HQ-25 Hikikomori: Severe Social Withdrawal

A latest news on hikikomori -“About 1.5 Million Japanese Living in Isolation” has gained the global attention recently. HQ-25 questionnaire is a self-report instrument which offers a tool to screen an individual at risk of Hikikomori. The HQ-25, has 25 questions with each question having score ranging 0-4, thus total score equals 100. A cut-off score of 42 (out of 100) was associated risk of Hikikomori.

Hikikomori- severe social withdrawal

What is Hikikomori

Hikikomori or Hikikomori Syndrome (HS) is “the state of avoiding social engagement (e.g., education, employment, and friendships) with generally persistent withdrawal into one’s residence for at least six months as a result of various factors.” is the definition given by Japanese Ministry of Health, Labor, and Welfare.

HQ-25 hikikomori Questionnaire

The HQ-25 consists of three factors:

lack of sociality
Isolation,
lack of emotional support.

And 25 self assessment questions:

		Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly disagree
1	I stay away from other people.	0	1	2	3	4
2	I spend most of my time at home.	0	1	2	3	4
3	There really isn’t anyone with whom I can discuss matters of importance.	0	1	2	3	4
4	I love meeting new people.	0	1	2	3	4
5	I shut myself in my room.	0	1	2	3	4
6	People bother me.	0	1	2	3	4
7	There are people in my life who try to understand me.	0	1	2	3	4
8	I feel uncomfortable around other people.	0	1	2	3	4
9	I spend most of my time alone.	0	1	2	3	4
10	I can share my personal thoughts with several people.	0	1	2	3	4
11	I don’t like to be seen by others.	0	1	2	3	4
12	I rarely meet people in-person.	0	1	2	3	4
13	It is hard for me to join in on groups.	0	1	2	3	4
14	There are few people I can discuss important issues with.	0	1	2	3	4
15	I enjoy being in social situations.	0	1	2	3	4
16	I do not live by society’s rules and values.	0	1	2	3	4
17	There really isn’t anyone very significant in my life.	0	1	2	3	4
18	I avoid talking with other people.	0	1	2	3	4
19	I have little contact with other people talking, writing, and so on.	0	1	2	3	4
20	I much prefer to be alone than with others.	0	1	2	3	4
21	I have someone I can trust with my problems.	0	1	2	3	4
22	I rarely spend time alone.	0	1	2	3	4
23	I don’t enjoy social interactions.	0	1	2	3	4
24	I spend very little time interacting with other people.	0	1	2	3	4
25	I strongly prefer to be around other people.	0	1	2	3	4

HQ-25 Hikikomori Questionnaire

Symptoms of Hikikomori

Spending nearly every day confined to home
Persistent avoidance of social situations and social relationships
Duration of at least six months, and
Absence of other physical or mental causes leading to social withdrawal symptom

HQ-25 may a be a good tool to know the risk of developing Hikikomori.

Causes of Hikikomori

Though consensus on etiology of Hikikomori is lacking, there are several possible explanations on Psychological level, at familial & environment level and sociocultural level.

On a psychological level:
- Traumatic childhood experiences, social exclusion as children, often having been victims of bullying at school, other forms of peer rejection, an introverted personality, temperamental shyness, and an avoidant attachment style may also predispose to develop hikikomori.
At a familial and environmental level:
- Parental rejection, overprotection and parental psychopathology, Poor academic achievement, combined with high expectations and sometimes subsequent school refusal.
Sociocultural explanations:
- Breakdown of social cohesion, urbanization, technological progress, globalization,
The invention of the Internet and subsequent changes to the way people interact with and within society may also be major factors contributing to hikikomori

Differential Diagnosis

Symptoms of Hikikomori are non-specific and can be found in various other conditions. These are most commonly mood or anxiety disorders, such as major depression and social phobia, schizophrenia, other psychotic disorders, personality disorders, such as schizoid or avoidant disorders, or cannabis abuse or even Internet addiction. HQ-25 questionnaire can help separating the hikikomori from others.

Hikikomori Treatment

There are three broad types of service providers to help hikikomori namely (1) Mental Health centers, (2) at community level and (3) various other settings offering alternative treatment.

Mental Health Centers that use psychological/clinical approaches;
Community settings that use non-clinical or psychosocial approaches; and
A variety of other settings offering alternative treatment (e.g., horse-assisted therapy, communal cooking in a farm, and online platforms).

The goal of the management is to break their physical isolation (that is to draw them out of their room or other environment) and social isolation, and then push them to adopt an active role in society.

Hikikomori Prognosis

Outcome of hikikomori treatment is variable and depends upon many factors. there are several issues that hamper the favorable outcome like If a hikikomori finally reintegrates voluntarily into society – often after several years – he/she faces a serious problem: catching up on the lost years of schooling or work. This makes it more difficult to return to society. The outcomes for individuals with hikikomori are much worse if they do not seek help, even if their family members are supportive.

