Efficacy of a Multicomponent Intervention with Animal-Assisted Therapy for Socially Withdrawn Youth in Hong Kong

Article (PDF Available)inSociety and Animals · June 2017with 461 Reads
DOI: 10.1163/15685306-12341462
   () -
©   , , | ./-
brill.com/soan
Ecacy of a Multicomponent Intervention with
Animal-Assisted Therapy for Socially Withdrawn
Youths in Hong Kong
Paul W.C. Wong
Department of Social Work and Social Administration, Faculty of Social
Sciences, The University of Hong Kong, Pokfulam
Chinpaulw@hku.hk
Rose W.M. Yu
Department of Social Work and Social Administration, The University of
Hong Kong, Hong Kong, China
Tim M.H. Li
Department of Social Work and Social Administration, The University of
Hong Kong, Hong Kong, China
Steven L.H. Lai
Chinese Evangelical Zion Church Social Service Division, Hong Kong, China
Henry Y.H. Ng
Chinese Evangelical Zion Church Social Service Division, Hong Kong, China
William T.W. Fan
Hong Kong Animal Therapy Foundation Limited, Hong Kong, China
Abstract
This is an evaluation study of a pilot multicomponent program with animal-assisted
therapy () for socially withdrawn youth with or without mental health problems
in Hong Kong. There were fty-six participants. Decreased level of social anxiety, and
increased levels of perceived employability and self-esteem across two withdrawn
groups were observed. When comparing those who did and did not receive the 
component(s), however,  did not seem to have additional impacts on outcomes.
The qualitative data collected through interviews with ten participants reected that
SOAN_advance_Wong.indd 1 5/18/2017 8:26:44 PM
 ./-|  .
   () -
the  component was attractive because the nonhuman animals made them feel
respected and loved. This pilot study showed that a multicomponent program with a
case management model correlated with increased levels of self-esteem and perceived
employability, and a decreased level of social interaction anxiety. In addition, using
nonhuman animals in a social service setting appears to be a good strategy to engage
dicult-to-engage young people.
Keywords
hikikomori – socially withdrawn youth – animal-assisted therapy – multicomponent
program – Hong Kong
Introduction
Young people who seclude themselves at home, do not attend school or work,
and have minimal social contact appear to be an increasingly common in
urbanized and technologically advanced societies (Kato, Shinfuku, Sartorius,
& Kanba, 2011; Kato et al., 2012; Li & Wong, 2015b). In Japan, people with so-
cial withdrawal behaviors are referred to as hikikomori (Kato et al., 2011), and
they are referred to as “socially withdrawn youth” in Korea (Lee, Lee, Choi, &
Choi, 2013), Hong Kong (Wong et al., 2014; Yong, 2010), and other countries (De
Michele, Caredda, Delle Chiaie, Salviati, & Biondi, 2013; Garcia-Campayo, Alda,
Sobradiel, & Abos, 2007; Ovejero, Caro-Canizares, de Leon-Martinez, & Baca-
Garcia, 2014; Newman, 2008; Furuhashi et al., 2013). Two observational studies
that reported data on the epidemiology of social withdrawal estimated that
the prevalence rate of social withdrawal among youth is about 1 to 2% in Japan
(n = 232,000; Koyama, & Kawakami, 2010) and Hong Kong (n = 16,900-41,000;
Wong et al., 2014).
Recently, with the increase in research on hikikomori in Japan, some
researchers proposed that hikikomori can be further divided into primary
hikikomori and secondary hikikomori (Kato et al., 2012; Suwa, Suzuki, Hara,
Watanabe, & Takahashi, 2003). Primary hikikomori refers to social withdraw-
al in youth that is not associated with psychiatric disorders, while secondary
hikikomori refers to social withdrawal in youth that seems to be caused by one
of the currently recognized psychiatric disorders: afective, anxiety, person-
ality, autism-spectrum, social anxiety, psychotic, and developmental disor-
ders (Kondo et al., 2007; Kondo et al., 2013). However, because of the limited
understanding on this issue, the diferentiation between primary and second-
SOAN_advance_Wong.indd 2 5/18/2017 8:26:44 PM
 | ./-
   () -
ary hikikomori, in terms of their intervention and prognosis, is largely unknown
and unexplored (Li & Wong, 2015a).
