Motohiro Sakai

General condition of hikikomori (prolonged social withdrawal) in Japan: Psychiatric diagnosis and outcome in mental health welfare centres

Background: The issue of hikikomori (prolonged social withdrawal) among Japanese youth has attracted attention from international experts. In previous research, the unique cultural and social factors of Japanese society have been the focus; however, in order to resolve the problem of hikikomori, individual mental health problems must be included. Aim: We examined the psychiatric background of individuals with hikikomori. Methods: We recruited 337 individuals with hikikomori; 183 subjects who utilized the centres were designated as the help-seeking group. We examined the multi-axial psychiatric diagnosis based on the DSM-IV-TR, treatment policies and treatment outcomes. We also examined 154 subjects who did not utilize the centers (non-help-seeking group). Results: Most of the subjects in the utilization group were classified into one of the diagnostic categories. Forty-nine (33.3%) subjects were diagnosed with schizophrenia, mood disorders or anxiety disorders, and this group needed pharmacotherapy. Other subjects were diagnosed with personality disorders or pervasive developmental disorders, and they mainly needed psycho-social support. The Global Assessment of Functioning (GAF) scores of the non-help-seeking group were significantly lower than the GAF scores of those who used treatments. Conclusion: Most hikikomori cases can be diagnosed using current diagnostic criteria. Individuals with hikikomori are much worse if they do not seek help.

Assessing adaptive behaviors of individuals with hikikomori (prolonged social withdrawal): development and psychometric evaluation of the parent-report scale

ABSTRACT It is important to appropriately assess the adaptive behaviors of individuals with hikikomori (IWH) using parent reports. However, currently, there is no gold standard in the assessment of adaptive behaviors of IWH. This study aimed to: (1) develop the Adaptive Behaviors Scale for Hikikomori (ABS-H); (2) examine the factor structure of the ABS-H; and (3) examine the reliability and validity of ABS-H. A factor analysis and item response theory (IRT) analysis were conducted using data from 761 parents. Reliability and validity of ABS-H were assessed using measures of severity of hikikomori, difficulty in social participation, extent of places where IWH were active, days on which IWH went out, duration of hikikomori and happiness about relationship with one’s child. A total of 26 items were selected and item-trait was examined from the IRT results. Factor analysis identified four group factors. Cronbach’s alpha was found to be .97. Criterion-referenced, convergent and discriminant validity of the instrument were satisfactory. This study suggests that the ABS-H is a reliable measure with acceptable criterion-referenced, convergent and discriminant validity. Further research is needed to clarify the extent to which the ABS-H is sensitive in capturing the changes in the features of hikikomori.