Researchers develop tool to identify, treat pathological social withdrawal

TOKYO: Researchers have created a new method to assist physicians and researchers in assessing patients for pathological social withdrawal, often known as Hikikomori.

The tool, known as the Hikikomori Diagnostic Evaluation, or HiDE, can serve as a useful guide for gathering information on this rapidly developing pathology worldwide.

Hikikomori is a condition defined by prolonged physical isolation or social withdrawal lasting more than six months. It was first established in Japan in 1998, and while it was assumed to be a Japan-specific 'culture-bound' condition, subsequent data has shown a significant increase in its global prevalence.

Researchers and medical professionals are particularly concerned that the recent COVID-19 epidemic has exacerbated the global increase of hikikomori patients. However, no standardised tool for identifying hikikomori disorder exists.

The new HiDE evaluation instrument, published in World Psychiatry by Associate Professor Takahiro A. Kato of the Graduate School of Medical Sciences, is meant to be the next stage in a transcultural tool to help identify and assess hikikomori patients.

In 2013, Kyushu University Hospital created the world's first hikikomori outpatient clinic with the goal of researching the pathology and developing improved treatment methods. Kato and his team have developed many approaches for early detection of hikikomori throughout the years, and they have even looked into possible pathology biomarkers.

"Hide is a questionnaire we've been developing at our clinic at the University Hospital. We've refined it over the years, and today it takes roughly 5-20 minutes to complete depending on the answers," explained Kato.

"It's primarily divided into two sections. The first section looks at the features of the patient's behaviour to see if they exhibit hikikomori. The second section is used to help us gain context to the patient's extent of social withdrawal."

The team has also added a screening form to the HiDE in case clinicians lack the time to administer the entire tool. They suggest that the full questionnaire be administered to patients who respond that they 'spend one hour or less per day out of their home, at least three days a week' and that 'their family, others, or are personally bothered by this.'

"The HiDE has proven to be an indispensable tool for the structured assessment of pathological social withdrawal in our clinical practice and research. But more empirical studies must be done to assess its validity beyond our practice," concluded Kato.

"We would like to see this used by our colleagues around the world, so we can work to refine the tool. Hikikomori is becoming a global phenomenon, and a collective effort in recognizing and treating hikikomori is going to be vital."