Search Results (19)

Objectives: Hikikomori is a condition characterized by extreme social withdrawal, functional impairment, and mental distress, which has gained increasing recognition worldwide. While it can be associated with comorbid psychiatric disorders, hikikomori shares similarities with autism spectrum, prompting investigations into their relationship. Given that hikikomori commonly manifests in early adulthood, this study aimed to explore the relationship between autistic features and hikikomori tendencies among university students. Methods: A total of 2037 university students were recruited via an online survey and assessed with the Adult Autism Subthreshold (AdAS) Spectrum and the Hikikomori Questionnaire (HQ-25). Participants were categorized into four groups: healthy controls (HCs), subjects with hikikomori tendencies (HKs), subjects with significant autistic traits (ATs), and subjects with both significant ATs and hikikomori tendencies (AT-HKs). Results: Results showed significant effects of both hikikomori presence and significant ATs on AdAS Spectrum and HQ-25 scores, while a significant effect of their interaction was detected on AdAS Spectrum scores. The AT-HK group consistently scored higher on both AdAS Spectrum and HQ-25 compared to other groups, with the AT and HK groups outperforming HCs in specific domains. HQ-25 Socialization and Isolation domains predicted higher AdAS Spectrum scores in hikikomori subjects, while various AdAS Spectrum domains served as predictors of HQ-25 scores in AT subjects. Conclusions: This study highlights a significant relationship between ATs and hikikomori tendencies in university students, suggesting that their comorbidity may represent a more severe phenotype, where each condition may exacerbate the other. Full article

Hikikomori is a form of social withdrawal lasting more than 6 months with significant associated functional impairment. To date, numerous studies confirm the presence of this condition not only in Japan, where it was first described, but also globally abroad. This is an underestimated clinical condition, and it is emerging especially in adolescents and young adults, representing an increasing management problem for families and society. Prevalence ranges from 1.1% to 6.7%. Hikikomori can be associated with other neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD). Indeed, ASD and hikikomori share numerous characteristics confirmed by functional neuroimaging studies that have highlighted in both conditions the presence of alterations in cerebral regions related to social functioning. We present a case report regarding the history of a 14-year-old girl with characteristics compatible with ASD and hikikomori. At present, there are no specific treatments approved for hikikomori in ASD patients. Further studies are necessary to understand the link between the two conditions, the boundary, and possible overlap. Full article

Background/Objectives: The COVID-19 pandemic has led to increased mental health issues, particularly among long-COVID patients, who experience persistent symptoms post-recovery, potentially leading to chronic conditions. The psychological impact of long-COVID is still largely unknown, but it may contribute to mental disorders like Post-Traumatic Stress Disorder (PTSD). Given the global rise in anxiety and depression, exploring therapies like Eye Movement Desensitization and Reprocessing (EMDR) for long-COVID traumatic disorders is crucial. This study explores the effectiveness of remote EMDR therapy for PTSD-like symptoms in long-COVID conditions (LCC), assessing their emergence, the impact of LCC on mental health, and identifying key commonalities. It also examines the potential advantages of an artificial intelligence (AI)-powered platform for EMDR treatments for both therapists and patients, evaluating the response differences between remote and in-person treatment. Methods: We enrolled a total of 160 participants divided into two groups of 80, with the experimental group receiving EMDR treatment for PTSD-like symptoms via a remote AI-powered platform, and the control group receiving traditional in-person therapy. We compared the ANOVA for Subjective Units of Disturbance (SUDs) scores, PTSD Checklist for DSM-5 (PCL-5) scores, and Impact of Event Scale-Revised (IES-R) scores between our two groups for three cases: pre-treatment, post-treatment, and decrement. Results: Statistical significance analysis showed a consistent absence of significant differences between online AI-powered platforms and traditional in-presence sessions. This effectively confirms our hypothesis and highlights that no significant differences were observed between the two groups. Conclusions: The AI-supported remote platform demonstrates comparable efficacy in delivering EMDR therapy, confirming its potential as an effective alternative to traditional in-person methods while providing added advantages in accessibility and adaptability (e.g., remote areas, hikikomori, natural disasters). Full article

