Hikikomori: an extreme form of social withdrawal

Hikikomori is a condition of prolonged social isolation, marked by a lack of contact with family, friends, and many social activities (such as school or work).

Hikikomori was first noticed in Japan, but has since been recognized across Asia, Europe, and North America. Throughout this article, we’ll explain what hikikomori is, how autistics are affected by it, as well as how the effects of social isolation may influence (or be influenced by) excessive Internet and online gaming use.^[1]Autism Spectrum, Hikikomori Syndrome and Internet Gaming Disorder: Is There a Link? (Dell’Osso et al., 2023)

What is hikikomori/ESW?

Definition: Hikikomori is a portmanteau word combining the Japanese verbs of ‘hiku’ (to pull back) and ‘komoru’ (to seclude oneself)

In Japan, there is an ancient religious myth that the light goddess Amaterasu once got into an argument with her brother Susanoo and got so fed up with him that she decided to hide from the world in a cave for the rest of eternity. Her actions sent the entire world into darkness and took all the gods’ powers to draw Amaterasu from her cave, where the world would experience lightness once again. This myth is one way to explain the phenomenon of hikikomori, which refers to the act of sheltering oneself in their home away from the social world as well as to the people taking part in these actions.^[2]A New Form of Social Withdrawal in Japan: A Review of Hikikomori (Teo, 2009)

This phenomenon of social withdrawal was first studied in Japan as early as the ’70s. Researchers first used the terms “withdrawal neurosis” or “school refusal syndrome” to describe hikikomori as it was first seen in children who refused to go to school for various reasons. While the condition is still strongly associated with young people, people young and old have experienced social withdrawal in one form or another. Hikikomori is currently known as a phenomenon specific to Japanese culture, where it is thought to affect around 1 to 2% of the adult population.^[3]Hikikomori Is Most Associated With Interpersonal Relationships, Followed by Suicide Risks: A Secondary Analysis of a National Cross-Sectional Study (Yong and Nomura, 2019)

While not yet recognized as an internationally known diagnosis, the phenomenon shares many similarities with a social anxiety-related syndrome called taijin kyofusho, a culture-bound syndrome found in the DSM-IV-TR. People affected by taijin kyofusho may also withdraw socially due to the fear that their presence (ex. their body odour, mannerisms, attitude) is hurting or offending others during social interactions. It’s thought that a percentage of these people also suffer from hikikomori.^[4]Hikikomori: Multidimensional understanding, assessment, and future international perspectives (Kato, Kanba, & Teo, 2019)

In collectivist cultures such as Japan and other Asian countries where hikikomori and taijin kyofusho are more recognized, there is a larger emphasis on family unity and the community as a person’s purpose is determined through social means (i.e., through their ancestral lineage, their occupation, their nationality, etc.). Collectivism, or centering the well-being of the group over the individual, is one framework we can use to understand the differences in national cultures across the world, according to social scientist Geert Hofstede’s cultural dimensions theory. To learn more about the differences between countries and their cultures, check out this cultural comparison tool created using Hofstede’s research.^[5]Hofstede’s Cultural Dimensions Theory & Examples (Nickerson, 2023) | Simply Psychology

Here, it is common for adult, sometimes unemployed, children to stay in their parents’ home until marriage. This is the case for many hikikomori in Japan who live with their parents and rely on their support. Likewise, fears about not wanting to offend others is also a common belief in collectivist cultures. This might be one reason why shyness and social anxiety are more common here, making social interaction a much more fraught landscape.^[6]What Is a Collectivist Culture? (Cherry, 2022, November 8) | VeryWellMind.com

Whereas, in individualistic cultures like Canada and the U.S., people hold personal autonomy and individual rights in high regard. They might leave their parent’s home as adults and are more concerned with their personal well-being than offending others. Additionally, this might mean that people in these countries have less social support in times of crisis. As the phenomenon of hikikomori became recognized across Asia, Europe, and North America, some researchers have started to use the term Extreme Social Withdrawal (ESW) to describe what seems to be a universal experience.^[7]Contemporary Hermits: A Developmental Psychopathology Account of Extreme Social Withdrawal (Hikikomori) in Young People (Muris & Ollendick, 2023)^[8]Individualistic Culture and Behavior (Cherry, 2023 March 10) | VeryWellMind.com^[9]Identifying Social Withdrawal (Hikikomori) Factors in Adolescents: Understanding the Hikikomori Spectrum (Hamasaki et al., 2020)

Generally, ESW looks like a person centring their lifestyle around being home and lacking direct social contact with family and friends. Of course, not every person with hikikomori looks the same. Some may not leave the house besides possibly taking out the garbage or taking a solo walk nearby, while others might occasionally go shopping. Some people with severe cases may not leave the house at all, and leave their room very rarely. However, all of these people find it difficult to do everyday things that revolve around social interaction.

