Understanding and Assessing Hikikomori: Introducing the Hikikomori Diagnostic Evaluation (HiDE)

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Our interconnected social ties play a pivotal role in shaping our daily lives and influencing our mental health and overall well-being. While social connections often bring meaning and positive emotions, there exists a phenomenon called hikikomori, where social ties take a distressing turn.

Emerging as a topic of study in psychiatry since the 1990s, hikikomori is characterized by prolonged physical isolation, coupled with significant functional impairment or distress lasting at least six months. Comorbidities with various psychiatric disorders, including autism spectrum disorder and major depressive disorder, have been identified in global studies.

Contributions to Hikikomori Research

Having engaged in hikikomori research and clinical care for over 25 years, our group has played a vital role in fostering popular interest and scholarly study of this condition across diverse cultures. In 2020, we introduced an updated definition of hikikomori to standardize its interpretation.

Notably, hikikomori has been included in the DSM-5-TR under “Culture and Psychiatric Diagnosis,” acknowledging its first description in Japan. Despite these advancements, we propose the need for a transcultural diagnostic tool. In response, we introduce the Hikikomori Diagnostic Evaluation (HiDE) to aid clinicians and researchers in understanding and assessing individuals for hikikomori.

The Need for a Specialized Tool

While structured diagnostic interviews in psychiatry are not uncommon, there is a glaring omission of social withdrawal assessment in existing tools like the SCID-5, CIDI, and MINI. The absence of reliable and standardized tools hampers the progress of hikikomori research.

Additionally, the use of self-report measures like the Hikikomori Questionnaire (HQ-25) for self-diagnosis may lead to inaccurate conclusions. HiDE bridges this gap by offering a clinician-administered tool that requires 5 to 20 minutes to complete.

Components of the Hikikomori Diagnostic Evaluation (HiDE)

The HiDE was initially developed for research and has been refined over two years through application in our academic medical center clinic in Japan. The tool’s first section focuses on essential features for diagnosing hikikomori, assessing the frequency of outings, chronicity of social withdrawal, and associated distress and functional impairment.

Notably, concern expressed by others is incorporated as evidence of distress or functional impairment. The second section gathers supplemental details to provide context to social withdrawal, exploring social participation, work and school involvement, personal activities, medical care attendance, and the nature of social interactions.

Implementation and Screening

To enhance feasibility, we developed a screening form that, if positive, indicates the need for a complete HiDE administration. Individuals spending one hour or less outside their homes at least three days a week and expressing personal or observed distress trigger a full HiDE assessment. Patients with a positive screen may also complete the HQ-25 to provide additional information on the severity of hikikomori symptoms.

Call to Action

While the HiDE has proven valuable in our clinical practice, we emphasize the necessity for further empirical study to establish its validity, reliability, and broader implications. We urge global colleagues to assess its implementation in diverse settings, considering factors like feasibility, acceptability, appropriateness, and clinical utility. A collective effort in this direction will propel hikikomori into the mainstream of psychiatric diagnostic assessment, ultimately improving our understanding and treatment of this complex phenomenon.


In deep….

Hikikomori Syndrome, a term originating from Japan, has emerged as a multifaceted and intriguing phenomenon in the realm of psychiatry and social sciences. This chapter delves into the intricacies of Hikikomori Syndrome, exploring its historical context, diagnostic criteria, prevalence, associated comorbidities, cultural implications, and potential interventions.

Historical Evolution

The roots of Hikikomori Syndrome trace back to the late 20th century in Japan, where a growing number of individuals began exhibiting extreme social withdrawal behaviors. The term “hikikomori” itself translates to “pulling inward” or “being confined.” Initially considered a predominantly Japanese phenomenon, it has since transcended cultural boundaries, garnering attention globally.

Diagnostic Criteria

Hikikomori Syndrome is characterized by prolonged social withdrawal, typically manifesting as individuals confining themselves to their homes for an extended period, often lasting six months or more. Central to the diagnosis is significant functional impairment or distress linked to this isolation. The isolation goes beyond mere introversion, marking a severe disruption in an individual’s daily life and societal participation. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition – Text Revision (DSM-5-TR) includes Hikikomori in the section on “Culture and Psychiatric Diagnosis,” acknowledging its significance in mental health assessments.

Prevalence

While initially observed in Japan, studies have illuminated the global prevalence of Hikikomori Syndrome. The World Health Organization (WHO) estimates suggest that millions of individuals across different cultures and societies may be grappling with this form of social withdrawal. The prevalence varies among countries, influenced by cultural, societal, and economic factors.

Comorbidities

Hikikomori rarely exists in isolation, often accompanied by a spectrum of psychiatric comorbidities. Research indicates connections between Hikikomori Syndrome and conditions such as autism spectrum disorder, major depressive disorder, social anxiety disorder, and obsessive-compulsive disorder. The interplay of these conditions further complicates the diagnostic landscape, emphasizing the need for a nuanced and comprehensive approach to understanding and treating Hikikomori Syndrome.

Cultural Implications

The cultural context in which Hikikomori Syndrome arises is crucial for a comprehensive understanding. Cultural factors, societal expectations, and economic pressures contribute to the development and perpetuation of Hikikomori behaviors. The concept of societal conformity, prevalent in many East Asian cultures, may amplify the distress experienced by individuals who deviate from social norms.

Introducing the Hikikomori Diagnostic Evaluation (HiDE)

Recognizing the need for a standardized diagnostic tool, researchers and clinicians have introduced the Hikikomori Diagnostic Evaluation (HiDE). This structured interview, designed to be administered by clinicians, addresses the core features of Hikikomori Syndrome, providing a systematic approach to assessment. The HiDE considers the frequency of outings, chronicity of social withdrawal, and the associated distress and functional impairment.

Interventions and Treatment Approaches

Developing effective interventions for Hikikomori Syndrome requires a multidimensional understanding of its causes and consequences. While there is no one-size-fits-all approach, therapeutic strategies may include cognitive-behavioral therapy, family-based interventions, and gradual exposure to social situations. Community support and reintegration programs also play a crucial role in facilitating the recovery of individuals affected by Hikikomori Syndrome.


reference link : https://onlinelibrary.wiley.com/doi/10.1002/wps.21123

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