Toward Early Detection of the Pathological Social Withdrawal Syndrome Known as ‘Hikikomori’

Summary: Hikikomori is a complex condition where a person withdraws from society and remains isolated at home for more than six months. The condition is becoming more prevalent in Western societies. Researchers have developed a new method designed to help detect hikikomori at an earlier stage and provide treatment.

Source: Kyushu University

Kyushu University researchers have developed a new ‘Hikikomori Questionnaire’ in an effort to detect the condition at an earlier stage.

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

Hikikomori is a complex pathological condition where an individual withdraws from society and remains at home almost every day for more than six months. Although it may be viewed as a condition unique to Japan, hikikomori has been reported globally from across Asia, to Europe and North America.

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

“Its growing international recognition has put hikikomori into the purview of many researchers and medical professionals, especially on the heels of the years long COVID-19 pandemic. Just this year, Hikikomori was recognized in the revised edition of the DSM-5.”

Kato and his team have been working on measures to evaluate, identify, and treat hikikomori patients, to the point of opening the world’s first outpatient clinic for hikikomori individuals in 2013. In 2018, the team developed the ‘Hikikomori Questionnaire,’ or HQ-25, that was design to assess whether individuals under social withdrawal after 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 evaluate symptomatic individuals at an earlier stage to help detect and potentially prevent hikikomori,” continues Kato.

The new Hikikomori Questionnaire, or HQ-25M—made in collaboration with Nihon University and Oregon Health and Science University—is composed of 25 questions that evaluate the three subfactors of socialization, isolation, and emotional support on a scale to 0–4, 4 being ‘strongly agree.’

For example, questions such as ‘I feel uncomfortable around other people’ gauge socialization, while ‘there are few people I can discuss important issues with’ covers emotional support.

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

This shows a woman standing at a fence
Hikikomori is a complex pathological condition where an individual withdraws from society and remains at home almost every day for more than six months. Image is in the public domain

“We analyzed the data to see any comparable differences between the different category groups,” explains Kato. “Multiple models showed us that hikikomori groups scored significantly higher on all metrics compared to non- and pre-hikikomori.”

Interestingly, between the pre- and non-hikikomori respondents, of all the three subfactors that were measured, the isolation subfactor was the only one that showed a significant difference in scores.

While still preliminary, the team is pleased with their initial findings and plans to use them to improve their questionnaire and data collecting.

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

“Nonetheless, we have to work on expanding and diversifying our sample size and fine tune our questions. Moreover, since the hikikomori pathology is being reported around the world, we must work with researchers and patients outside of Japan.”

About this psychology research news

Author: Press Office
Source: Kyushu University
Contact: Press Office – Kyushu University
Image: The image is in the public domain

Original Research: Open access.
One month version of Hikikomori Questionnaire‐25 ( HQ‐25M ): Development and initial validation” by Takahiro A. Kato et al. Psychiatry and Clinical Neurosciences


One month version of Hikikomori Questionnaire‐25 ( HQ‐25M ): Development and initial validation

Hikikomori is a pathological condition of social withdrawal in which a person remains at home almost every day for more than 6 months.

Although first observed in Japan, hikikomori is described around the world, causing serious impacts on healthcare, welfare, and the economy.

The COVID-19 pandemic has further led to social isolation at home to avoid the risk of infection, and perhaps 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 evaluate social withdrawal at an earlier stage are needed to help detect and potentially prevent hikikomori. Therefore, we herein developed a modified version of the HQ-25 to assess the prior 1 month and preliminarily examined its validity.

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  1. Well, I’m astonished that so many people who seem at best semi-literate even bother to read scientific articles, and cracking up at the judgement and misinterpretation that are the only things your small minds can come up with. Depression, anxiety, panic attacks, ME/CFS for 37 years, fibromyalgia, and thyroid disease have made me gradually turn from a social person who throws the best parties and has a lot of creative, intelligent friends to someone who stays at home most of the time. Covid contributed, but it’s having to be around and interact with people like a lot of you commentors that is the deciding factor. I don’t want to breath your germs, and I don’t like willful ignorance and lazy stupidity. I can go out if and when I want to, and be around people who are worth it. You bunch need to learn critical thinking and deductive reasoning and grow up.