Because of how different these cases are, many researchers believe hikikomori exists both as a unique condition and as a strategy to cope with stress and unwanted social judgments by avoiding others, eventually impairing people’s ability to interact with others.^[10]Hikikomori: Multidimensional understanding, assessment, and future international perspectives (Kato, Kanba, & Teo, 2019)

So what are the various reasons behind social withdrawal? In school children, children experiencing hikikomori refused to go to school, mostly due to the fear of being bullied or rejected by their peers. Experiencing trauma like bullying or mistreatment in school can make it an intensely frightening place to go back to. In adults, experiencing the death of a loved one, physical abuse, or even developing physical conditions like skin rashes have all influenced people’s decisions to socially withdraw from places outside of the home. Additionally, hikikomori co-exists with a number of psychological conditions including depression, schizophrenia, personality disorders, and social anxiety.^[11]Internet Addiction, Hikikomori Syndrome, and the Prodromal Phase of Psychosis (Stip et al., 2016)

In Japan, many families might not report symptoms fitting traditional psychological conditions as those above because of the negative social stigma surrounding those conditions. As such, many people in Japan feel the term hikikomori is more socially acceptable than terms describing clinical depression or schizophrenia, which may account for why hikikomori seems to have a whole host of potential causes. These conditions are associated with ESW (the causes of which vary extremely) and may influence how the condition is treated across different people. Let’s take a closer look at some of the factors that influence people to withdraw from society.

Factors influencing social withdrawal

Because the research on ESW is still limited, it’s been hard trying to determine solid criteria for extreme social withdrawal. However, what we do know is that there are many factors increasing a person’s risk for developing ESW. Some of these factors might be individual-related (ex. Trauma and psychological conditions like depression and anxiety) while other causes might be part of larger systems at play (like going against cultural and gender norms). However, all of these factors will cause the extreme distress that is featured in this condition.

Trauma

Experiencing trauma can have a devastating impact on a person’s sense of security and self-worth. Take, for example, losing a person you love very suddenly. I’ve seen how the grief of this event can cause people to isolate themselves from family and friends because talking about it seemed so painful and would “re-open the wound.” When experiencing trauma such as abuse or harassment in places like school or work, people might choose to avoid places that retrigger those memories as they can bring feelings of shame and defeat to avoid re-traumatizing themselves.^[12]Hikikomori: understanding the people who choose to live in extreme isolation (Rooksby, McLeod, & Furuhashi, 2020) | The Conversation

Cultural norms

Similarly, some people’s traumatic experiences might also come from feeling alienated by their country’s cultural values. For example, someone coming from a collectivist culture might define “who they are” in relationships with others as a child or a worker, while people from individualist backgrounds are more likely to see their hobbies, likes and dislikes as “who they are.” In Japan, people place a higher importance on the role of community in one’s life. If people who have lost an important job or relationship feel they have failed in the eyes of their peers and family, it can have devastating effects on their self-worth and identity. Going against these standards laid out by society can be alienating to people with ESW and can bring feelings of shame and failure.^[13]What Is a Collectivist Culture? (Cherry, 2022, November 8) | VeryWellMind.com)

This might be one reason why this phenomenon is much more popular in Japan. However, it is important to note that research suggests ESW is independent of individualist and collectivist differences in countries.^[14]The impact of higher levels of autistic traits on risk of hikikomori (pathological social withdrawal) in young adults (Brosnan & Gavin, 2023)

Depression

Many people with ESW are afflicted with depression. Loneliness and a perceived lack of social support, which are common symptoms of depression, are highly associated with social withdrawal across different cultures.^[15]Identification of the hikikomori syndrome of social withdrawal: Psychosocial features and treatment preferences in four countries (Teo et al., 2014) Based on the research, it’s difficult to say whether people who experience loneliness and a lack of social support are more likely to then experience ESW, or that social isolation is the one at the root of the depression.

Social anxiety

Social anxiety is very commonly occurring in people with ESW, with 54% of South Korean youth with ESW reported experiencing distressing levels of social anxiety, compared to 36.8% of healthy subjects.^[16]Home visitation program for detecting, evaluating and treating socially withdrawn youth in Korea (Lee et al., 2013) Many people afflicted with social anxiety suffer similar experiences of ESW, including finding social interaction, especially face-to-face interactions, difficult and/or frightening.^[17]Hikikomori: Multidimensional understanding, assessment, and future international perspectives (Kato, Kanba, & Teo, 2019)

Gender

Like autism, people socialized as males are overwhelmingly represented in research identifying hikikomori, outnumbering people socialized as women by a 4:1 margin. Many of the smaller studies found in research are heavily biased toward male participants, some not featuring any self-identified women.^[18]The ‘Hikikomori’ syndrome: worldwide prevalence and co-occurring major psychiatric disorders: a systematic review and meta-analysis protocol (Pozza et al., 2019)

There may be a few reasons for this: First, it could be that men are generally asked to perform (and get away with performing) less social responsibilities than women. Likewise, men are called “loners” while women are pathologized for the same behaviours. As such, more extreme social withdrawal behaviours might be easily documented in male populations because it is more of a “taboo” subject for women and there might be fewer women willing to talk about their experiences.

