Prolonged Social Withdrawal Research Articles

The fourth ecology: Hikikomori, depressive hedonia and algorithmic ubiquity

In this article we expand upon the conceptual framework of Félix Guattari’s 1989 essay, The Three Ecologies. Here Guattari examines changes in subjectivity that have come about due to scientific and technological advances which, as he sees it, brought about an “ecological disequilibrium” ([1989]2000, 27) and deteriorated individual and collective modes of being. In response to this Guattari proposes a kind of holistic therapy or ‘ecosophy’ between three ecological registers: “the environment, social relations and human subjectivity” (ibid., 28). Guattari cautions that we not only take note of these macro determinations, but also heed the libidinal impulses of desire – what captures it, what directs it, and what shuts it down. Since the publication of The Three Ecologies, the rise of digital technologies has dramatically influenced the ways in which people think, live and communicate. Technological infrastructures, for instance, are used to spread disinformation at a vast speed and scale, and because social networks are often homophile many people infrequently encounter critical disagreement and debate. The increase in media and digital communications usage has also led to new forms of social inclusion and exclusion, the most exacerbated form of which is probably the phenomenon known as hikikomori – acute, prolonged social withdrawal. Taking hikikomori as our focus, we describe what we see as a general set of symptoms of society and trace its myriad intersections with an ever-increasing algorithmic ubiquity, which we posit as the new form of hyper-modulation following from Foucault’s disciplinary societies and Deleuze’s control societies.

Chaos and confusion in Hikikomori research. Commentary on "The suitability of outing frequency as a definition of hikikomori (prolonged social withdrawal)".

GENERAL COMMENTARY article Front. Psychiatry, 17 May 2023Sec. Psychopathology Volume 14 - 2023 | https://doi.org/10.3389/fpsyt.2023.1199359

Hikikomori: A Scientometric Review of 20 Years of Research

The Japanese term hikikomori was first used to describe prolonged social withdrawal in the 1990s. Since then, research across the world have reported similar prolonged social withdrawal in many countries outside Japan. This study systematically analyses the evolution of literature on hikikomori in the past 20 years to gain a better understanding of the development of the knowledge base on hikikomori since it garnered attention in Japan. Findings from the scientometric review indicate many perspectives on the etiology of hikikomori including cultural, attachment, family systems and sociological approaches. However, similarities with modern type depression, a novel psychiatric syndrome, have been proposed and there are signs of a recent paradigm shift of hikikomori as a society-bound syndrome rather than a cultural-bound syndrome unique to Japan. As research into hikikomori continues to grow, results from the review also highlight the need for a more universally shared definition of hikikomori in order to better consolidate cross-cultural research for meaningful and valid cross-cultural comparisons which can help to promote evidence-based therapeutic interventions for hikikomori.

The suitability of outing frequency as a definition of hikikomori (prolonged social withdrawal).

Data included 397 self-rated online samples, 72 self-rated offline samples, and 784 parent-rated samples. Quantitative and qualitative indicators of outings and subjective social functioning impairment were used in the analysis. The cut-off points supported the criteria for the number of days outside the home proposed in previous studies. The results revealed that the outing frequency condition excluded about 14.5-20.6% of those previously considered to have hikikomori. Logistic regression analysis showed that low outings with interpersonal interaction, low frequency of outings, and high subjective social functioning impairment consistently predicted hikikomori. However, outings without interpersonal interaction did not predict hikikomori. These results indicate that outing frequency tends to be suitable as one of the conditions for hikikomori. However, they indicate that we should also focus on the quality of outings, that is, outings with or without interpersonal interaction, to evaluate hikikomori consistently with previous findings. Further research is needed to clarify the appropriate frequency of outings to define hikikomori and determine its severity.

Prolonged Social Withdrawal During Adolescence: Transdiagnostic Syndrome or a New Psychiatric Entity?