There is a lack of evidence-based practices for socially withdrawn youth.
According to a narrative review by Chan and Lo (2014), there are many forms
of help and support available for socially withdrawn youth in Japan that range
from job training, online counseling, psychotherapy, and residential care, to
horse therapy; however, many of their ecacies remain untested. As far as
we know, there is only one empirically tested intervention on helping socially
withdrawn youth reported in the English literature (Li & Wong, 2015b).
In Lee et al.’s (2013) study, youth with social withdrawal behaviors in Korea
were visited at home and case-managed by well-trained caseworkers and
assistants. A team visited the home of each withdrawn youth and delivered
ve manual-based, person-centered psychotherapy intervention sessions.
After the home visits, most of the young people utilized treatment centers,
such as attending community mental health centers, visiting psychiatric clin-
ics, participating in camps for socially withdrawn youth, and receiving on-
line counseling. Lee et al. (2013) found that after the intervention, the Global
Assessment Functioning scores and participation in social activities had im-
proved somewhat in 68.3% of the participants. However, their study did not
examine or discuss the diferent impacts of such a program on withdrawn par-
ticipants with or without psychiatric disorders.
Social withdrawal behavior in youth began to attract public attention as
an emerging youth problem in Hong Kong in the 2000s. However, only a few
local studies have been conducted to explore this issue (Ngai & Ngai, 2007;
Wong et al., 2014; Wong, 2009). Wong et al. (2014) telephone-interviewed 1,010
young individuals to examine the prevalence and correlates of socially with-
drawal behaviors in Hong Kong measured by a proposed research diagnos-
tic criteria for hikikomori (Teo & Gaw, 2010). They found that the prevalence
rates of social withdrawal among young people aged 12 to 29 years in Hong
Kong were 1.9%, 2.5%, and 2.6%, respectively, for those who had the prob-
lem for more than six months, less than six months, and those who met the
diagnostic criteria but self-perceived as non-problematic. Youth who with-
drew for more than three months faced a number of risks—for example, bul-
lying and self-injurious behavior, as well as low rates of help-seeking behavior
(Wong et al., 2014).
This paper reports the development and evaluation of a pilot multicompo-
nent intervention for withdrawn youth in Hong Kong. This program adopted
a case management model aimed at addressing a wide range of concerns of
socially withdrawn youth, including self-esteem, social needs, and employ-
ment, in addition to their social withdrawal behaviors through a variety set of
SOAN_advance_Wong.indd 3 5/18/2017 8:26:44 PM
 ./-|  .
   () -
components. Animal-assisted therapy () with dogs and job training were
introduced as core components of the program.
 was introduced for three main reasons: (1) the intrinsic attributes of the
nonhuman animals, in particular dogs, that could create a calming efect that
might help to ease the anxieties of withdrawn youth in individual or group
situations (Katcher & Wilkins, 1993; Kruger & Serpell, 2010); (2) the therapeutic
function of the nonhuman animals that can facilitate cognitive and behavioral
changes that supplement the working relationship between the youth and the
professionals, which can help enhance self-ecacy and facilitate the mastery
of new skills (Adams, 2009; Fine, 2006; Kruger & Serpell, 2010); and (3) pre-
vious research has shown that inpatient settings have a positive impact on
individuals with social withdrawal behaviors due to mental health problems
(Matuszek, 2010). Employment training was included because many of the
withdrawn individuals were unemployed, and it was hypothesized that this
component would assist the participants in their job search.
The present study evaluated the feasibility, ecacy, and also the potential
harm of the “Regain Momentum” () program: a pilot multicomponent pro-
gram that involves dogs. We aimed to answer three major research questions
(): (1) What is the ecacy of the  program in enhancing self-esteem
and perceived employability, as well as reducing social interaction anxiety of
youth who have been withdrawn with and without mental health problems?;
(2) What are the diferences in outcomes of the youths who did and did
not receive the animal-assisted therapeutic component of the program?; and
(3) What are the roles of the nonhuman animals in this innovative program,
the rst multicomponent program with an  component to undergo empiri-
cal testing in Hong Kong?
