their homes (two to three days/week) are characterized as having mild social isolation. Those who rarely do so (one day a week or less) are considered moderate while people who rarely leave their rooms have a severe form of hikikomori.
The authors noted that people ho leave their home four or more days a week don't meet the criteria for the condition. People with a duration of at least three (but no more than six) months of social isolation are classified as pre-hikikomori.
• Avoiding people: The new definition removes the avoidance of being in social situations and relationships. This decision is because the findings, based on interviews assessing people for hikikomori, report having few meaningful social relationships and little social interaction.
However, these people denied that they avoided these situations. It's this lack of avoidance that makes hikikomori different from a social anxiety disorder.
• Improved evaluation of distress: Many people with hikikomori said they are content in their social withdrawal, especially during the early stages of the condition. Clinical interviews report patients feeling a "sense of relief at being able to escape from the painful realities of life outside the boundaries of their home," Psychology Today says.
However, it noted that the prolonged duration of social withdrawal led hikikomori patients to start feeling distressed or lonely.
• Other disorders: The authors removed other mental health conditions like depression as an exclusion for diagnosing patients with hikikomori. They believe that the frequency of these co-occurring conditions increases the need to address extreme social withdrawal as a health issue.
There are very few population studies that look into a hikikomori, and a lot less aimed to identify the social and health characteristics associated with the condition.
One of which, published last year in the journal Frontiers in Psychiatry, found that hikikomori symptoms may also have other psychiatric symptoms (e.g. suicide risk, addictive tendencies) due to interpersonal difficulties and a possibly a previous history of psychiatric treatment.
Hikikomori in Japan
Last year, the Japanese government released the first survey on hikikomori. It found that older people are more likely to fall into the category than the younger population.
The Cabinet Office survey showed that about 613,000 people aged 40 to 64 withdraw themselves from the outside world. In comparison, the same is said for 541,000 people aged 15 to 39. Officials said the total number of people with hikikomori is believed to be over a million, the Japan Times reports.
It adds that most of the recluses were men (76.6%), although most of the respondents (both male and female) began withdrawing after they retired. This explains why there is more social isolation among the older bracket.
The survey also showed that 46.7% of the respondents lived in isolation for at least seven years while 21.3% said are in similar conditions for three to five years. These findings imply a trend in which people are shutting the world out for long periods.
The reasons for their social withdrawal include retirement (36.2%), relationship troubles or illness (21.3%), and feeling like misfits in the workplace (19.1%).
Shut-in children normally depend on their parents for financial support (34.1% of cases). People with hikikomori understand that having this condition is difficult, especially once their primary financial provider is gone.
"I was lucky to have found someone who helped me, but once you become a hikikomori, it is difficult to consult others," a hikikomori patient told Japan Times. "I wish there was a system specially designed to support such people.”
Recognizing Hikikomori as a Health Issue
The medical community has yet to recognize extreme social isolation as a health issue, despite the shifts from being a typical Japanese problem to a condition that may have implications on people's health around the world.
Researchers also find it ironic that modern tools that aim to improve interpersonal communication may be mitigating the opposite effect. They said the advancements in digital and communications technologies, which provide alternatives to personal social interactions, are making hikikomori an "an increasingly relevant concern."
"Your social life is critical to your quality of life – yet in health care, we often forget to think about that," Teo said. "A person’s day-to-day social life is really what brings them meaning and value."
The study in Frontiers in Psychiatry says living in residential areas with many business and service industries may help curb hikikomori among people. However, more studies are needed to verify this finding.
Teo and his co-authors hope that the simplified criteria to diagnose hikikomori help in standardizing evaluation and make way for cross-cultural comparison of the global phenomenon.