In 1998, the Internet was in its infancy but growing fast. So, too was a mental health phenomenon called hikikomori — a name for extreme social withdrawal and isolation — that the rise of the Internet may well have helped feed.
That same year, Tamaki Saito coined the term from the Japanese “hiki,” which means pulling inward or withdrawing, and “komori,” which means being confined or being inside. Saito first applied it to a patient who had socially withdrawn for six months, then popularized the term in his book Social Withdrawal – Adolescence Without End.
Since then, the Internet has taken control of more aspects of our lives. And cases of hikikomori have spread globally — sometimes affecting 1-2 percent of a country’s population. Extreme and long-term social withdrawal, often fueled by the Internet, has now become a globally recognized mental health problem.
As both cases and awareness of hikikomori have risen, so have several crucial questions: How can you identify it? What causes it? How can it be treated? And the most important question: Is hikikomori a unique condition unto itself, or a combination of mental health comorbidities — diseases or conditions that often occur together? How that question is answered has implications for how the condition is diagnosed, treated, and prevented.
The Meaning of Hikikomori
Japan took its first wide look at hikikomori syndrome in 2003. The country’s Ministry of Health, Labor and Welfare defined hikikomori as a state in which someone mainly stays at home, cannot or does not engage in social activities, has isolated for 6 months or longer, has not been diagnosed as psychotic, and has no close friends.
Early studies initially focused on Japan and pointed to social and cultural factors contributing to the condition. They pointed to declining motivation among young adults, an increasing dependence on parents for economic stability, and a loosening of parental discipline.
As more research on hikikomori emerged, so did a more complicated and nuanced take on the condition. Researchers first differentiated between hard core subtypes, who almost never leave their room and rarely talk to family members, and the soft category, who occasionally venture out and have some contact with their families. Scientists have also distinguished between subjects who live alone — about 11 percent — and the rest.
Read More: What Happens When Humans Are Extremely Isolated?
The Global Prevalence of Hikikomori
Other researchers suggested that the hikikomori might not be limited to Japan, or even just Asian countries. Even within Asia, epidemiological research shows a range of prevalence from approximately 0.87 percent to 1.2 percent in Japan, to 1.9 percent in Hong Kong, to 2.3 percent in Korea. However, it can be difficult to compare countries, because diagnosis criteria may vary.
Also, as researchers have taken a closer look at symptoms — both of individual cases and hikikomori sufferers as a whole — they have identified several psychiatric disorders that often co-occur with it. These include psychosis, social anxiety disorder, avoidant personality disorder, depressive disorders, Internet addiction, and post-traumatic stress disorder.
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Carol Berman, a New York psychiatry professor who sees patients in private practice, says that multiple issues might keep hikikomori sufferers isolated.
“You could have a whole bunch of different things as a mental health patient and that could cause you to not want to go outside,” Berman says. “Someone with a bad anxiety disorder could be afraid that if they go outside they’ll get a panic attack.”
Berman says that no two psychiatric patients are alike, so treatment needs to be tailored to the individual. She points to Alice, a long-term patient who has isolated herself on and off for decades. Alice has bipolar disorder, takes her medications, but still has manic episodes. “It’s very complicated,” she says.
For instance, as a psychiatrist, it can still be difficult to find the right drug at the right dose for conditions like anxiety or depression, which may contribute to hikikomori. The trial and error necessary to find effective medication could make the patient lose patience or trust.
Read More: How Loneliness Can Impact a Person's Health and Wellbeing
Medication alone won’t solve the problem. Compliance is key.
“If people forget or refuse to take their medications for depression or anxiety, that could fuel those conditions," Berman says. “And as they isolate further, they might not have anyone to help them or remind them to take their medications. So the isolation can feed upon itself.”
If someone is socially isolated, getting medical help can be different. Video consultations can be a good way to break the ice — but shouldn’t be considered a long-term solution.
“Maybe they have to go out and get to the therapy session,” Berman says.
While Berman doesn’t completely blame technology like social media and online gaming as the sole cause leading people to socially isolate, it is certainly a contributing factor.
“Some young people are just looking at their phones or their computers and they're not really getting out,” she says, adding that technology and social media can also isolate older adults. Home delivery of food, goods, and services can also enable hikikomori.
The COVID-19 pandemic unintentionally showed how easy it can be to socially isolate.
“We all had an excuse to stay inside,” Berman says. That experience may have had unintentional consequences in creating more hikikomori cases. “Let’s say that you're one of these people with panic disorder and all of a sudden you get to stay home and you have an excuse with the COVID, you know, it could stick then.”
While it’s pretty obvious to identify a person who is socially isolating themselves, finding out the reason why can be more difficult. It could be social anxiety, depression, body dysmorphia, addictions, or a combination of those and others. It may be necessary to pick apart issues to help someone. For instance, if addiction is playing a role in isolation, the patient will need treatment for that first.
Read More: What Can the Pandemic Teach Us About Mental Health?
How to Help Someone with Hikikomori Syndrome
As for helping someone with hikikomori, it’s necessary to go step by step.
“Try to get someone with social anxiety to see a psychiatrist. Make sure they take their medication, once it’s been prescribed," says Berman. "If and when they are referred to a psychologist or therapist, make sure they go to their appointments. If they are anxious to go out, see if they can do talk therapy virtually. But make sure you use an accredited individual. Ultimately, it might be a good goal to get the patient to see a therapist in person.”
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Article Sources
Our writers at Discovermagazine.com use peer-reviewed studies and high-quality sources for our articles, and our editors review for scientific accuracy and editorial standards. Review the sources used below for this article:
Lancet. Are Japan's hikikomori and depression in young people spreading abroad?
The Journal of nervous and mental disease. Hikikomori, A Japanese Culture-Bound Syndrome of Social Withdrawal? A Proposal for DSM-V
International Journal of Social Psychiatry. General condition of hikikomori (prolonged social withdrawal) in Japan: Psychiatric diagnosis and outcome in mental health welfare centres
New York psychiatry professor. Carol Berman
Before joining Discover Magazine, Paul spent over 20 years as a science journalist, specializing in U.S. life science policy and global scientific career issues. He began his career in newspapers, but switched to scientific magazines. His work has appeared in publications including Science News, Science, Nature, and Scientific American.