In the previous literature, specific attention has been paid to investigate autism spectrum symptoms and traits in university students. In this framework, we aimed to evaluate the presence and correlates of autistic traits, hikikomori tendencies, altered eating behaviors, and pathological videogaming in a sample of Italian university students enrolled in bachelor’s degree courses. A total of 1192 students were recruited via an online survey and assessed with the Hikikomori Questionnaire-25, the Adult Autism Subthreshold Spectrum Questionnaire, the Eating Attitude test-26, and the Assessment of Internet and Computer Game Addiction. Our results highlighted significant differences in the prevalence of autistic traits, social withdrawal tendencies, altered eating habits, and pathological videogame use in university students based on gender, age, parents’ level of instruction, and field of study. A significant effect of the presence of autistic traits and gender on the scores obtained with the other questionnaires was reported. Our results not only support the role of autistic traits as a vulnerability factor for the development of a set of psychopathological conditions but also suggest that gender could modulate this vulnerability, supporting the hypothesis of gender-specific phenotypes in the autism spectrum. Full article

Background: Long COVID refers to the persistence or development of signs and symptoms well after the acute phase of COVID-19. Objective of the study: To investigate the long-term outcomes of the SARS-CoV-2 infection in terms of psychological, social, and relational consequences within the Italian population. Materials and methods: We conducted an observational, cross-sectional, and multicenter study using an online questionnaire distributed to a sample of the Italian population. By utilizing the Short Form 12 Health Survey (SF-12) and the Hikikomori scale, we assessed perceived quality of life and social isolation, respectively. The questionnaire also included an open-answer question: “What will you remember about the pandemic period?”. We used generative artificial intelligence to analyze and summarize the corresponding answers. Results: A total of 1097 people participated in this study. A total of 79.3% (n = 870) of participants declared that they had been hospitalized and 62.8% (n = 689) received home care. Physical symptoms included headaches (43%, n = 472) and asthma (30.4%, n = 334). Additionally, 29.2% (n = 320) developed an addiction during the pandemic and, among these, 224 claimed internet addiction while 73 declared an emotional addiction. Furthermore, 51.8% (n = 568) experienced limitations in carrying out daily life activities. According to the Hikikomori scale, participants with positive SARS-CoV-2 infection exhibited higher levels of isolation compared to the others (p < 0.001). Participants without COVID-19 showed higher levels of emotional support (p < 0.001). Our semiautomatic analysis of the open-ended responses, obtained by a procedure based on a free large language model, allowed us to deduce and summarize the main feelings expressed by the interviewees regarding the pandemic. Conclusions: The data collected emphasize the urgent need to investigate the consequences of long COVID in order to implement interventions to support psychological well-being. Full article

The phenomenon of some patients with schizophrenia withdrawing and becoming hikikomori needs to be resolved. In some countries, outreach methods are being employed. In Japan, psychiatric home-visit nursing for patients with schizophrenia and hikikomori is being implemented. However, it is not based on sufficient evidence and relies on the experience and intuition of individual nurses. This study explored the underlying themes in the nursing practices of psychiatric home-visit nurses via semi-structured interviews with 10 nurses and a thematic analysis. Nine key themes emerged. Four themes—(i) understanding the patient’s world, (ii) supporting the patients as they are, (iii) providing a sense of relief, and (iv) having equal relationships—highlighted the nurses’ commitment to respecting patients’ individuality while building and sustaining relationships. Two themes—(v) exploring the right timing and (vi) waiting for the appropriate timing—illustrated the nurses’ anticipation of proactive patient engagement. Finally, three themes—(vii) working together on things, (viii) continuing care for expanding the patient’s world, and (ix) nursing care for the patient’s future—underscored the nurses’ gradual and methodical approach to working alongside patients. Nursing practices based on these nine themes cultivated meaningful relationships and secured a sense of relief for the patients. Additionally, they awaited patients’ proactive engagement and delivered timely support to facilitate positive daily life changes. These findings contribute to the establishment of evidence-based nursing practices for patients with schizophrenia and hikikomori. Full article

Severe social withdrawal, including staying alone in one’s bedroom, non-attendance at school or work, and minimal or absent social contacts, sometimes only through electronic devices, can be found in several psychiatric disorders, or in a ‘primary’ form, firstly defined in Japan as ‘Hikikomori’. The distinction between primary and secondary forms is questionable, as it prevalently depends on the quality of psychiatric assessment. To date, few studies specifically explored Hikikomori in an adolescent population outside Japan. The aim of the present study is to describe clinical features of a consecutive group of 80 referred youth (13 to 18 years, 57 males) with social isolation, of which 40 were followed up on for 4–6 months, to characterize clinical features and outcome. All the participants presented psychiatric comorbid disorders, prevalently anxiety disorders, mood disorders, and autism spectrum disorder. Suicidality (ideation and behavior) was reported in 32.5% of the participants, and 20% of the participants attempted suicide. More than half of the participants exceeded the cut-off of the Internet Addiction Test, and 42.4% met the criteria for the Internet Gaming Disorder. At the follow-up appointment, an improvement of social withdrawal was reported in 75% of the sample; 67.5% of the participants significantly improved according to the CGI-improvement scale; and 55% of the participants had an improvement of functioning according to the C-GAS. Our findings suggest that Hikikomori is a transnosographic entity, with high rates of suicidality and Internet addiction, and that can it improve when it is timely diagnosed and treated. Full article