The Japanese term Hikikomori is used to describe a clinical condition in which young people present a prolonged social withdrawal and isolation. Hikikomori syndrome represents an emergent worldwide phenomenon but is still poorly reported and often misdiagnosed. This study investigates and describes an Italian hikikomori adolescent group. Socio-demographic and psychopathological profiles and the relationship between hikikomori and psychopathological conditions were analyzed. No gender difference, a medium-high intellectual level, and no correlation with socioeconomic status were highlighted among the clinical group. The relationship between social withdrawal and social anxiety was significant while no correlation was found with depressive symptoms. The presence of Hikikomori syndrome was also significant in Italian adolescents, suggesting that hikikomori is not a culture-bound syndrome related to the Japanese cultural context, but rather a syndrome occurring in the upper-medium class.

Symptoms of Prolonged Social Withdrawal, Problematic Internet Use, and Psychotic-Like Experiences in Emerging Adulthood: A Moderation Model.

Prolonged social withdrawal (PSW) or hikikomori and problematic internet use (PIU) have attracted the attention of mental health experts worldwide. The scientific literature suggests a complex relationship between these conditions and psychotic-like experiences (PLEs) or disorders. In the present cross-sectional study, we tested the role of PIU symptoms as a moderator of the relationship between symptoms of PSW and PLEs in a sample of 238 Italian emerging adults. Data was collected using the 25-item Hikikomori Questionnaire, the Internet Disorder Scale, the Brief Prodromal Questionnaire, and the Brief Symptom Inventory. In addition, lifetime psychological disorders and drug and alcohol use during the last month were explored. No participant reported a lifetime episode of schizophrenia or other psychotic disorder. Symptoms of PSW and PIU were significantly associated with PLEs total distress and PLEs total number of symptoms endorsed, after adjustment for age and symptoms of depression and anxiety. Further, PIU symptoms moderated the relationship between symptoms of PSW and PLEs total distress (b= 2.745, s.e.= 1.089, p= 0.012). However, PIU symptoms did not moderate the relationship between PSW and PLEs total symptoms (b= 0.615, s.e.= 0.349, p= 0.078). This study is limited because the participants were most likely university students and because of the cross-sectional design. Findings from this study partially support the role of high symptoms of PIU as a risk factor in the relationship between symptoms of PSW and PLEs. Future longitudinal research is needed to confirm our findings examining the temporal relationship between PSW, PIU, and PLEs using both dimensional and categorical approaches.

Bullying Victimization and Quality of Life among Chinese Adolescents: An Integrative Analysis of Internet Addiction and Social Withdrawal

Bullying victimization has been proven to be a direct predictor of adolescents' quality of life, whereas elaborate mechanisms remain inconclusive. This study aims to explore the mediating pathway of Internet addiction and social withdrawal on the relationship between bullying victimization and quality of life among Chinese adolescents. This study used the cross-sectional data collected by self-reported questionnaires, including multidimensional peer-victimization scale, youth quality of life instrument-short form, prolonged social withdrawal questionnaire, and compulsive Internet use scale. A total of 1278 participants from four junior middle schools and two high schools participated in the questionnaire survey. SPSS 25.0 and Amos 25.0 were adopted to analyze the data. The results indicated that bullying victimization was directly and indirectly associated with adolescents' quality of life. Internet addiction and social withdrawal partially mediated the relationship between bullying victimization and quality of life among adolescents. The current study demonstrated the underlying pathway of how bullying victimization affected adolescents' quality of life, which could provide an intervention perspective for governments and social workers to improve adolescents' quality of life by controlling Internet addiction and social withdrawal.

