Hikikomori syndrome is a psychopathological and sociological disorder in which people who suffer from it voluntarily isolate themselves socially, do not leave the house – and even their room – except for the essential, leaving aside any kind of social commitment, either with their friends, family or even abandoning education and employment. This can have serious consequences for their health, both physical and mental.

Although this term was first coined in Japan two decades ago, and there and in other Asian countries it is quite prevalent (1.9% of the population), in recent years it has been discovered that it is a global phenomenon that affects several Western countries, where more and more cases are being diagnosed, especially after the emergence of the coronavirus.

Hikikomori is a disorder that particularly affects young men, although there are also older people and women. These are young people who voluntarily decide to leave society and isolate themselves at home or in their room to avoid any social contact. Their life usually revolves around new technologies, the Internet, video games… Those affected by this syndrome have nothing to do with those suffering from agoraphobia, as the latter do not reject social relations, but are afraid to go out in the street.

What do people with hikikomori syndrome look like?

Japanese psychiatrist Tamaki Saito, who first referred to the disorder in 1998 in his book “Sakateki hikikomori, an endless adolescence”, tentatively defined it as “those who withdraw completely from society and remain in their own homes for a period longer than 6 months, with an onset in their late 20s and for whom this condition is not best explained by another psychiatric disorder”.

Two decades later, the concept has evolved greatly and is considered somewhat more complex. In fact, most of the cases described last an average of 39 months and cases of up to 30 years’ duration have been described.

The characteristics of these people are also complex, although broadly speaking, people are hikikomori, they are characterized by:

  • They are usually young males.
  • They reject social life, which leads them to stay most of the time at home or in their room.
  • They refuse to go to their work, academic or social activities.
  • hey usually have low self-esteem and a depressive personality.
  • They suffer from insomnia and altered schedules, since they tend to be more active at night.
  • They neglect hygiene, tidiness and eating habits.
  • They escape from reality to a closed or virtual world because in the real world they are afraid of rejection or criticism.
  • They reside in high-income countries.

This disorder also has different degrees and types. Some authors even classify them into pre-hikikomori -going out to school or university, but avoiding any kind of social relationship-, social Hikikomori -refusing work and studies, but maintaining some social relationships, only through the internet; and Tachisukumi-gata, who presents a very marked social phobia and feels paralyzed by fear.

In the long term, this voluntary reclusion can cause significant health problems, both physical and mental, such as anemia, fragile joints, sores… and at the psychological level, depression, insecurity, guilt, etc.

What causes hikikomori syndrome?

Another controversial issue is the causes of this disorder, because what was initially associated with the abuse of new technologies, today we know that its origin is very complex and, rather than causes, there is talk of predisposition. As it started and was much more prevalent in Japan, it was associated with the rigidity and demands of a society such as the Japanese one, which leads to social isolation of those who do not meet expectations. It is also associated with increasingly individualistic and competitive societies, changes in the economic structure, etc. It has also been associated to a series of factors that predispose to suffer it, such as:

  • Having a very shy and withdrawn personality.
  • Having suffered some childhood trauma, such as bullying or having grown up in a dysfunctional family.
  • Having suffered from overprotection by the family, parents having high expectations of their children, academic pressure, etc.
  • Having a mental or psychiatric disorder beforehand, such as psychotic disorders, anxiety or affective disorders.
  • Abuse of new technologies. They are not the reason why people decide to isolate themselves at home, but it makes it easier for those who are predisposed to suffer from this disorder.

How is it treated?

The approach to this disorder is also complex, especially because it is rare for people themselves to ask for help. This, in addition to complicating the treatment, means that it is still a very underdiagnosed disorder. In Japan, for example, which advises more conversational treatments, it is advocated to ‘capture’ these patients through social networks and help them, at first, remotely, while in Europe it is advocated more to ‘push’ them to go out into the street and interact to begin treatment. In this sense, there is, for example, the magazine Hikipos, created by a group of exhikikikomoris. In it, they express their concerns, on the one hand, to make society aware of this problem and, on the other hand, to attract potential hikikomoris and invite them to ask for help.

Once they ask for help, the approach must be multidisciplinary and combine psychological therapies and medication with different approaches:

  • Therapeutic: Patients with hikikomoris will in many cases require medication, and even hospital admissions, something that should be combined with psychotherapy.
  • Social: Group activities and support to help patients gradually reintegrate into society.
  • Educational, to ‘relearn’ their social, work, communication skills, etc.

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