  2. During the pandemic many persons developed something similar. Two years later I still have it

  3. dude wtf is wrong with you.. why are you so angry and tbh its just as much of a cop out to just automatically jump to the talking point of blame the corporate “masters” as you say as it is to automatically dismiss this as something thats not real or the persons fault.. your part of the problem that this is becoming more common between stupid covid lockdown policies divisive vaccine mandates and then the unhinged angry people like you always blaming everyone else for yiur own problems, problems of society and the whole dam world.. do you also include blaming anyone who has more money than you or the average person or drives a nicer car lives in a bigger house tha. you or the average person? I would have thought this thing was either extremely rare or something over blown few years ago but iv seen people iv known my whole life really chage for the worse over the last few years im not willing to say this thing is is extremely rare or overblown anymore.. b.c Iv wit essed something like it play out in real time and im not going to blame the people who are suffering from either this or some other form of ptsd social withdrawal depression even drug addiction.. the people I know who drasticly changed weren’t like this at all just 2 or 3 years ago and it’s next to impossible to deny the feeling that society as a whole is on a decline worldwide as the statistics and facts are slowly validating it

  4. Where could one find and take this?
    I’ve known the term since I was in highschool, and anymore, when combining everything going on with my brain… I want to see where or if I’d fall into this.
    Between depression, C-PTSD, anxiety, autism and Multiple Sclerosis… I go out when I need to shop or have appointments. Can’t drive, can’t work, and only really interact with my roommate/caretaker- she’s also my only close friend. Spending two weeks not even stepping out of our apartment was way too easy. But guess it’d be a little harder to tell, because I have at least 2 appointments a month…

  5. Oh my..something New to have Government give Millions $ grants to study for decades…
    That’s my take.

    1. Without a PhD in mental health and social behavior who are you to it’s valid or not. I know men who still don’t believe in depression. But just because you don’t see it as valid doesn’t mean that’s its not. That’s like believing someone’s lie even though you ha e all the evidence of them lying, but you think the lie is just to impossible! People who say things like this is part of the fault of other who do have serious mental issues never reaching out to get help because there to embarrassed of the the stigma of being considered to have mental health issues

  6. The biggest issue I’ve had with people tackling the hikkikomori phenomenon in Japan is the assumptions to mental disorders based on Western context like how the general audience who don’t know East Asian cultures and how it affects those with a mental disorders, let alone Japanese cultures, indirectly belittling those in their community who are affected by the phenomenon for many years before COVID (be it the sufferer or their caretakers or both). COVID just merely exposed it publicly to a wider audience because what was a situation in Western cultures of those who want to seek isolation in the past and we’re ostracized/humiliated for it (due to some outside situation they cannot control be it their own mental disorders or fear of getting sick or dying) is similar to the hikkikomori phenomenon in Japan. It’s way more than a introvert/extravert, astrology/mythical/spiritual, or ‘bad vs good’ mental disorders that the narration online and on news are pushing; it’s a hope vs hopeless situation forced down onto them for having something different that society looks down upon be it an un-romanticized mental disorder, disfigurement/physical disabilities, lack of a support/fears of people/lack of social skills, having/looking ambiguous race/mixed/indigenous/’half’ and more. Not every problem is black or white.

  7. What’s wrong with using the existing DSM agoraphobia? Half genuinely wanting to know and half finding this cringe, TBH.

  8. The only people my staying in my home bothers is everyone else therefore it’s bothering me . It’s not only social it’s going outside . I can’t go outside and take my puppy to pea so I pee pee pad trained him and in my mind that was ok . Even talking now about this causing me huge guilt I didn’t realize I had this disorder till I rescued my pup. I had to shelter in place because of Covid and I have an immune disease but I got very sick . I was treated via phone and video no one came to house to clean .groceries dropped off .I was so weZkened I was down to 103 pounds it was a long recovery but house bound 2.5 years except for going to get shots and pick up my puppy . And it continued . Don’t okay in my yard nothing I used to garden decorate iut there grocery shop errands nothing ! I went to my sons for Thanksgiving my friend had to come get my clothes ready for me I couldn’t it all worked out but I wanted to get home I’m not apart of anything anymore very strange feeling

  9. Perhaps they should examine people who never stay home!!! Introversion and/or the wish to be removed from this wasteful, selfish, narcissistic, violent society is a sign of a healthy mind, not a disease. Ugh.

    1. I totally agree!! I find this study and classification of people who may be introverted or not interested in society to be a mental condition. When will extroverts catch a friggin clue.

  10. So where would I get treatment if this is just a beginning stag of understanding? This is what’s wrong with the world, smacking labels on what’s already the known and how. I’ve been like this since I was a middle schooler, doesn’t mean I have a disease, but maybe we do have “something” off, and that’s why we stay to ourselves. Your society labeling is why people with disease and actual problems distant them self and end up worse, you, SOCIETY, treat them like misfits and poor minded individuals.

  11. For the past 2 1/2 years a broken relationship led me to a place where I don’t leave my apartment except for MD appointments and groceries
    I get very uncomfortable around people.

  12. It isn’t a medical condition. It’s regular people, disillusioned by your bullshit society. A society ran by merchants who only care about money. All of you that participate in it are just dumbass lonely people, not strong enough to survive the world on your own. If we withdraw, maybe turn the microscopes back on yourselves, and ask why you teach us morals as children, only to have us break each and every rule we know just to prove our loyalty to your corporate masters. Burn, society. Burn. You are modern savages with no real knowledge of how the world works. Sheep.

