title: Social isolation associated with depression: a case report of hikikomori.
abstract: BACKGROUND
  Social isolation is associated with significant morbidity and mortality. A severe form of social isolation or social withdrawal, called hikikomori in Japan, has been described, but controversy over the etiology and universality of the phenomenon remains.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  Diagnostic assessment by structured clinical interview and psychometric tools revealed hikikomori and underlying bipolar disorder, in which the patient's social withdrawal occurred exclusively during major depressive episodes. The patient declined pharmacotherapy, but his hikikomori and depression went into remission after 25 sessions of cognitive behavioural therapy targeting his social isolation.
  
  
  CONCLUSIONS
  This is the first reported case of hikikomori in the Americas. It illustrates the association between hikikomori and a mood disorder, and suggests the importance of international study of the prevalence and potential treatment strategies for severe social isolation.
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor 48109-0604, USA. alanteo@umich.edu
authors.forename: Alan R
authors.initials: AR
authors.lastname: Teo
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D011594:Psychometrics; D012934:Social Isolation / Q000523:psychology*; D016896:Treatment Outcome