Reengaging Youth with Prolonged Social Withdrawal Behaviours in Hong Kong: Efficacy of an Intervention Programme Involving Human and Non-human Partners

This study examined the efficacy of a multicomponent intervention program for reengaging youth with prolonged social withdrawal behaviors (YPSW) in Hong Kong. Highlighting the involvement of more approachable others encompassing human and non-human partners, the intervention program included case work, group work, and transitional support activities for re-connecting YPSW to community. It turned out that 125 participants, counting as 75% of all participants, who were not in education or employment before enrolling into the program, have managed to find a full-time (i.e. 28.8% of all participants) or part-time (11.2%) job, or resume schooling (35.2%) after going through the program. Significant pre-post changes were identified in terms of reduced socially withdrawn behaviors and social interaction anxiousness, and enhanced self-esteem and perceived self-employability. The paper discussed the implications for informing multi-component intervention work and research study for reengaging YPSWs accordingly.

Hikikomori: A Society-Bound Syndrome of Severe Social Withdrawal.

Hikikomori, a severe and often prolonged social withdrawal observed primarily in young people, was first described in Japan, but cases have now been reported in many other countries. A review paper on hikikomori has been prepared following the literature searches in 3 databases. Search terms related to hikikomori included epidemiology, globalization, diagnosis, treatment, comorbidity, and COVID-19. Hikikomori was first reported in Japan and has been described in detail by researchers there, but there are now reports in many countries of hikikomori-like cases. It occurs primarily in young people, often men in their late teens and early twenties who isolate themselves, sometimes confining themselves to their homes for months or even years. It has been proposed that hikikomori has increased in recent years in part because of advances in information technology that result in decreased socialization. Hikikomori was originally considered a non-psychotic phenomenon, but comorbidity with psychiatric disorders is often present and should be considered during diagnosis. Considerable efforts have been made in recent years to establish reliable, widely applicable guidelines for the diagnosis and treatment of hikikomori. There is very little information with regard to neurobiology, although involvement of the immune system, oxidative stress, and the social brain network has been proposed. It is widely agreed that hikikomori must be treated in a multi-dimensional fashion, with family support very important. Lessons learned from these treatment approaches are relevant to the potential increased risk of social withdrawal arising from COVID-19 pandemic lockdowns.

Who are hikikomori? Demographic and clinical features of hikikomori (prolonged social withdrawal): A systematic review.

This review, which was registered with PROSPERO (CRD42021237988), aimed to systematically extract common elements in the hikikomori definition or criteria applied by researchers and examine cultural differences and chronological changes in the demographic characteristics of hikikomori individuals such as age, gender and hikikomori duration. For inclusion in the review, the hikikomori criteria, age and gender of the hikikomori individuals had to be specified, and the article had to be peer-reviewed and written in Japanese or English, focusing on hikikomori individuals or their families. Case studies, reviews and qualitative studies were excluded. The total sample size for the 52 studies included in the review was 4744. Over 80% of the studies included the elements 'not working or attending school', 'not socializing outside one's home' and 'duration of hikikomori' in their hikikomori criteria, and many studies included the element 'staying at home on most days except solitary outings'. A cross-temporal meta-analysis showed the possibility that the age of hikikomori individuals increased chronologically (β = 0.44, B = 0.50, 95% confidence interval = [0.16, 0.84]). Comparisons weighted by sample size between Japan and other countries showed the possibility that the age of hikikomori individuals was higher (d = 0.32), the percentage of males was lower (d = 0.91) and the hikikomori duration was shorter (d = 2.06) in studies conducted in countries other than Japan. However, many of the included studies had a high risk of selection bias, and this bias may have influenced the results obtained. Thus, the results of this study may represent the researcher's perception of hikikomori rather than accurately representing the actual condition of hikikomori. Researchers should specifically identify similarities and differences in the clinical picture of hikikomori and compare the studies to organize the findings derived from studies focusing on hikikomori.

Psychological Factors Associated with Social Withdrawal (Hikikomori).

