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: 0.89). 02/2005; 35(2):191-8. DOI: 10.2190/7WEQ-216D-TVNH-PQJ1
Source: PubMed


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.

    • "Social scientists studied hikikomori phenomenon in Japan (Ogino, 2004; Kaneko, 2006; Borovoy, 2008; Furlong, 2008; Miller and Toivonen, 2010) and outside of Japan, by psychiatrists and psychologists in Spain, South-Korea, Australia, Hong-Kong, Italy, France, United-States and Canada 3 (Garcia-Campayo et al, 2007; Gariup et al, 2008; Kim et al, 2008; Wong, 2009; Malagon, 2010; Teo, 2010, 2012; Krieg and Dickie, 2011; Guedj-Bourdiau, 2011; Sagliocco et al, 2011; Chong and Chan, 2012; Lee et al, 2013). Moreover, collaborative investigations of international research teams including Japanese and non-Japanese psychiatrists and psychologists where conducted including those of Japanese and Omanese researchers (Sakamoto et al, 2005), Japanese and French researchers (Furuhashi et al, 2013), and an international investigation involving North-American and Asian psychiatrists (Kato et al, 2012). Hikikomori has been defined by two American psychiatrists as a culture-bound syndrome that could possibly fit the DSM-5 (Teo and Gaw, 2010), whereas investigations conducted by Japanese psychiatrists discovered that the cases that might be considered as 'culture-bound syndrome hikikomori' had the prevalence of 1/337 among the withdrawn population (Kondo et al, 2011). "
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    ABSTRACT: The aim of this research is to transmit and comment on the authentic voices of socially withdrawn subjects and to contribute toward refining subjective inquiry in contemporary Japan. Here, I detail the cases of four individuals visiting Japanese Non Profit Organizations between August 2011 and August 2012. In accordance with my findings, I define socially withdrawn individuals as post-modern social renouncers. Hikikomori should not be reduced to a mental disorder but should be seen as an idiom of distress and a modality where one can recognize him/herself as a subject, or a mode of enjoyment. I suggest ways of improving qualitative methodology and directions for future research at the intersection of cultural history, anthropology, and subjectivity theory.
    Subjectivity 09/2015; 8(3):283-304. DOI:10.1057/sub.2015.11
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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: Background: 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. Objective: The purpose of this article is to provide a review of psychiatrists' studies on social withdrawal ( hikikomori), bring out the main themes and recurrent problems, and suggest a focus for future research. Methods: I reviewed the literature and identified 53 studies - books, guidelines and articles from 1978 to 2014 - investigating social withdrawal in Japan and outside Japan. I collected articles available from Japanese and international databases such as CiNii, JAIRO, JSTAGE, Web of Science, PubMed, and Scopus. I also summarize and analyze selected psychiatrists' investigations. Results: The results are broken down into four sections: first, an introduction to idioms of social withdrawal in Japan; second, an investigation into the insistence of hikikomori as a culture-bound syndrome; third, a description of the competition of two categories for inclusion in the DSM-5 - ". hikikomori" and ". taijin kyōfushō" fourth, an analysis of the use of typification by psychiatrists, especially when it involves inventing fictive cases of hikikomori. Conclusions: The results are coherent with the non-inclusion of hikikomori in the DSM-5, and a specific clinical description of hikikomori cannot be found in the existing scientific literature. Hence, the review suggests that hikikomori is not a syndrome, with a precise and specific clinical description, but an idiom of distress. The persons concerned resist psychiatric treatment for several reasons, the major one being that psychiatrists only meet with a minority of hikikomori cases.
    Neuropsychiatrie de l Enfance et de l Adolescence 04/2015; 198(5). 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 · 3.41 Impact Factor
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