Original article The phenomenon of “hikikomori” (social withdrawal) and the socio-cultural situation in Japan today Il fenomeno del ritiro sociale “hikikomori” e la situazione socio-culturale in Giappone oggi M. Suwa, K. Suzuki Faculty of Health and Medical Sciences, Aichi Shukutoku University, Graduate School of Medicine, Nagoya University, Nagoya, Japan Summary Results Firstly, a typical case of hikikomori is presented. Secondly, we Objectives identified the psychological features of “primary hikikomori”, In Japan today it is believed that there are a million young adults or hikikomori with no obvious mental disorder, as follows: 1) who refuse to work and who avoid social contact. This phenom- display a tendency to avoid competitive settings; 2) cherish an enon, known as “hikikomori” (social withdrawal), has become “ideal image” based on the expectations of others; 3) are un- a serious socio-psychological problem throughout the country. able to make a fresh start from their current situation; and 4) However, there has been little psychopathological considera- have parents who continue to invest in their child’s ideal im- tion of this phenomenon, and no detailed discussion of diag- age. We assert that “primary hikikomori” is a new manifestation nosis. In this article, we investigate the phenomenon from a of the conflict prevalent among contemporary Japanese youth. psychiatric perspective by introducing the concept of “primary Thirdly, we discuss possible contributing factors to the phenom- hikikomori” and examining its relationship to recent changes in enon from three viewpoints: 1) changes in the socio-cultural Japanese society. constellation; 2) changes in communication; 3) changes in the labour system and examined the implications of such wide- Methods spread change. We reviewed several studies concerning the epidemiology and psychopathology of hikikomori. As psychiatrists, we have Conclusions considerable experience treating hikikomori youth (referred to We believe that it is necessary to consider the possibility that the simply as hikikomori) in individual therapy, group therapy, fam- hikikomori phenomenon, which emerged in Japan in the 1990s, might be the first sign of a larger disturbance within present-day ily therapy and family group therapy sessions. Based on this society in general. Moreover, the pathology of societies giving experience, we present a typical case of “primary hikikomori” rise to this hikikomori phenomenon ought to be examined. and identify its psychological features. We also analyze hikiko- mori from a socio-cultural perspective. The observations made Key words herein are based on this first-hand clinical experience as well as careful consideration of a number of other psychiatric and Hikikomori (social withdrawal) • Primary hikikomori • Psychological sociological reports concerning hikikomori. feature • Japanese culture Introduction they do not even speak with other family members, and shut themselves up in their rooms with day-night reversal, sleep- Hikikomori (social withdrawal) means behaviour in which ado- ing during the day and staying awake all night. Others may lescents and young adults refuse all contact with society and sometimes leave the house for such things as going to the withdraw from all social activities. The word hikikomori de- library or shopping in the neighbourhood. scribes both the phenomenon and the person suffering from it. The hikikomori phenomenon in youth has been a social Since the 1990s, hikikomori among young adults, and oc- problem in Japan for the past two decades. It has also been casionally adults up to their 40s, has been the focus of con- recognized in other countries in recent years, particularly in siderable attention as a new social problem in Japan. It is a Europe. At the same time, there has been no detailed psy- phenomenon in which young adults who have either gradu- chopathological discussion of hikikomori in Japan. We have ated from high school or university, or who have dropped therefore attempted a psychiatric placement of this problem out and not completed their education, do not take up em- by presenting the concept of “primary hikikomori”. ployment but rather cut off contact with society and con- In this article, we firstly review several studies concerning fine their lives mainly to the family home. In some instances hikikomori in Japan. Hikikomori is not a diagnosis, but a Correspondence Mami Suwa, Faculty of Health and Medical Sciences, Aichi Shukutoku University, 9 Katahira, Nagakute-city, Aich-ken, Japan • Tel. +81-561-62- 4111 • Fax +81-561-56-0025 • E-mail: [email protected] Journal of Psychopathology 2013;19:191-198 191 M. Suwa, K. Suzuki condition in which young adults avoid social activities. It may be caused by depression, anxiety disorder or some personality disorders. In an earlier paper 1 we reviewed 82 articles about hikikomori, and will discuss some of them herein. Secondly, we present a typical case of “primary hikikomori”, and outline the psychological features of this condition that we defined