ObjectiveCases of prolonged social withdrawal (hikikomori) have recently been reported in several countries. This study examined the impact of cognitive-behavioral and emotional factors on hikikomori behavior to identify intervention targets. Identifying such targets could facilitate the development of techniques to address hikikomori characteristics. MethodsTwo hundred Japanese individuals (mean age=38.73, SD=6.85) completed the Adaptive Behaviors Scale for Hikikomori and Stress Response Scale-18, along with the Japanese versions of the Self-Compassion Scale (Short Form), Acceptance and Action Questionnaire-II, and Brief Coping Orientation to Problems Experienced Inventory. Participants were divided into two groups: individuals with no experience of social withdrawal, and those with experience of social withdrawal. Results Hierarchical multiple regression analysis showed that the use of instrumental support, behavioral disengagement stress coping skills, self-compassion, and psychological stress were associated with hikikomori behaviors. Furthermore, higher instrumental support levels, associated with a decrease in hikikomori behaviors, were found in the hikikomori group. Conclusion The use of instrumental support, behavioral disengagement stress coping skills, self-compassion, and psychological stress should be targeted in hikikomori prevention interventions. Moreover, encouragement for the use of instrumental support is needed for improving hikikomori.

A correlational study of socioeconomic factors and the prevalence of hikikomori in Japan from 2010 to 2019

BackgroundAlthough several surveys have suggested that socioeconomic factors function as background variables for the incidence of hikikomori (prolonged social withdrawal), no research has directly examined whether socioeconomic indicators increase the incidence of hikikomori. This study aimed to examine the relationship between socioeconomic factors and the incidence of hikikomori using data from eight cross-sectional studies conducted by our group between 2010 and 2019. MethodsWe used socio-economic data from national surveys and collected the demographic data of members of a multi-branch Japanese association for family members of hikikomori patients for the period of 2010–2019. ResultsThe results of the partial correlation analysis showed that the incidence probability of hikikomori increased in tandem with unemployment rates and household income. Further, the associations were positively strong in the 2010–2015 research period; however, they were absent, weak, or medium in the 2016–2019 research period. ConclusionsThe findings suggest that socioeconomic factors relate to the increase in hikikomori, and that these factors should be considered when identifying the individual or cultural factors that cause hikikomori.

Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours

Self-harm and suicidal behaviour are recognised as public health concerns. Prolonged social withdrawal behaviour, or hikikomori, is reported as a risk factor for suicidal behaviour. To examine the occurrence and additional risk of prolonged social withdrawal behaviour on self-harm and suicidal behaviour among Chinese university students. A cross-sectional online survey was conducted with three universities in southern China. A two-stage random sampling was adopted for recruitment, with students in different years of study, in different departments of each participating university. Hierarchical logistic regression analyses were conducted to investigate the sociodemographic and psychological correlates of self-harm and suicidal behaviours among male and female participants with hikikomori status. Of the students who completed the online survey, 1735 (72.23%) were included in the analysis; 11.5% (n = 200) reported self-harm behaviour and 11.8% (n = 204) reported suicidal behaviours in the past 12 months. Men showed a higher prevalence rate of self-harm than women (14.7% v. 10.8%, P = 0.048), but a similar rate of suicidal behaviours (11.9% v. 11.3%, P = 0.78). The overall prevalence rate of social withdrawal behaviour was 3.2% (7.0% for men and 2.3% for women, P < 0.001). Prolonged social withdrawal behaviour status was significantly associated with self-harm (odds ratio 2.00, 95% CI 1.22-3.29) and suicidal behaviour (odds ratio 2.35, 95% CI 1.45-3.81). However, the associations became statistically insignificant after adjustment for psychological factors in the final models in the logistic regression analyses. Prolonged social withdrawal behaviour appears to be associated with self-harm and suicidal behaviour, but psychological factors have stronger links with suicidality.