Hikikomori and Covid

Since covid pandemic has raised many social and economic challenges and have raised the mental stress level , Hikikomori phenomena may become more common.

Hikikomori in India

Although described originally in Japan India is also having the people with Hikikomory [5] Aside from case reports, surveys of psychiatrists from various countries like Australia, Bangladesh, Iran, Taiwan, and Thailand suggest hikikomori cases are seen in all the countries examined, especially in urban areas. Research is needed to know the depth of situation in India.

Hikikomori in America

Hikikomori was originally described in Japan, but cases have subsequently been reported in Oman, Spain, Italy, South Korea, Hong Kong, India, France, and the United States. According to a 2015 Pew study, about 10 million NEETs exist in the United States and NEETS are are prone to develop Hikikomori.

FAQ:

What does Hikikomori mean in English

Hikikomori comes from the verb hiki, which means to move back, and komoru, which means to come into. Term Hikikomori was coined was coined by Japanese psychologist Tamaki Saito.(source: BBC)

Can HQ-25 Diagnose the Hikikomori

No, it is self assessment tool that can help individual to know the risk of developing the hikikomori. for the diagnosis other factors are also taken into consideration and other diseases having similar symptoms are ruled out.

Is Hikikomori a mental disorder?

Not exactly, It is considered as a psycho-sociological condition. At the present it is not clear whether other psychiatric disorders give rise to hikikomori as a symptom or whether it is indeed HS that is causing mental health conditions, as recently summarized by Kato et al[4]. Thus, it could be argued that both possibilities exist.

Which country has the most hikikomori

Japan has around 1.5 million people affected with hikikomori (source TIO) which accounts for largest number of people suffering from it worldwide.

What does a Hikikomori do all day?

They spend most of the time sometimes even more than 12 hours a day online, playing online games or others. they remain inside the home and do not communicate with even family members and leave their room only for unavoidable bodily demands.

Do Males and Females are equally affected by Hikikomori

Males are found to be more prone than females in the studies so far.

What is a NEET and its relation with Hikikomori

NEET, an acronym for “Not in Education, Employment, or Training“, refers to a person who is unemployed and not receiving an education or vocational training. The classification originated in the United Kingdom in the late 1990s. It has role in Hikikomori.

Are Hikikomori unhealthy?

Yes. The majority of such cases of hikikomori are classifiable as a variety of existing DSM-IV-TR (or ICD-10) psychiatric disorders. However, a notable subset of cases with substantial psychopathology do not meet criteria for any existing psychiatric disorder. We suggest hikikomori may be considered a culture-bound syndrome and merits further international research into whether it meets accepted criteria as a new psychiatric disorder.

Is hikikomori a Phobia?

NO, hikikomori is not phobia, though social phobia is a part of Hikikomori including other group of sign and symptoms.

How do I stop being a hikikomori?

You have to develop belief in yourself. once you are determined to overcome the hikikomori most of the work is already done. just say to yourself that yes I can do it. seek the help of mental health centers. listen and spend time with people with positive attitude. Everything is going to favor you once you are determined.

Do Hikikomori talk to people online?

Many hikikomori turn to the Internet, and sometimes spend more than 12 h a day in front of the computer and may talk to other game-partners while playing video games.

How do you know if you are a hikikomori?

HQ-25 self assessment questionnaire may be a helpful tool to know the risk of hikikomori. A score of 42 or more is related to risk of hikikomori. you can also consult the doctor if having symptoms of hikikomori as described above.

refrenses:

Teo AR, Chen JI, Kubo H, Katsuki R, Sato-Kasai M, Shimokawa N, Hayakawa K, Umene-Nakano W, Aikens JE, Kanba S, Kato TA. Development and validation of the 25-item Hikikomori Questionnaire (HQ-25). Psychiatry Clin Neurosci. 2018 Oct;72(10):780-788. doi: 10.1111/pcn.12691. Epub 2018 Jul 27. Erratum in: Psychiatry Clin Neurosci. 2019 Sep;73(9):603. PMID: 29926525; PMCID: PMC6221010.

Saito T. Shakaiteki hikikomori: owaranai shishunki (Social withdrawal: a neverending adolescence) Tokyo: PHP Shinsho; 1998.

Teo AR, Gaw AC. Hikikomori, a Japanese culture-bound syndrome of social withdrawal?: A proposal for DSM-5. J Nerv Ment Dis. 2010 Jun;198(6):444-9. doi: 10.1097/NMD.0b013e3181e086b1. PMID: 20531124; PMCID: PMC4912003.

Kato TA, Kanba S, Teo AR. Hikikomori: multidimensional understanding, assessment and future international perspectives. Psychiatry Clin Neurosci 2019:427–40. 10.1111/pcn.12895 [PubMed] [CrossRef] [Google Scholar]

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