in a previous report 2. As psychi- atrists, we have treated hikikomori in individual therapy, group therapy, family therapy and family group therapy. Therefore, our considerations in this paper about the pa- thology of hikikomori are based on these clinical experi- ences. Lastly, we consider possible contributing factors to this phenomenon. We bring together the analyses of three major contemporary Japanese sociologists and the clinical presentation of hikikomori, and consider them from the perspectives of social change in general, change in com- FIGURE 1. munication and change in the labour system. The number of hikikomori studies. Numero delle ricerche su “hikikomori”. The hikikomori phenomenon History of the usage of the word ‘hikikomori’ in Japan pling of citizens from 6 of the 47 prefectures in Japan. Of Before discussing the phenomenon of hikikomori, we the 4,134 people interviewed, 1,660 were aged from 20 shall first explain the changes that have occurred in the to 49 years, and among this group 19 people (1.2%) had usage of the word hikikomori in Japan. Originally, hikiko- experienced hikikomori themselves. Koyama suggested mori was simply a general term referring to a condition in that the number of people within that age group who which people withdrew from relationships with others. It had experienced hikikomori during their lifetime was in was also used as a psychiatric term describing the symp- fact higher because participation in the investigation was tom of withdrawal in autistic, schizophrenic, depressive voluntary. Therefore, based on Koyama’s study in which or aged patients. After 1990, hikikomori among youth re- 1.2% of the sample group had experienced hikikomori, ceived increasing attention from psychiatrists and society we can postulate that in the total population the num- at large, and came to be used mainly for young adults. In ber of hikikomori youth aged from their 20s to 40s years Figure 1, we show the changes from 1986 to 2011 in the might be over 600,000. With respect to diagnosis, Koy- number of papers about hikikomori with other patholo- ama also stated that 45.5% of hikikomori cases had no gies, compared with those specifically about hikikomori lifetime experience of a psychiatric disorder, which we in young adults. It is evident that the number of the latter call primary hikikomori 2. Kondo et al. 6 investigated 183 increased quickly, and among young adults this phenom- subjects who utilized mental health welfare centres and enon became a new area of interest in psychiatry. Some met the definition of hikikomori. Based on DSM-IV-TR psychiatrists have written about the psychopathology of criteria, 49 of these patients (33.3%) were diagnosed with hikikomori, which we discuss further in a later section. schizophrenia, mood disorders or other mental disorders, 47 patients (32%) were diagnosed with developmental Review of studies about hikikomori disabilities, and 51 patients (34.7%) were diagnosed with personality disorders (including personality features not Epidemiological studies reaching the threshold of actual personality disorder). The number of hikikomori adolescents and young adults As for the long-term prognosis of hikikomori, there is lit- in Japan is believed to range from 500,000 up to one mil- tle information since it is a relatively new phenomenon. 3 4 lion . In the first epidemiological study of this phenom- However, of the 183 subjects in the study of Kondo et enon in 2003, the Japanese Ministry of Health, Labour al. 6 28 (15.3%) achieved social participation after 21.7 and Welfare defined hikikomori as a state in which a months of consultation. young person (a) mainly stays at home, (b) cannot or does not engage in social activities such as going to school or Studies on hikikomori and psychiatric personality working, (c) has continued in this state for more than 6 months, (d) has neither a psychotic pathology nor me- disorders dium to lower level mental retardation (IQ < 55~50), Some psychiatrists have reported on the hikikomori phe- and (e) has no close friends. They reported that 6,151 nomenon by discussing the patients’ pathology from the cases had presented at public health centres during the viewpoint of personality disorders or neurotic disorders. previous 12 months. Among these, males outnumbered Kondo 7 reported that schizoid pathology is commonly females, comprising 76.4% of the total. Koyama et al. 5 found among hikikomori cases. Kinugasa 8 indicated that interviewed 4,134 people (55.1%) from a random sam- most hikikomori youth have schizoid personality disor- 192 The phenomenon of “hikikomori” (social withdrawal) and the socio-cultural situation in Japan today der, narcissistic personality disorder or avoidant personal- that NEET do not work or study. However, we regard the ity disorder. Nakamura et al. 9 reported that a new type of phenomenon of NEET as simply a labour-related problem taijin kyofusho*, characterized by avoidant and withdraw- that is not concerned with the individual’s mental tenden- al tendencies, has been increasing.