Materials and Methods
Design
A pre-post evaluation design was adopted to investigate the efectiveness of
the  program. A less rigorous approach was adopted because this was a pilot
study, and inclusion of a comparison group, therefore, was beyond the scope
of this preliminary investigation. Individual and small focus group interviews
were conducted to investigate the perspectives on using non-human animals
in the multicomponent program.
Participant Recruitment
In this program, withdrawn youth were dened as young people who, by self-
report, had been socially withdrawn with or without mental health problems.
SOAN_advance_Wong.indd 4 5/18/2017 8:26:44 PM
 | ./-
   () -
Youth in these two groups who did not exhibit other mental health problems
were considered to be primary hikikomori. Youth who had withdrawal behavior
and exhibited other mental health problems were considered to be secondary
hikikomori, regardless of the duration of their withdrawal state.
Participants were recruited through referrals mainly from non-governmen-
tal organizations, schools, and the hotline inquiry service. Initially, partici-
pants were limited to youth between the ages of 15 and 24 who were suspected
of having been withdrawn for three months or more. However, the program
accepted referrals beyond the age range for ethical reasons due to the limited
services available for socially withdrawn people in Hong Kong.
Participants
A total of 115 youths participated in the  program. Among them, 56 con-
sented to take part in the research study and completed both the pre- and post-
questionnaires. The percentages of male and female study participants were
66.1% and 33.9%, respectively. Around 16% (n = 9) of the participants were
older than 25 years and 7% (n = 4) were younger than 14 years old. Fifty-two
(92.9%) were eligible to participate in the labor force, but 79% were unem-
ployed at intake. About 70% (n = 39) were considered to be primary hikiko-
mori; 22 of these subjects participated in the , and 17 did not. About 30%
(n = 17) were withdrawn individuals with mental health problems, and they
were considered to be secondary hikikomori; 15 of these subjects participated
in the , and 2 did not. Depressive or anxiety disorders (41%, n = 7) and psy-
chosis (23%, n = 4) were the most common disorders among those with mental
health problems.
Intervention
The  Program adopted a multicomponent intervention approach with a
case management model. Components of the intervention included four non-
 components and four  components. The Pet Partners’ (previously
Delta Society) denition of  was used to guide the design of the  com-
ponents, which denes “animal-assisted therapy as a goal oriented, planned,
structured and documented therapeutic intervention directed by health and
human service providers as part of their profession” (Pet Partners, n.d.). The
non- components included (1) a hotline for referrers, parents, and socially
withdrawn youths; (2) referral to further clinical assessment; (3) 3 to 5 face-
to-face, individual counseling sessions with social workers; (4) support groups
led by professionals. The  components included (5)  in the form of indi-
vidual counseling and small group activities with the therapy dog as a support
to the trained social worker; (6)  in the form of social gatherings with dogs
and volunteers from several dog visitation agencies; (7) a pre-employment
SOAN_advance_Wong.indd 5 5/18/2017 8:26:44 PM
 ./-|  .
   () -
training program focused on companion animal grooming; and (8) a pre-em-
ployment training program focused on taking care of the therapy dog in the
youth center.
As a case management model was adopted, the mobilization and coordi-
nation of various service components were tailor-made to the participants’
needs. In general, participants in the  program received all the non-
components (1 to 4). They were then invited to receive the  components
(5 to 8) on a voluntary basis. However, not all the participants in the  pro-
gram received the  components due to reasons such as cultural beliefs,
previous negative experiences with nonhuman animals, or potential allergies
to nonhuman animals. The combination of the service components was tailor-
made and formulated in conjunction with the participant to meet their per-
sonal goals.  was carried out by qualied social workers under the close
supervision of a psychiatrist specialist through a monthly case conference to
discuss and review the progress of the cases and to identify psychosocial fac-
tors underlying the social withdrawal behavior.