Background: The coronavirus disease (COVID) 2019 pandemic has been reported to have resulted in psychological disturbances. The Japanese term “hikikomori” refers to a state of preferring to stay at home. The COVID pandemic provided an opportunity to extend our current understanding of hikikomori by examining the psychological states of individuals who were in this state under lockdown, during which, paradoxically, their condition may have been adaptive. Methods: We administered a questionnaire to examine psychological changes among 600 people with hikikomori traits in Japan. The Hospital Anxiety and Depression Scale (HADS), Subjective Stress Scale, and Stigma Questions for hikikomori were administered retrospectively at three time points. We also collected descriptive data regarding the participants’ coping strategies. Results: The participants’ sense of stigma regarding hikikomori was improved during the pandemic, whereas depression and anxiety worsened. The participants with ‘definite’ hikikomori (they met the diagnostic criteria) reported more severe depression and anxiety than those with ‘possible’ hikikomori. Their coping strategies were adaptive to the pandemic situation. Conclusion: Although the sense of stigma against hikikomori was improved and adaptive strategies were employed, the participants with hikikomori experienced a worsening of depression and anxiety during the COVID lockdowns. The improvement of stigma and the participants’ indoor adaptive coping strategies could not ameliorate the mental state of hikikomori. Therapeutic interventions should be considered in the future for definite hikikomori meeting the criteria. Full article

The aim of this study is to review the available literature investigating the relationship between hikikomori, a pathological condition characterized by severe social withdrawal or isolation, autism spectrum disorder (ASD) and Internet gaming disorder (IGD). Studies on the relationship between ASD and IGD have found significant positive correlations between these two conditions. Individuals with ASD would appear to be at risk of developing a problematic use of the Internet, which, to the right extent, would represent a useful tool for social interaction and cognitive development. Even subjects with hikikomori, in whom rarefied interpersonal relationships and social isolation could be balanced by the use of online connections, appear to be at high risk of developing IGD. On the other hand, the finding of significant autistic traits in populations with hikikomori could lead to considering this psychopathological condition as a particular presentation of autism spectrum, a hypothesis that requires further investigation. Full article

Hikikomori is a severe form of social withdrawal increasing among the young Italian population. Hikikomori has been connected to psychological problems and high environmental sensitivity. Nevertheless, only a few studies have been carried out in the Italian context, and they did not analyze several aspects strictly related to the hikikomori phenomenon, such as the role of attachment and sensitivity. We aimed to investigate the relationship between attachment, sensitivity, and psychological problems in a sample of Italian hikikomori. Our sample comprised 72 Italian adolescents and young adults (49 males and 23 females), meanly aged 22.5 years, recruited through online forums and clinical centers for the hikikomori phenomenon. Our participants fulfilled the Highly Sensitive Person Scale (HSPS), the Attachment Style Questionnaire (ASQ), and the Hopkins Symptom Checklist (SCL-90-R). The results showed high psychological issues (i.e., depression and anxiety), environmental sensitivity, and insecure attachment orientations. Moreover, we discovered a significant relationship between attachment dimensions, environmental sensitivity, and psychopathology. Our study sheds light on a novel research path and could help both the researchers and the clinicians who work with people suffering from social withdrawal. Full article

The Japanese term hikikomori was first used to describe prolonged social withdrawal in the 1990s. Since then, research across the world have reported similar prolonged social withdrawal in many countries outside Japan. This study systematically analyses the evolution of literature on hikikomori in the past 20 years to gain a better understanding of the development of the knowledge base on hikikomori since it garnered attention in Japan. Findings from the scientometric review indicate many perspectives on the etiology of hikikomori including cultural, attachment, family systems and sociological approaches. However, similarities with modern type depression, a novel psychiatric syndrome, have been proposed and there are signs of a recent paradigm shift of hikikomori as a society-bound syndrome rather than a cultural-bound syndrome unique to Japan. As research into hikikomori continues to grow, results from the review also highlight the need for a more universally shared definition of hikikomori in order to better consolidate cross-cultural research for meaningful and valid cross-cultural comparisons which can help to promote evidence-based therapeutic interventions for hikikomori. Full article