Impacto do isolamento social ocasionado pela pandemia COVID- 19 sobre a saúde mental da população em geral: Uma revisão integrativa

Objetivo: investigar o impacto da pandemia causada pela COVID-19 sobre a saúde mental da população em geral. Método: trata-se de uma revisão integrativa da literatura, realizada através da busca nas bases de dados PubMed, Web of Science, PsycINFO, Scopus, BVS e Scielo, utilizando os descritores "SARS-CoV-2"; "COVID-19"; "Coronavirus"; "Mental health"; "Population". Foram identificados 1538 artigos, dos quais 16 foram incluídos neste estudo, sendo considerados elegíveis artigos originais e publicados em periódicos nacionais e internacionais, com data de publicação em 2020, disponíveis em língua portuguesa, inglesa e espanhola. Resultados: As evidências encontradas na literatura demonstram que indivíduos em isolamento social estão mais suscetíveis ao estresse e como consequência a esta privação social, tem apresentado principalmente transtornos de ansiedade, transtornos depressivos e a alteração na qualidade do sono. Foram observados também sentimentos de raiva, confusão e sintomas de estresse pós-traumático, que podem estar associados ao período de afastamento social prolongado, ao medo da contaminação, à frustração, à falta de suprimentos básicos, às informações insuficientes e a problemas financeiros. Conclusão: o enfrentamento da COVID-19 gerou uma mudança no modo de viver da sociedade, sendo necessário preparar os serviços em saúde para esta demanda, para que haja acolhimento e suporte psicológico e social da população geral, direcionando a atenção aos fatores, que desencadeiam o sofrimento psíquico, amparando os indivíduos neste período e nos pós- pandemia.

The scope and nature of prolonged social withdrawal in Israel: An initial quantitative and qualitative investigation.

Objective:Over the past few decades, prolonged social withdrawal (PSW) among young people has been recognized in several countries. Most research has been quantitative and focused on the characteristics of PSW individuals and their families. Little attention has been given to the valuable perspective of professionals providing service to this population. The purpose of the present study is to identify the characteristics of PSW in Israel, where this phenomenon has not been researched yet. For this initial investigation, the study will utilize a combination of quantitative self-report data from parents of PSW individuals, as well as qualitative data gathered from interviews with mental health professionals who work with this population.Methods:Quantitative data were derived from records of referrals by parents of 121 PSW individuals, and later categorized into apparent characteristics of PSW. Qualitative data was collected through semi-structured interviews conducted with 19 professionals experienced in treating PSW, and later analyzed in a thematic analysis process.Results:Findings from the quantitative data revealed a majority of males (70%) with an average age of 24.2, with previously diagnosed psychiatric conditions (64%). Findings from the qualitative data exposed frequently reported characteristics of PSW individuals and their families, out of which five themes emerged: Family Dynamics, Psychological Characteristics, Typical Behaviors, Past Difficulties, and Present Challenges.Conclusion:This study is the first to identify and report characteristics of PSW in Israel, which are consistent with previous research reported in other countries. The study is highlighting familial characteristics as well as individual ones, while also considering the broader socio-cultural context. These findings draw attention to the importance of notifying the general public, clinicians, researchers, and policymakers in Israel and beyond to the concerning problem of PSW, while contributing to the efforts to develop a map of this barely explored territory.

The psychometric properties of a self- report scale on assessing social interaction of people with prolonged social withdrawal (HIKIKOMORI)

This study assessed the social interaction behaviors of individuals with prolonged social withdrawal (HIKIKOMORI), subsequently developing a 26-item self-reported scale called the Adaptive Behaviors Scale for Hikikomori Self Report version (ABS-H-SR). The psychometric properties of the scale were confirmed using the item response theory. Confirmatory factor analysis (CFA) and item response theory (IRT) analysis were conducted using data from participants classified into three groups: the HIKIKOMORI group (n = 72), those who previously experienced it (previous group; n = 175), and the control group (n = 849). The reliability was assessed using the test-retest method and Cronbach’s alpha. The results suggest a reliable scale with acceptable criterion-related, convergent, and discriminant validity. This study suggests that the ABS-H-SR adequately assessed the social interaction behaviors of individuals with prolonged social withdrawal (HIKIKOMORI). Further research may clarify the extent to which the ABS-H-SR is sensitive to changes in the characteristics of prolonged social withdrawal (HIKIKOMORI).

International experience of hikikomori (prolonged social withdrawal) and its relevance to psychiatric research.