Nonhuman Animals in the  Component
Dogs were the nonhuman animals used in the program. They served as an ad-
junct to the social workers either in individual or group sessions. The therapy
dog supported the social workers in fullling two major therapeutic tasks:
(1) facilitating personal expression and social interaction; and (2) creating a
safe environment where the human-nonhuman animal relationship could be
reected on as mirroring the interpersonal issues of the participants.
For the individual counseling sessions, an on-site therapy dog was recruited.
The dog was adopted from a dog shelter after being assessed by a qualied dog
trainer who was familiar with  as suitable for the tasks. To ensure that the
on-site therapy dog could adapt to the new environment smoothly, support
from all the team members in the center was secured before the study recruit-
ment began. In addition, a member of staf at the center, who was a social
worker and the team leader of the  program, was designated to take care of
and provide continuous training for the on-site dog to fulll the role as a thera-
py dog. Measures were also taken to protect the health and well-being of both
the therapy dog and individuals who had contact with the dog; for example,
provisions were made for frequent medical check-ups, veterinarian back-up
for the dog during weekends or holidays, and training for all center staf on the
care and management of the dog. Each session involving the on-site therapy
dog lasted no longer than one hour.
Therapy dogs for the group sessions were provided by two local organi-
zations in Hong Kong specialized in registering/training therapy dogs for
SOAN_advance_Wong.indd 6 5/18/2017 8:26:44 PM
 | ./-
   () -
services. Before the commencement of the program, volunteers of the two
organizations were briefed on the special characteristics of the target partici-
pants to ensure that therapy dogs with suitable temperaments were selected.
Around 3 to 5 therapy dogs, accompanied by their guardians, participated in
each group session, which did not last for more than 45 minutes.
Quantitative Measurements
Rosenberg Self-Esteem Scale ()
The  is a widely-used instrument to measure an individual’s sense of self-
worth. It consists of 10 items regarding both positive and negative feelings
about the self. All items are answered using a four-point Likert scale that rang-
es from Strongly Agree to Strongly Disagree with the corresponding statement.
Scores range from 0 to 30, and a higher score indicates higher self-esteem with
the cut-of for high self-esteem being 15; for instance, individuals scoring less
than 15 are considered to have low self-esteem (Rosenberg, 1962).
Interaction Anxiousness Scale ()
The  is a 15-item self-report measure that assesses the dispositional social
anxiety of an individual. The items relate to subjective feelings of anxiety and
are answered on a ve-point Likert scale. The scores ranges from 15 to 75, and
a higher score indicates a higher level of social anxiety. In a sample of over
1,000 students in three U.S. universities, the mean value was 38.9 (Robinson,
Shaver, & Wrightsman, 1991).
Perceived Employability Self-Ecacy Scale ()
The  is a 14-item self-report test designed to measure participants’ be-
liefs about their ability to successfully deal with situations and act in ways that
facilitate their career development (Daniels, D’Andrea, & Gaughen, 1998). A
ve-point Likert scale was used to indicate their perceived capability in ac-
complishing job-related tasks. Scores range from 15 to 75 and a higher score
indicates a participant’s stronger belief in his/her ability to accomplish those
tasks (Daniels et al., 1998).
Qualitative Measurements
The les of ten cases were reviewed, and unstructured individual and small
group interviews were conducted within three months of completing the
 program with participants who had received the  component(s) that
examined the potential harm of using nonhuman animals in the program and
participants’ experiences and perceptions of the assisted nonhuman animal
component of the program.
SOAN_advance_Wong.indd 7 5/18/2017 8:26:44 PM
 ./-|  .
   () -
Statistical Analysis
Cronbach’s alpha coecients were calculated for the three measurements. A
repeated measures analysis of variance () was conducted to compare
the efects of the two intervention groups (no  vs. with ) on , ,
and  in the three withdrawal groups (withdrawn vs. withdrawn and with
mental health problems; between-subjects factor). Following any signicant
interaction efects and main efects, pre- and post-test correlated t-tests were
conducted for each group, and the efect sizes (Cohen’s d) were reported. The
sample was weighted by the sample sizes to address the unbalanced design for
the  analyses and the t-tests. Estimated marginal means in the 
analyses (rather than the actual means) were reported, given the disparity in
sample sizes. All data analyses were conducted using  software.
