Does the 'hikikomori' syndrome of social withdrawal exist outside Japan? A preliminary international investigation

Takahiro A. Kato, Masaru Tateno, Naotaka Shinfuku, Daisuke Fujisawa, Alan R. Teo, Norman Sartorius, Tsuyoshi Akiyama, Tetsuya Ishida, Tae Young Choi, Yatan Pal Singh Balhara, Ryohei Matsumoto, Umene Nakano Wakako, Yota Fujimura, Anne Wand, Jane Pei Chen Chang, Rita Yuan Feng Chang, Behrang Shadloo, Helal Uddin Ahmed, Tiraya Lerthattasilp, Shigenobu Kanba

Research output: Contribution to journalArticlepeer-review

150 Citations (Scopus)


Purpose: To explore whether the 'hikikomori' syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated. Methods: Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome's prevalence in their country, etiology, diagnosis, suicide risk, and treatment. Results: Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents' felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization. Conclusions: Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.

Original languageEnglish
Pages (from-to)1061-1075
Number of pages15
JournalSocial Psychiatry and Psychiatric Epidemiology
Issue number7
Publication statusPublished - Jul 2012

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Social Psychology
  • Health(social science)
  • Psychiatry and Mental health


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