Hikikomori: New definition helps identify, treat extreme social isolation

Health Care
Hikikomori
Hikikomori
A woman looking out a window, standing alone.
Hikikomori is a form of pathological social withdrawal or isolation whose essential feature is physical isolation in one’s home. Authors of a new article propose additional identifiers for the condition. (Getty Images)

Experts in the Japanese phenomena of hikikomori say the condition of extreme social isolation is more widespread than previously acknowledged, and it deserves a clear and consistent definition to improve treatment across the globe.

In an article published in the February issue of the journal World Psychiatry, experts cite a lack of broad clinical understanding of the condition.

Although hikikomori is typically associated with young adults in Japan, the researchers say many of the same criteria of extended social isolation apply to people around the world, including among older adults and stay-at-home parents. A simplified and clear definition will improve the recognition and subsequent treatment for people who suffer from the condition, the authors write.

The article highlights four key aspects of the newly proposed definition of hikikomori:

an asian woman sitting in a hallway alone, on the floor, leaning against a door as she looks at a mobile phone
“With advances in digital and communications technologies that provide alternatives to in-person social interaction, hikikomori may become an increasingly relevant concern,” write the authors of the new article on social isolation. (Getty Images)

Social isolation as a health issue

Alan Teo, M.D., M.S.
Alan Teo, M.D., M.S.

Senior author Alan Teo, M.D., associate professor of psychiatry in the Oregon Health & Science University School of Medicine and a researcher and psychiatrist in the VA Portland Health Care System, said the medical profession hasn’t traditionally recognized social isolation as a health issue.

“There is a cultural issue within the house of medicine whereby we don’t pay attention to it and don’t think it is in our lane to deal with,” he said. “These are shared problems, whether it’s an 80-year-old Portlander who’s a meals-on-wheels recipient living by herself or an 18-year-old with hikikomori in Japan.”

Ironically, modern tools to improve communication may be having the opposite effect.

“With advances in digital and communications technologies that provide alternatives to in-person social interaction, hikikomori may become an increasingly relevant concern,” the authors write.

Spending time online can be damaging when it substitutes for interacting with people face to face, Teo said. Those person-to-person social relationships are a critical aspect of mental health.

“Your social life is critical to your quality of life – yet in health care, we often forget to think about that,” Teo said. “A person’s day-to-day social life is really what brings them meaning and value.”

In addition to Teo, authors included Takahiro A. Kato, M.D., Ph.D., and Shigenobu Kanba, M.D., Ph.D., of Kyushu University in Japan.

The recommendations published online today in World Psychiatry represent an outgrowth of an earlier collaboration between the three authors, including a perspective published in the journal Psychiatry and Clinical Neurosciences in 2019.

Teo’s work is supported by a Career Development Award (CDA 14-428) from the U.S. Veterans Health Administration Health Service Research and Development and the HSR&D Center to Improve Veteran Involvement in Care. The views expressed in the paper are those of the authors and do not necessarily reflect the position nor policy of the U.S. Department of Veterans Affairs of the U.S. government.

Hikikomori is a form of pathological social withdrawal or social isolation whose essential feature is physical isolation in one’s home. The person must meet the following criteria:


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