Results
Reliability of the Measurements
In the pre-test, Cronbach’s alpha coecients were 0.769, 0.859, and 0.929 for
, , and , respectively. In the post-test, Cronbach’s alpha coe-
cients were 0.876, 0.845, and 0.925 for , , and , respectively.
Three-Way  Analyses

The time × withdrawn groups interaction was marginally signicant, Wilk’s
Lambda = .96, [F (1, 71) = 3.36, p = .071], with a small efect size (eta-squared =
.04). Mean  was signicantly greater at post-test (M = 16.4) than at pre-test
(M = 14.5) in the withdrawn group (d = 0.43, p = .005). The change from pre- to
post-test fell short of signicance in the group with mental health problems.
There were no other signicant interaction efects and main efects.

There was a statistically signicant main efect for time, Wilk’s Lambda = .81,
[F (1, 71) = 16.25, p < .001]. Post-test  was signicantly lower (M = 44.3) than
pretest  (M = 47.6, p = .003, d = 1.16). The time × intervention groups inter-
action was statistically signicant, Wilk’s Lambda = .94, [F (1, 71) = 4.48, p =
.038], with a small efect size (eta-squared = .04). Mean  was signicantly
lower at post-test (M = 45.3) than at pre-test (M = 49.1) in the non- group,
d = 1.17, p = .019. The change from pre- to post-test fell short of signicance in
the .
SOAN_advance_Wong.indd 8 5/18/2017 8:26:44 PM
 | ./-
   () -
The time × withdrawn groups interaction was marginally signicant, Wilk’s
Lambda = .95, [F (1, 71) = 3.73, p = .057], with a small efect size (eta-squared =
.04). Mean  was signicantly lower at post-test (M = 44.5) than at pretest
(M = 47.4) in the withdrawn group (d = 1.14, p = .032) and signicantly lower at
posttest (M = 43.7) than at pretest (M = 48.4) in the group with mental health
problems (d = 1.21, p = .017).
The time × intervention groups × withdrawal groups interaction was statisti-
cally signicant, Wilk’s Lambda = .92, [F (1, 71) = 5.96, p = .017], with a moderate
efect size (eta-squared = .06). The signicant triple interaction was probed
by conducting simple main efects tests of the efect of time within each of
the four groups. The change from pre- to post-test was signicant only for the
withdrawn with mental health problems without . For the ones with men-
tal health problems with no , the means of  reduced from pre-test (M =
48.5) to post-test (M = 33.5, d = 1.48, p = .014).

There was a statistically signicant main efect for time, Wilk’s Lambda = .94,
[F (1, 71) = 4.56, p = .038]. Post-test  was signicantly greater (M = 48.6)
than pretest  (M = 44.8, p < .001, d = 0.96). There were no other signicant
interaction efects and main efects.
Self-Reported Qualitative Process Outcomes
Ten respondents who had participated in the  components were inter-
viewed either individually or in small groups of 2 to 3. Examples of the in-
terview questions included “Why did you decide to stay at home in the rst
place?”, “What did the social workers in the organization do to make you in-
terested in the program?”, and “How did you feel about having a therapy dog
in the program?” The interviews were transcribed and a thematic analysis was
conducted.
In general, participants gave positive feedback about the intervention. No
potential harm was recorded in the case les or reported in the interviews.
We identied two major themes: (1) The  component(s) served as a cata-
lyst for program participation. Some participants were attracted by the inclu-
sion of dogs in the program, which aroused their interest to learn more about
it. Among the ten participants interviewed, three participants stated that if
it were not for the inclusion of nonhuman animals, they probably would not
have joined the  program at all. This result was echoed by ndings of the
intake assessment. Respondents were asked in the intake assessment if there
were no  component, would they would join the  program. Around
SOAN_advance_Wong.indd 9 5/18/2017 8:26:44 PM
  ./-|  .