  13. Isn’t this how society has been designed? Now with all these new technologies and “smart” phones, many people will have less reason to go outside. Personally, I’m more worried about the kids and how it will affect them. They can’t handle isolation and I feel like most parents have become careless and irresponsible. Children should not have a phone or be on social media until at least 15 years old!

    1. Ah, but you forget- school shottings, kidnappings, stalking and harassment are all things, and a less horrible one would be getting separated at the store… or being able to tell your dad when the wife he divorced- after finding her in bed with his friend after coming home from tour- is abusive now that her new bf is also fond of starving her kids during her primary custody time.
      I’d want my kids to be able to communicate if and when they need to… cellphones provide a means for that.
      (And yes, that example was my own experience. Why do they always believe a mom could never hurt her children when it comes to custody cases?)

  14. What a bunch of absurd gibberish. There’s no science in this article. Do you have a neuroscientific category for people who make up nonsense and think that a behavior that’s been around for thousands and thousands of years in human behavior is brand new science. This sounds like something an artificial intelligence would think up, like a load of gibberish, or a sales pitch to The unscrupulous. Do I have to turn around and say that maybe oriental races are becoming too dyscognitive to use their brain ? Trying not to I’m really trying not to.

  15. Brain health is often caused by viruses and bacteria so please be sure to test for infections.For example, PANDAS is from strept, PANS is any infection.Lyme is a spirochete like syphillis only 6 times more frequent. It hides in joints, heart and brain tissue so blood tests can be falsely negative. Lyme is the quiet epidemic affecting half a million people per CDC.This is more than breast cancer and HIV combined yet research funding is miniscule and the tests highly inaccurate.

  16. Yes. I agree with everyone … Agoraphobia. Panic disorder. PTSD. I have this. I go maybe to the store from time to time. I bet I go in 6 months 6 places. To get my meds…that’s usually the Only time. I don’t visit anyone really I stay at home I have roommates and don’t even visit them unless they come to my space. Which is a large room equipt. They always give an old syndrome a new name makes no since and it started way before COVID. For me anyways. Up to the age of 40 I was always out n about I worked daily and I had normal life. Now I do nothing for the last 25 years same as my grandmother. Hummm. I just now thought this. Maybe it runs in the family.

  17. Is this another way to prescribe more meds. From the giant pharmaceutical co.and for our government to also make a profit?? I’m so disappointed over the false diagnosis about the chemical imbalance and everyone involved!!

  18. Some people just choose to go where necessary and only mingle with specific individuals. I don’t hang with everybody. Far as professional sides, only do whatever required but I don’t mix business with personal life. I am comfortable going out with certain trusting peers & hate those full of drama. It’s everyone’s choice how they decide to interact at the end of the day. 🤷‍♀️💯

    1. I believe that global connection vial social networking has a lot to do with self isolation. If you can interact with the world in your Jammie’s, from the comfort of your recliner and IPad, in every way imaginable, including telemed physicans, ordering groceries, pizza, household goods, appliances and even vehicles… and last but not least, working from home, why would you not withdraw from society? I don’t have a set opinion on this, I’m just raising the question for thought.

  19. Sounds a lot like intermittent autism or could be equated to seasonal depression what’s everything got to be so complicated

  20. Sounds like agoraphobia and gad to me. The name does sound better though. But psychological distress would be like anxiety or panic attacks I’d imagine. Unless this article is examining the mental state of some one after isolation….

    1. what is wrong with these judgemental haters? No one wants to feel isolated, it’s not a thing you can just make go away anymore then if it were cancer. People need empathy not pity but understanding instead of being labeled a freak. Walk in my body for a week, be me, then you can judge.

  21. The determinative factor l believe hinges on the following;
    1.Any Co-Morbidities such as Depression; not triggered by Loss of a Loved one or Protest action as self-protective measure taken to avoid unpleasant,mental or physical Distress .

    1. Agoraphobia is a phobia. This isn’t referring to an immeasurable or irrational fear of going outside.

  22. This article doesn’t say what’s wrong with staying home. If there isn’t some sort of co-morbity that causes distress, such as depression or agoraphobia, then there isn’t really a disease — only a confounding of society’s, and extraverts’, expectations.

  23. I just think it’s depression and anxiety. They just like to relabel the same ole thing as something different and act like they did something.

    1. I agree with you completely. I enjoy being alone 99% of the time. My wife understands how I am and is fine with it. I couldn’t be more happy than I am.

    2. Yep LOVE being alone. I am finally semi retired and so enjoy peacefully reading and puttering about at home alone. I have adult children that live far away and we chat a few times a week. I feel free of pressure to socialize.

  24. Right, they’re not talking about involuntary withdrawal as in with covid when we had no choice but to stay home. They’re talking about non-compelled, voluntary social withdrawal. Hope you are doing better!

  25. I stayed home, except for cancer treatments, for nearly a year with the pandemic.Hardly some psychological disease, unless it was one that affected our healthcare professionals to prescribe such careful behavior by folk with compromised immune systems.

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