title: Does the 'hikikomori' syndrome of social withdrawal exist outside Japan? A preliminary international investigation.
abstract: OBJECTIVE
  To explore whether the 'hikikomori' syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated.
  
  
  METHODS
  Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome's prevalence in their country, etiology, diagnosis, suicide risk, and treatment.
  
  
  RESULTS
  Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents' felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization.
  
  
  CONCLUSIONS
  Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan. takahiro@npsych.med.kyushu-u.ac.jp
authors.forename: Takahiro A
authors.initials: TA
authors.lastname: Kato
authors.forename: Masaru
authors.initials: M
authors.lastname: Tateno
authors.forename: Naotaka
authors.initials: N
authors.lastname: Shinfuku
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fujisawa
authors.forename: Alan R
authors.initials: AR
authors.lastname: Teo
authors.forename: Norman
authors.initials: N
authors.lastname: Sartorius
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Akiyama
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ishida
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Choi
authors.forename: Yatan Pal Singh
authors.initials: YP
authors.lastname: Balhara
authors.forename: Ryohei
authors.initials: R
authors.lastname: Matsumoto
authors.forename: Wakako
authors.initials: W
authors.lastname: Umene-Nakano
authors.forename: Yota
authors.initials: Y
authors.lastname: Fujimura
authors.forename: Anne
authors.initials: A
authors.lastname: Wand
authors.forename: Jane Pei-Chen
authors.initials: JP
authors.lastname: Chang
authors.forename: Rita Yuan-Feng
authors.initials: RY
authors.lastname: Chang
authors.forename: Behrang
authors.initials: B
authors.lastname: Shadloo
authors.forename: Helal Uddin
authors.initials: HU
authors.lastname: Ahmed
authors.forename: Tiraya
authors.initials: T
authors.lastname: Lerthattasilp
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Kanba
mesh_terms: D000328:Adult; D006801:Humans; D038622:Internationality; D007564:Japan; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder; D012934:Social Isolation / Q000523:psychology*; D011795:Surveys and Questionnaires; D013577:Syndrome