   () -
one fourth (23.2%) of the respondents stated that they would denitely not or
probably not do so. Further, engagement through the therapy dog was found to
have minimized the negative stigma attached to being “in counseling.
(2) The presence of the therapy dog(s) enhanced the therapeutic environ-
ment. A majority of the interviewees expressed that the most helpful element
in the  project was feeling that the therapy dog(s) accepted them as they
were. One participant who had previously experienced being bullied said he
felt more at ease when interacting with the on-site therapy dog, whom he per-
ceived to be “very straightforward and simple.” Some participants originally
felt that seeing a social worker was threatening and anxiety provoking; but the
presence of the on-site therapy dog was enough to calm them down and pro-
vided a distraction from their anxiety. One participant expressed that she felt
less depressed and that her mood improved with the therapy dog during her
counseling session. The participants also spoke of having a sense of achieve-
ment after the dog grooming training session. Taking care of the on-site ther-
apy dog provided the participants with a high level of satisfaction and a sense
of worth. As one participant described, “If you helped them [the nonhuman
animals], they would show their happiness directly, as if they wanted to say
‘Thank you.’”
Discussion
In this study, we sought to provide empirical data to evaluate the ecacy of a
multicomponent program with  and job training in enhancing self-esteem
and perceived employability, and reducing social anxiety of young people who
were socially withdrawn with and without mental health problems, using an
uncontrolled research methodology. Although this was an uncontrolled study
with a small number of participants, irrespective of whether the participant
had received  as an intervention component, the  program appeared to
have achieved its goals of enhancing self-esteem and perceived employability,
as well as reducing social anxiety for socially withdrawn youth without (pri-
mary hikikomori) and with mental health problems (secondary hikikomori).
The  component did not seem to provide statistically signicant additional
impacts on the outcomes of the program.
Based on the analysis of qualitative ndings from the ten in-depth inter-
views, it seems that the involvement of nonhuman animals (therapy dog,
visiting dogs, dog grooming training) was an important factor in attracting
withdrawn youth to join and remain in the program, helping the partici-
pants to feel comfortable with the intervention setting, and giving them extra
opportunities and responsibilities to look after the on-site therapy dog. Most
SOAN_advance_Wong.indd 10 5/18/2017 8:26:45 PM
 | ./-
   () -
importantly, adverse harmful efects were not observed in the participants
who completed the program, although we acknowledge that most likely, those
who felt uncomfortable with nonhuman animals had already refused to par-
ticipate in the  component at the very beginning. Also, post-intervention
data showed that the percentage of those unemployed at intake dropped from
85% to 33%, indicating that the job training component was helpful and that
the participants were able to step out from their withdrawn status and re-enter
the society.
This study was one of the very rst programs developed for socially with-
drawn youth being evaluated in places with such youth issues, and the inclu-
sion of nonhuman animals in social services was novel in Hong Kong. At this
stage, it is premature to conclude that such multicomponent programs with
 are efective in helping socially withdrawn youth in terms of their with-
drawn status. Participation in the  component(s) was self-selected, and on
a voluntary basis, probably driven by previous positive experience in keeping
companion animals and a more positive attitude toward dogs. This might limit
the generalizability of the results to those who are less comfortable with non-
human animals. Future evaluation studies should focus on the content and
designs of the programs to determine the correlational or causal efects of the
improvements of outcomes with specic program components.
Conclusion
In sum, the  program has provided an alternative model for providing social
services for withdrawn youth who are usually dicult to identify, engage, and
retain for services. There were correlations between the program as a whole
with post-intervention improvement in self-esteem, reduction in social anxi-
ety level, and increased perceived employability of the participants. The 
program is distinctive from other service approaches for withdrawn youth who
tend to be “invisible” in society (Li & Wong, 2015a) and shy away from tradi-
tional service models. We believe that the results drawn from this study are
an important reminder of the real diculties we face in dealing with emerg-
ing problems among youth and that innovation is needed to tackle this new
problem.