In this work, we suggest that children’s social withdrawal might be a precursor of Hikikomori, a phenomenon observed among adolescents and young adults. Hence, psychotherapy interventions with preschool children showing signs of social withdrawal might play a critical role in Hikikomori prevention. This paper presents the case of a five-year-old child treated with intensive psychoanalytic psychotherapy who began therapy due to his refusing to go to school and exhibiting isolating behavior from other children. Among other symptoms were regression, emotional tension, nightmares, and nocturnal and diurnal enuresis. Moreover, the relationship in the family was difficult, both between the parents and between the parent and the child. The intensive psychoanalytic treatment involved three weekly sessions for about a year, followed by six months with one weekly session. Besides illustrating the therapeutic process through clinical vignettes taken from the sessions, this paper also provides clues on how early social withdrawal can contribute to the construction of internal personality organizations that lead to social withdrawal up to self-reclusion (or Hikikomori). Full article

We can classify the Hikikomori phenomenon with the classification of “social pathology”: the Hikikomori phenomenon, and its spread in society, appear to be a real danger to the sustainability and resilience of the very society in which it occurs. This is because the social isolation of an individual, especially if young and non-independent, impacts the community of reference in human, economic and psychological terms. Therefore, an analysis that investigates the social aspects of the Hikikomori phenomenon cannot disregard the fact that it can be said to be sustainable in the community of reference within which it occurs. This, without wishing to produce a judgment on the merits of the social pathology, is relevant to assessing the capacity of that community to sustain its presence and spread and the human and social costs required to contain it. The research aims to explore the Hikikomori phenomenon in the context of Southern Italy, considering it as an emerging social vulnerability that impacts very deeply onto the sustainability of a social, economic and community systems such as the Campania region one. The following paper therefore presents empirical work conducted in southern Italy, in the Campania region. The methodology used is Mixed Methods, and the research design is Sequential Exploratory. The respondents were reached through the help of the association Hikikomori Italia. Full article

A serious form of social withdrawal, initially described within Japan as hikikomori, has received increasing attention from the international scientific community during the last decade. The 25-item Hikikomori Questionnaire (HQ-25) was initially developed and validated in Japan. To date, data on its psychometric properties in other populations where cases of hikikomori have been described are still scarce. Thus, the aims of this study were to (1) translate, adapt, and validate the Italian version of the HQ-25 analyzing its psychometric properties; and (2) verify the association between hikikomori and personality functioning, social support, and problematic Internet use. A sample of 372 Italian adults aged 18 to 50 years completed the HQ-25 and measures of psychoticism, personality dysfunction, social support, and problematic Internet use were employed to test the convergent validity of the HQ-25. The data showed a satisfactory fit for a three-factor model, significantly better than a one-factor model. The three factors (socialization, isolation, and emotional support, as in the original study on the HQ-25) correlated positively with psychoticism, personality dysfunction, and problematic Internet use, and correlated negatively with social support. A lifetime history of hikikomori was present in 1.1% of the sample (n = 4). This is the first study to use the Italian validated version of the HQ-25 with an adult population. The findings from this study provide evidence of the satisfactory psychometric properties of the Italian version of the HQ-25 and support further investigation of the HQ-25 as an instrument to help screen for and investigate the presence of hikikomori. Full article

Hikikomori is a form of social withdrawal that is commonly described as having an onset during adolescence, a life stage when other psychiatric problems can also emerge. This study aimed to adapt the 25-item Hikikomori Questionnaire (HQ-25) for the Italian adolescent population, examining its psychometric properties; associations between hikikomori and psychoticism, depression, anxiety, problematic internet use (PIU), psychotic-like experiences (PLEs), to confirm convergent validity of the HQ-25; and the interaction effect between symptoms of hikikomori and PIU in predicting PLEs. Two-hundred and twenty-one adolescents participated in the study. Measures included the HQ-25, the Psychoticism subscale of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, the Depression and Anxiety subscales of the Brief Symptom Inventory, the Internet Disorder Scale, and the Brief Prodromal Questionnaire. Data showed a satisfactory fit for a three-factor model for the HQ-25 that is consistent with the original study on the HQ-25. Three factors (socialization, isolation, and emotional support) were associated with psychopathology measures. Six participants reported lifetime history of hikikomori. Symptoms of hikikomori and PIU did not interact in predicting PLEs. This is the first study to validate the HQ-25 in a population of adolescents. Findings provide initial evidence of the adequate psychometric properties of the Italian version of the HQ-25 for adolescents. Full article