Towards Early Detection of the Pathologic Social Withdrawal Syndrome Known as “Hikikomori”


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Summary: Hikikomori is a complex condition in which a person withdraws from society and remains isolated at home for more than six months. The disease is becoming increasingly common in Western societies. Researchers have developed a new method to help identify and treat hikikomori at an earlier stage.

Source: Kyushu University

Researchers at Kyushu University have developed a new “hikikomori questionnaire” to detect the condition at an earlier stage.

Preliminary results indicate that isolation is a possible factor that can differentiate between non-hikikomori and pre-hikikomori individuals, allowing possible validation of the new questionnaire as a tool for early detection and treatment.

Hikikomori is a complex pathological condition in which a person withdraws from society and stays at home almost every day for more than six months. Although it can be considered a condition unique to Japan, hikikomori has been reported worldwide from across Asia, Europe and North America.

“Hikikomori was first defined in 1998. When we examined the condition, we found that it is a very complex pathology caused by an intersection of physical, societal and psychological conditions,” explains Takahiro A. Kato of the Faculty of Medical Sciences at Kyushu University and First author of the study.

“His growing international recognition has brought Hikikomori into the focus of many researchers and medical professionals, especially after the years of the COVID-19 pandemic. Just this year, Hikikomori was recognized in the revised edition of the DSM-5.”

Kato and his team worked on measures to evaluate, identify and treat hikikomori patients until 2013, when they opened the world’s first outpatient clinic for hikikomori people. In 2018, the team developed the “Hikikomori Questionnaire,” or HQ-25, designed to assess whether individuals experiencing social withdrawal at six months are symptomatic of hikikomori.

“This questionnaire allowed us to identify symptomatic individuals with hikikomori. As our work progressed, we found that we needed an assessment tool that could assess symptomatic individuals at an earlier stage to detect and potentially prevent hikikomori,” Kato continues.

The new Hikikomori Questionnaire, or HQ-25M, created in collaboration with Nihon University and Oregon Health and Science University, consists of 25 questions that measure the three sub-factors of socialization, isolation, and emotional support on a 0-4 scale, 4 rate “I totally agree”.

For example, questions such as “I feel uncomfortable around other people” measure socialization, while “there are few people with whom I can discuss important issues” covers emotional support.

The pilot test of the new questionnaire, reported in Psychiatry and Clinical Neuroscience, was conducted with 762 Japanese individuals. The questionnaire first asked about the person’s social withdrawal status in the previous month to categorize participants into hikikomori, non-hikikomori, and pre-hikikomori groups. The team also added a questionnaire that assesses the person’s psychological distress over the same month.

Hikikomori is a complex pathological condition in which a person withdraws from society and stays at home almost every day for more than six months. The image is in the public domain

“We analyzed the data to see comparable differences between the different category groups,” explains Kato. “Multiple models have shown us that hikikomori groups perform significantly better than non- and pre-hikikomori on all metrics.”

Interestingly, of all three sub-factors measured, the isolation sub-factor was the only one showing a significant difference in ratings between respondents before and without hikikomori.

While still preliminary, the team is satisfied with their initial results and plans to use them to improve the questionnaire and data collection.

“These initial results are promising and show that our questionnaire could be a good tool for early detection of hikikomori,” concludes Kato.

“Nevertheless, we need to work on expanding and diversifying our sample size and refining our questions. Additionally, since hikikomori pathology is reported around the world, we need to collaborate with researchers and patients outside of Japan.”

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About this news from psychology research

Author: press office
Source: Kyushu University
Contact: Press Office – University of Kyushu
Picture: The image is in the public domain

Original research: Open access.
“Monthly Version of the Hikikomori Questionnaire-25 (HQ-25M): Development and Initial Validation” by Takahiro A. Kato et al. Psychiatry and Clinical Neuroscience


One-month version of the Hikikomori Questionnaire-25 (HQ-25M): development and initial validation

Hikikomori is a pathological state of social withdrawal in which a person stays at home almost daily for more than 6 months.

Although hikikomori was first observed in Japan, it is described worldwide and has serious public health, welfare and economic implications.

The COVID-19 pandemic has further led to social isolation at home to avoid the risk of infection and may have increased the number of people with hikikomori-like conditions. The 25-item hikikomori questionnaire (HQ-25) was designed to assess social withdrawal after at least 6 months of symptoms.

However, assessment tools that can quickly assess social withdrawal at an earlier stage are needed to detect and potentially prevent hikikomori. So here we have developed a modified version of the HQ-25 to evaluate the last 1 month and preliminary studied its validity.

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