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Hikikomori, is it a culture-reactive or culture-bound syndrome? Nidotherapy and a clinical vignette from Oman

Sultan Qaboos University, Masqaţ, Muḩāfaz̧at Masqaţ, Oman
The International Journal of Psychiatry in Medicine (Impact Factor: 0.81). 02/2005; 35(2):191-8. DOI: 10.2190/7WEQ-216D-TVNH-PQJ1
Source: PubMed

ABSTRACT Hikikomori, a form of acute social withdrawal, is becoming a silent epidemic in Japan. As it has not been reported from other parts of the world, hikikomori fulfills the criteria for "a culture-bound syndrome." We report a case from Oman, in the southern part of Arabia, with all the essential features of hikikomori. We speculate that the social environment of Japanese and Omani society could reinforce behavior akin to hikikomori although this condition may also transcend geography and ethnicity.

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Available from: Samir AlAdawi, Feb 21, 2015
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    • "For those patients who cannot be classified, they propose including hikikomori among the DSM's list of culture-bound syndromes. This project should face a first critique: hikikomori cases have been encountered outside Japan: in South Korea [17] [18], Hong-Kong [19] [20] [21], Australia [17], United States [22] [23], Spain [24] [25] [26], Italia [27] [28], Oman Kingdom [29], and France [30] [31] [32]. Moreover, a wide group of psychiatrists from diverse countries (Australia, Bangladesh, Iran, India, South Korea, Taiwan, Thailand, United States) testify to the presence of hikikomori cases outside of Japan [33]. "
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    ABSTRACT: Hikikomori in Japan is the phenomenon of social withdrawal that effects hundreds of thousands of individuals, in which the individual shuts his/herself in their room, generally at their family's home, for several months or even years without engaging in social relationships. Although the number of articles on this topic is increasing, a thorough review of the literature has yet to be done.
    Neuropsychiatrie de l Enfance et de l Adolescence 04/2015; 198. DOI:10.1016/j.neurenf.2015.03.008
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    • "To cope, they will deny their need for connectedness and disengage from social relationships; consequently , they avoid intimacy, emotional closeness and interdependence in relationships. In the literature, youth social withdrawal behavior is perceived as a form of avoidance strategy for avoidant individuals to cope with nonresponsive attachment figures and attachment traumas (Sakamoto et al., 2005), and they therefore avoid social contacts (Kato et al., 2012), social situations (Tateno et al., 2012) and even crowds, trains and public places (Hattori, 2006). Avoidant attachment is also often associated with the problems of self-inflation and being overly competitive (Mikulincer and Shaver, 2013). "
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    ABSTRACT: Objective: Acute and/or severe social withdrawal behavior among youth was seen as a culture-bound psychiatric syndrome in Japan, but more youth social withdrawal cases in different countries have been discovered recently. However, due to the lack of a formal definition and diagnostic tool for youth social withdrawal, cross-cultural observational and intervention studies are limited. We aimed to consolidate existing knowledge in order to understand youth social withdrawal from diverse perspectives and suggest different interventions for different trajectories of youth social withdrawal.
    Australian and New Zealand Journal of Psychiatry 04/2015; 49(7). DOI:10.1177/0004867415581179 · 3.77 Impact Factor
    • "Nonetheless, cross-national studies designed to identify hikikomori have been lacking. Reasons for the lack of recognition have included ambiguity about the features of hikikomori (Tateno et al., 2012; Watts, 2002), and inconsistent or insufficiently detailed definitions of hikikomori (Furuhashi et al., 2011; Garcia-Campayo et al., 2007; Sakamoto et al., 2005). This has caused concern that researchers may not be referring to the same phenomenon. "
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    ABSTRACT: Background: Hikikomori, a form of social withdrawal first reported in Japan, may exist globally but cross-national studies of cases of hikikomori are lacking. Aims: To identify individuals with hikikomori in multiple countries and describe features of the condition. Method: Participants were recruited from sites in India, Japan, Korea and the United States. Hikikomori was defined as a 6-month or longer period of spending almost all time at home and avoiding social situations and social relationships, associated with significant distress/impairment. Additional measures included the University of California, Los Angeles (UCLA) Loneliness Scale, Lubben Social Network Scale (LSNS-6), Sheehan Disability Scale (SDS) and modified Cornell Treatment Preferences Index. Results: A total of 36 participants with hikikomori were identified, with cases detected in all four countries. These individuals had high levels of loneliness (UCLA Loneliness Scale M = 55.4, SD = 10.5), limited social networks (LSNS-6 M = 9.7, SD = 5.5) and moderate functional impairment (SDS M = 16.5, SD = 7.9). Of them 28 (78%) desired treatment for their social withdrawal, with a significantly higher preference for psychotherapy over pharmacotherapy, in-person over telepsychiatry treatment and mental health specialists over primary care providers. Across countries, participants with hikikomori had similar generally treatment preferences and psychosocial features. Conclusion: Hikikomori exists cross-nationally and can be assessed with a standardized assessment tool. Individuals with hikikomori have substantial psychosocial impairment and disability, and some may desire treatment.
    International Journal of Social Psychiatry 05/2014; 61(1). DOI:10.1177/0020764014535758 · 1.15 Impact Factor
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