In the last two decades, reports of a severe form of social withdrawal have been surfacing in Japan. This syndrome called ‘hikikomori” describes a condition in which adolescents and young adults isolate themselves from society, refusing to work or go to school, and shutting themselves in their parents’ home.
DEFINING “HIKIKOMORI”
The medical profession has not reached a consensus definition of the condition; however in Japan specific criteria have been set for a diagnosis of ‘hikikomori”. Those include a state of confinement to a home and a refusal to engage socially for at least six months.
Although epidemiological research (i.e., research on the frequency and distribution of a disease) on “hikikomori’ is scant, the available findings indicate that the age of onset is set around the 20s.
Furthermore attempting to classify this condition within accepted diagnostic categories, researchers found that the majority of patients with “hikikomori” endorsed a diagnosis of an anxiety disorder, a mood disorder, a psychotic disorder or a personality disorder.
It is noteworthy to add that in certain cases of “hikikomori”, the individual’s self-confinement was ego syntonic, which means that they were not disturbed by their condition, nor were they gripped by the fear of acting in a way that would lead to social rejection. These two features of “hikikomori” clearly sets it apart from social anxiety disorder.
A PROXY FOR AN UNDERLYING MENTAL DISORDER
Expanding from those findings, it has been argued that “hikikomori” could actually be a culture-bound syndrome that is specific to Japan. Indeed, it was proposed that the term itself could represent a kinder proxy for an underlying mental disorder, thus serving as a buffer against stigmatization. Accordingly, the popularity of “hikikomori” in Japanese society would be a reflection of their aversion to unnecessary psychiatric labels and their desire to prevent stigmas.
In addition, the condition fits most of the criteria for a culture-bound syndrome as it is for the most part a distinct condition that frequently occurs in Japan and is triggered by cultural factors from that society.
The only criterion that remains debatable is that which concerns the recognition of “hikikomori” as an illness, as government experts from Japan reject the view that it could be a psychiatric diagnosis.
Reference:
Teo AR, Gaw AC. Hikikomori, a Japanese culture-bound syndrome of social withdrawal?: A proposal for DSM-5. J Nerv Ment Dis. 2010 Jun;198(6):444-9. doi: 10.1097/NMD.0b013e3181e086b1. PMID: 20531124; PMCID: PMC4912003