A 12-month study of the hikikomori syndrome of social withdrawal: Clinical characterization and different subtypes proposal

• Published in: Psychiatry research Vol. 270; pp. 1039 - 1046
• Main Authors: Malagón-Amor, Ángeles, Martín-López, Luis Miguel, Córcoles, David, González, Anna, Bellsolà, Magda, Teo, Alan R., Pérez, Víctor, Bulbena, Antoni, Bergé, Daniel
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-12-2018
• Subjects: Comorbidity; Differential diagnosis; Home treatment; Long-term treatment; Social isolation; Home treatment; Differential diagnosis; Long-term treatment; Social isolation; Comorbidity
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2018.03.060

•Hikikomori syndrome of social withdrawal is comorbid with several psychiatric disorders in our society.•There are subgroups based on comorbidity, with differences in basal characteristics and evolution.•The anxiety-affective subgroup presents more favorable baseline characteristics, but worse evolution at 12 months.•These subjects present fragility and tendency to relapse and have disengagement, which is particularly relevant in the anxiety-affective subgroup.•Long-term intensive home or hospital treatments are more effective than short outpatient treatments.
Social withdrawal is a new mental health problem increasingly common, present in different cultures, whose psychopathology and treatment is not yet established. This study aims to determine the socio-demographic and clinical features and possible clinical subtypes that predict the 12-month outcomes of cases with hikikomori syndrome, a severe form of social withdrawal. Socio-demographic and clinical data at baseline were analysed as well as data obtained for 12 months after at-home treatment in 190 cases. The inclusion criteria were: spending all time at home, avoiding social situations and relationships, significant deterioration due to social isolation, with a minimum duration of 6 months. Six major diagnostic groups were identified: affective, anxiety, psychotic, drug use, personality and other Axis I disorders. The anxiety-affective subgroup demonstrated lower clinical severity, but worse evolution. Less than half of the cases were available for medical follow-up at 12-months. Subjects undergoing intensive treatment had a higher medical follow-up rate and better social networks at 12-months. Therefore, our findings provide data to reach consensus on the specific characteristics of social isolation hikikomori syndrome. The analysis demonstrated the fragility and tendency to relapse and have disengagement, particularly relevant in the anxiety-affective subgroup, suggesting that intensive treatments are more effective.