Hikikomori as a possible clinical term in psychiatry: a questionnaire survey

A total of 1,038 subjects were requested to complete a questionnaire regarding hikikomori phenomenon.While some differences in the perception of hikikomori do exist, all subjects tended to disagree with the statement, “hikikomori is NOT a disorder”. Regarding the underlying psychiatric disorders of hikikomori, approximately 30% of psychiatrists chose schizophrenia as the most applicable ICD-10 diagnosis for hikikomori, whereas 50% of pediatricians chose neurotic or stress-related disorders.An argument still exists regarding the relationship between hikikomori and psychiatric disorders. We propose that the term hikikomori could be used to describe severe social withdrawal in the setting of a number of psychiatric disorders.The word hikikomori was recently added to the Oxford Dictionary of English [1] where it joins other words of Japanese origin such as otaku (person with obsessive interests) and karoshi (death from overwork). It is defined as ‘the abnormal avoidance of social contact, typically by adolescent males’. Hikikomori was first introduced to the public when a Japanese psychiatrist, Tamaki Saito, published a book with this word in its title in 1998 [2]. In his book “Social Withdrawal (shakaiteki hikikomori): A Neverending Adolescence”, Saito defined hikikomori provisionally as ‘those who withdraw entirely from society and stay in their own homes for more than six months, with onset by the latter half of their twenties, and for whom other psychiatric disorders do not better explain the primary causes of this condition’. Since then, the word hikikomori has been used widely in Japan and has more recently been reported in the foreign media and discussed in medical journals by psychiatrists from other countries [3-13]. Much of this attention occurred without a thorough discussion of its precise definition [14-17].In May 2010, a research group supported by the Japanese government published guidelines for the assessment and treatment of hikikomori [18]. The guideli