Acknowledgements
The “Regain Momentum” Animal-Assisted Therapy () Mentorship Pro-
gram ( Program) was a 2-year pioneer project launched by the Chinese
SOAN_advance_Wong.indd 11 5/18/2017 8:26:45 PM
  ./-|  .
   () -
Evangelical Zion Church in 2010 with funding from the Bank of China Car-
ing - Heart Warming Campaign. We thank all the volunteer nonhuman
animals and guardians of the animals who participated in the program. And
most importantly, we thank all the colleagues from the Chinese Evangelical
Zion Church who made this research possible. In delivering these services, the
 Program also worked in partnership with several agencies: the Richmond
Fellowship of Hong Kong who provided clinical psychology services, the Hong
Kong Animal Therapy Foundation and Fat Fat the therapy dog who provided
 supervision, and the Animal Asia and Mongrel Club who provided nonhu-
man animal visitations.
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    The Japanese term hikikomori means literally 'to be confined'. Social withdrawal can be present in severe psychiatric disorders; however, in Japan, hikikomori is a defined nosologic entity. There have been only a few reported cases in occidental culture. We present a case report of a Spanish man with prolonged social withdrawal lasting for 4 years. This is a case of prolonged social withdrawal not bound to culture, as well as the second case of hikikomori reported in Spain. We propose prolonged social withdrawal disorder as a disorder not linked to culture, in contrast to hikikomori. Further documentation of this disorder is still needed to encompass all cases reported in Japan and around the world.
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    In 1998 the Japanese psychiatrist Tamaki Sait¯o invented the term hikikomori, referring to a condition characterised by a state of social withdrawal and avoidance (education, work, friendships) combined with a persistent isolation and confinement in the own home for at least 6 months, due to various factors. Initially it undoubtedly regarded a disorder related to a specific socio-cultural context, however in the last couple of years some cases of hikikomori behaviour have also been observed in other countries far from Japan, both geographically and culturally. By way of hypothesis this diffusion can probably be attributed to the cultural revolution represented by mass communication in the internet era; in particular, it seems to be closely related to the immediateness and diffusion of web 2.0, i.e. of social networks. Therefore, we report a case of hikikomori behaviour, who was referred to our ward. M. is a 28-year-old man, who has lived the last 10 years in a state of almost complete isolation. He has maintained contacts with the outside world almost exclusively via internet. He started several therapies with psychiatrists and psychologists, without achieving significant results. The case of M. represents, to our knowledge, the first case of hikikomori described in Italy.
  • Article
    Un certain nombre de cas de retrait social majeur chez des adolescents et jeunes adultes, a été constaté ces dernières années en Europe, en particulier en France où les cliniciens et travailleurs socioéducatifs sont de plus en plus confrontés à des tableaux inédits de repli au domicile. Au Japon, le terme Hikikomori est utilisé pour désigner les situations de retrait social extrême. Ce syndrome n’est pourtant pas encore clairement défini, ni totalement compris. Nous présentons une revue du concept de Hikikomori ainsi que des réflexions préliminaires, issues de la première année de nos recherches internationales. Selon les études de cas que nous avons analysées une différence semble apparaître quant aux facteurs déclenchant le retrait et l’abandon des investissements. Une des hypothèses soulevées concerne le rapport à l’idéal : il semble qu’au Japon, le retrait anticipe et évite une chute de l’idéal, alors que ce serait plus suite à des difficultés concrètes que se fait le repli en France. L’objectif de la recherche est, à travers le rapprochement de situations de retrait en France et au Japon, qui seront analysés avec les mêmes outils méthodologiques, d’interroger la notion de Hikikomori en tant que catégorie, et de poser les bases d’une réflexion clinico-socio-anthropologique sur ces phénomènes, dans le cadre d’une recherche pluridisciplinaire. Nous allons effectuer au Japon et en France des enquêtes par questionnaires avec des critères communs pour les cas japonais et français tenant compte des circonstances sociales et culturelles de ces pays.