However, this isn’t to say that women and people outside of the gender binary do not experience hikikomori. Likely, 30–40% of Japan’s recluse population identify as female. Also, many older women whose lives have centred around domestic labour may have experiences with unemployment, loneliness, and being isolated from friends and similarly-aged people.^[19]Japan’s female recluses (2023, April 24)| NHK World Japan.

Transgender, non-binary, and gender-diverse people may also feel isolated from friends and the public sphere because they have to contend with overwhelmingly rigid standards of behaviour and appearance. Feelings of loneliness may also be heightened because of difficulties finding employment, as many employment forms don’t even recognize genders outside of the binary.^[20]Loneliness and Social Isolation among Transgender and Gender Diverse People (Hajek et al., 2023)^[21]Japan’s Younger Generations Look for a New Way of Living (Klien, 2021)

Autism & Extreme Social Withdrawal

Currently, research on ESW suggests there is an overlap between ESW and autistic characteristics. Some found that people with ESW traits are more likely to also have autistic traits based on the ASQ-Japanese version.^[22]Autism spectrum conditions in hikikomori: A pilot case-control study (Katsuki et al., 2020) They showed that those who scored higher on the ASQ shared similar challenges with autistics in social skills and communication.

Because it is connected to so many different psychological conditions, it is difficult to determine the main cause of ESW. However, struggling with social interactions seems to be one common feature of ESW related to why people choose to withdraw from society.

It’s not hard to imagine how autistics are particularly vulnerable to ESW. Many of us have felt that we would rather be alone than have to interact with people who don’t understand us. Naturally, our home is also a much more comfortable place than places like school or work, both because of its familiarity, control of our sensory environment, as well as the lack of unwanted people. As such, it’s likely that many autistics have experienced prolonged social isolation and ESW in one way, shape, or form.

Additionally, many autistics also share some major life experiences that increase the risks of experiencing ESW, such as being bullied and feeling that there isn’t a place where you can feel completely yourself.^[23]Hikikomori: Multidimensional understanding, assessment, and future international perspectives (Kato, Kanba, & Teo, 2019) In autistics, struggling with neurotypical social rules can lead to bullying and being ostracized by our peers. This may lead to isolating ourselves socially by refusing to interact with people who aren’t interested in understanding us. This could be another reason why autistics might experience varying levels of hikikomori.

Importantly, research shows that ESW affects the psychological well-being of individuals with autistic traits.^[24]The impact of higher levels of autistic traits on the risk of hikikomori (pathological social withdrawal) in young adults (Brosnan & Gavin, 2023) For example, one study conducted during the COVID-19 lockdown showed that university students with autistic traits, were less likely to leave their house, and consequently reported lower psychological wellbeing.

To summarize, autistics are more vulnerable to experiencing prolonged social withdrawal like ESW or hikikomori, as well as commonly linked conditions like depression and anxiety. This can have detrimental effects on our sense of self-worth as well as on our overall well-being.

Internet usage & ESW

Over the past few decades, the Internet has changed the ways people interact and communicate with others, in that it’s no longer necessary to go outside for social interaction. Additionally, Internet platforms like online gaming and social networking sites are commonly used by young adults (the people most at risk of ESW) as an “escape” from the pressures of society and as a way to create meaningful connections with others. This might be why people with ESW traits are using the Internet significantly more often than people without ESW traits, and for longer periods of time.^[25]A preliminary cross-cultural study of Hikikomori and Internet Gaming Disorder: The moderating effects of game-playing time and living with parents (Stavropoulos et al., 2018)

Could it be that the various Internet platforms people use (i.e., social networking sites and online gaming) indirectly encourage people to socially isolate themselves because of their easily accessible and immersive nature? Or is it that the Internet can be a safe space for people with ESW to connect with the outside world in ways they have control over, making them feel less of a need to engage outside the Internet, thus less likely to leave their home? Like the chicken or the egg, it’s hard to know which phenomenon is directing the other.^[26]Internet society, internet addiction, and pathological social withdrawal: the chicken and egg dilemma for internet addiction and hikikomori (Kato, Shinfuku, & Tateno, 2019)

