Bibliografia a sostegno dell'articolo - 3
Hikikomori in Spain: A descriptive study
1. 1Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain 2. 2Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain 3. 3Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain
1. Ángeles Malagón-Amor, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Passeig Marítim 25, 08003 Barcelona, Spain.
Background: Social withdrawal behaviour is a major health problem that is becoming increasingly important, being necessary studies that investigate its psychopathology and existence in different cultures.
Aims: To describe the clinical and socio-demographic characteristics of hikikomoriindividuals in Spain.
Method: Participants were 200 subjects referred to the Crisis Resolution Home Treatment (CRHT) because of social isolation. The definition of hikikomori was the state of avoiding social engagement with generally persistent withdrawal into one’s residence for at least 6 months. Socio-demographic and clinical data were analysed, including Severity of Psychiatric Illness (SPI), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI) and World Health Organization Disability Assessment (WHODAS) scales.
Results: A total of 164 cases were evaluated. Hikikomori were predominantly young male, with the mean age at onset of hikikomori of 40 years old and a mean socially withdrawn period of 3 years. Only three people had no symptoms suggestive of mental disorder. Psychotic and anxiety were the most common comorbid disorders. The scales administered describe the presence of serious symptoms and impairment in social functioning, with a high prevalence of poor collaboration with treatment.
Conclusion: This study shows the existence of hikikomori in Spain. Its difficult detection and treatment highlights the need for specialized domiciliary teams. The high comorbidity leads us to conclude that it may not be a new diagnosis, but rather a severe syndrome associated with multiple mental illnesses. Primary hikikomori also exist, but less commonly. Future cross-national studies are needed in order to describe its definition and psychopathology.
Social isolation associated with depression: A case report of hikikomori
1. Alan R Teo
1. Department of Psychiatry, University of Michigan, USA
1. Alan R Teo, University of Michigan, R. W. J. Clinical Scholars Program, 6312 Medical Science Building I, 1150 W. Medical Center Drive, Ann Arbor, MI 48109-0604, USA. Email:
Background: Social isolation is associated with significant morbidity and mortality. A severe form of social isolation or social withdrawal, called hikikomori in Japan, has been described, but controversy over the etiology and universality of the phenomenon remains.
Method: Case report.
Results: Diagnostic assessment by structured clinical interview and psychometric tools revealed hikikomori and underlying bipolar disorder, in which the patient’s social withdrawal occurred exclusively during major depressive episodes. The patient declined pharmacotherapy, but his hikikomori and depression went into remission after 25 sessions of cognitive behavioural therapy targeting his social isolation.
Conclusions: This is the first reported case of hikikomori in the Americas. It illustrates the association between hikikomori and a mood disorder, and suggests the importance of international study of the prevalence and potential treatment strategies for severe social isolation.