Magazine article Clinical Psychiatry News

Fink! Still at Large: 'Hikikomori' Syndrome and Social Withdrawal. (Opinion)

Magazine article Clinical Psychiatry News

Fink! Still at Large: 'Hikikomori' Syndrome and Social Withdrawal. (Opinion)

Article excerpt

Japan, a country that prizes communal commitment over individualism, is grappling with a troubling antisocial phenomenon: hikikomori, or "withdrawal." Increasing numbers of young adults, mostly young men, are shunning work and social contact--literally shutting themselves in their rooms for months and even years at a time.

Hikikomori's origins are as elusive as its estimated 1 million victims, although experts assert that most who retreat show no signs of psychiatric problems.

Discussion Question: Is there an unrecognized American equivalent of Japan's hikikomori phenomenon? What psychiatric and nonpsychiatric factors--from parenting styles to social expectations--can spur extreme social withdrawal among young adults? What strategies can clinicians use to find and reach those who have created their own social, mental, and emotional "islands"?

Support and Outreach

In America, individuals with this kind of problem would have an avoidant, schizoid personality type or a social anxiety disorder, with biologic factors likely.

Why this is happening now deserves more research. Could the phenomenon be like the probe autism, where the disease may be just diagnosed more often than before, or is there an actual increase in the disorder? I wonder if the Japanese mental health community has attempted to identify these individuals and to identify the reason for the upsurge.

Support and outreach are the most significant ways to identify and reach those who have withdrawn. TV and radio information could help, but family and friends may be the best route to those who do not wish to be found.

Peter Robbins, M.D.

Fairfax, Va.

Silicon Valley Similarities?

The most likely parallel here would be the increasing number of cases of Asperger's and high-functioning autism. The number of offspring with autism has tripled in Silicon Valley over the last 10-15 years. The parents were the "nerds" in school who never dated or were very shy and often obsessed with things that seemed inappropriate for their age. When computers came of age these bright individuals became obsessed with them and started earning money, marrying, and producing more children with the disorder.

The disorders usually are associated with some form of serotonin dysfunction. The use of SSRIs seems to improve the willingness to socialize. Medications like methylphenidate and Tenex sometimes are added to the regimen. Therapy can help these children understand their condition and find a niche in society.

I wonder if Asperger's and high-functioning autism have increased in Japan as well because of the emphasis put on technology post war in order to rebuild.

Deborah Simkin, M.D.

Destin, Fla.

Slacker Mentality?

The American equivalent to hikikomori might be slackers--those who don't get a job even when their way to one has been paved by high-achieving parents. However, the slacker mentality usually is to hang out with other slackers. Instead, these young Japanese live in the schizoid range. And if they're not hurting like the avoidant type is, then they are not going to seek care, so we'll have to seek them out.

Alan Paul Sandler, M.D.

Encino, Calif.

Dr. Fink: The question of Japan's hikikomori syndrome and any counterpart among Americans is an important one. There is no analogue that closely resembles it that I know of, but there are both historical and current accounts of teenagers imitating the behavior of other teenagers, which can be disastrous.

In Japan there is a long history of cultural reaction to failure in university entrance exams. …

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