Either way, research shows that increased hours playing video games is associated with more pronounced social withdrawal symptoms.^[27]A preliminary cross-cultural study of Hikikomori and Internet Gaming Disorder: The moderating effects of game-playing time and living with parents (Stavropoulos et al., 2018)

In terms of platform types, researchers found that people with ESW traits who mainly use online gaming as their preferred Internet platform spent significantly more time on the Internet than people using social networking sites. This is likely because online gaming is preferred on a stationary desktop or laptop computer, which encourages the user to stay in their rooms and avoid outdoor social activities. Interestingly, it could be the case that there are fewer women affected by ESW partly because of the fact that men participate in online gaming more than women do and, thus are more vulnerable to isolation.^[28]Internet Addiction, Smartphone Addiction, and Hikikomori Trait in Japanese Young Adult: Social Isolation and Social Network (Tateno et al., 2019)

Because of the freedom many young people have found in online gaming and social networking, people with high social withdrawal symptoms are at an increased risk of becoming dependent on using the Internet and online gaming. So much so that it makes participating in daily activities like sleeping, eating, and spending time with family a lot more difficult.

Autism, problematic Internet use, & ESW

We have a similar relationship with the internet as people with ESW because we also turn to the internet to help us avoid social interaction and social rejection. Similar to people with ESW, we feel free from social limitations within our online communications.^[29]Autism, Problematic Internet Use and Gaming Disorder: A Systematic Review (Murray et al., 2021)

For example, playing video games can be a way for autistic youth to release stress. Autistic youth are likely to participate more in online gaming than social communication sites, which, like people with ESW, can increase the risk for prolonged social isolation. However, video games are also beneficial for cognitive development and psychological well-being in autistic children.

Besides avoiding social interactions, it is possible that for autistics, the risk of ESW may also be related to executive functioning differences. Because of our struggles with behavioural inflexibility, it can be difficult for us to “switch gears” from gaming to other activities and we can end up spending many hours hyper-focused on our screens.

Therefore, a desire to reduce social interactions combined with executive functioning differences work together to increase autistic people’s risk of experiencing ESW.^[30]Gaming Disorder and Computer-Mediated Communication in Children and Adolescents with Autism Spectrum Disorder (Paulus et al., 2019)

Support & prevention

While I’ve never experienced social withdrawal at this level, I know the feeling of not wanting to get out of bed and talk to anyone. I felt like I wasn’t achieving what I was supposed to achieve in life and that brought feelings of shame and low self-esteem that were too big to take on. In my experience (but also in research), these feelings make it challenging to find support. Similarly, while many people with ESW do want treatment, the internalizing nature of ESW blocks people’s view from seeing a pathway to support.^[31]Identification of the hikikomori syndrome of social withdrawal: Psychosocial features and treatment preferences in four countries (Teo et al., 2014)

Finding other neurodivergent people with similar experiences to talk to is always a great way to find support. Personally, when I’m feeling very disconnected from others, I’ve tried to stay engaged by reaching out to one person I haven’t talked to in a while. Recently, this looked like contacting an ND friend who was also feeling isolated and going on a walk together. During the walk, there were no expectations to talk much besides commenting on the various birds and the local vegetation around us, but we were both amazed at how much better we felt just existing and engaging with nature with someone else. This made it easier to open up to each other about our life’s challenges and showed us there is someone we can turn to when we need support.

While there has never been an easier time in history to fully sustain yourself within the confines of your home, advances in the Internet have never been better to communicate with like-minded people virtually. Interestingly, online gaming can also be a way for people to spend more time outside. For example, researchers have studied the popularity of the online game Pokémon Go, which has its participants physically travelling to new locations in the real world to “catch pokémon” and get rewarded with unique, in-game prizes from different locations. This game encourages people with ESW, through a platform exciting to them, to go outside their comfort zones where they will be rewarded. Games like Pokémon Go are an attractive way to get people to re-engage with the world and people around them.^[32]New game software (Pokémon Go) may help youth with severe social withdrawal, hikikomori (Tateno et al., 2016)

Have you experienced “hikikomori”? What helps you stay connected to others?

Summary

• There is no known cause for ESW; rather, there are many factors that increase your chances of experiencing it, including: experiencing trauma, depression, social anxiety, and cultural norms
• Autistics are highly vulnerable to experiencing ESW as we share similar experiences already (ex. difficulties with social interaction). Like people with ESW, autistics are highly vulnerable to using Internet platforms for significantly longer periods which may impair other important functions, like sleeping and spending time with family and friends
• Online gaming is of particularly high risk to autistics and people with ESW as its immersive and usually stationary nature encourages people to stay in one place for long periods. However, games like Pokémon GO are examples of how technology can be used to encourage people with social withdrawal to spend time outside