When prolonged social withdrawal was first described in Japan as 'hikikomori', many studies examining its etiology suggested it to be related to factors unique to Japan and thus a culture-bound syndrome. However, existing research has suffered from a lack of standardised definitions, impeding comparability between studies. We summarise existing research and discuss its relevance to psychiatric practice today.

Behavioral Repertoire of Families for Coping with Individuals with Hikikomori (Prolonged Social Withdrawal) in Japan1

AbstractThis study aimed to examine the characteristics of families’ behavioral repertoires in hikikomori (prolonged social withdrawal) cases. We asked 243 parents of individuals with hikikomori (hikikomori group) to complete the Family Behavioral Repertoire Scale for Coping With Hikikomori (FBS‐H), the Negative Evaluation of Hikikomori Scale, and a self‐efficacy measure of coping with problem behaviors of hikikomori in order to develop the FBS‐H and to examine its reliability and validity. Additionally, we examined the characteristics of hikikomori cases regarding the families’ behavioral repertoires using data from the hikikomori group and from 458 parents of individuals with no experience of hikikomori (control group). The results of the analysis indicated the acceptable reliability and validity of the FBS‐H. The hikikomori group did not have lower FBS‐H scores than the control group. This result indicates the possibility that a family's behavioral repertoire does not strongly influence the “expression” of hikikomori. Further research is needed to clarify the influence of families’ behavioral repertoires to refine family support.

Hikikomori Is Most Associated With Interpersonal Relationships, Followed by Suicide Risks: A Secondary Analysis of a National Cross-Sectional Study.

There have been few population studies of hikikomori (that is, prolonged social withdrawal and isolation), and the basic correlating factors of hikikomori are yet to be identified. Therefore, this study aimed to identify the associated basic characteristics and psychiatric factors of hikikomori. Data were obtained from the Survey of Young People’s Attitudes of 5,000 residents (aged 15–39 years) who were randomly selected from 200 urban and suburban municipalities in Japan in February 2010. The chi-square test and multiple logistic regression were used in the analysis. The data contained 3,262 participants (response rate: 65.4%); 47.7% were men (n = 1,555) and 52.3% were women (n = 1,707). Its prevalence was 1.8% (n = 58), and 41% had been in the hikikomori state for more than 3 years. There were fewer hikikomori people in neighborhoods filled with business and service industries. Significantly more men were in the hikikomori group (65.5%) than in the non-hikikomori group (47.3%). The hikikomori group was more likely to drop out of education (p < .001) and to have a psychiatric treatment history compared with non-hikikomori (37.9% vs 5%, p < .001). The multiple logistic regression analyses revealed that interpersonal relationships were significantly associated with hikikomori across three models (Model 1 adjusting for all basic characteristics, OR = 2.30, 95% CI = 1.92–2.76; Model 2 further adjusting for mental health-related factors, OR = 2.1, 95% CI = 1.64–2.68; Model 3 further adjusting for a previous psychiatric treatment history, OR = 1.95, 95% CI = 1.52–2.51). Additionally, the hikikomori group was more likely to have suicide risk factors (Model 1: OR = 1.85, 95% CI = 1.56–2.20; Model 2: OR = 1.33, 95% CI = 1.05–1.67), obsessive–compulsive behaviors (Model 1: OR = 1.57, 95% CI = 1.20–2.05), and addictive behaviors (Model 1: OR = 1.93, 95% CI = 1.37–2.70). This is the first study to show that hikikomori is associated with interpersonal relationships, followed by suicide risks. Hikikomori people are more likely to be male, have a history of dropping out from education, and have a previous psychiatric treatment history.

Assessing adaptive behaviors of individuals with hikikomori (prolonged social withdrawal): development and psychometric evaluation of the parent-report scale

It is important to appropriately assess the adaptive behaviors of individuals with hikikomori (IWH) using parent reports. However, currently, there is no gold standard in the assessment of adaptive...