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• W3038904739 abstract "The issue of social isolation and loneliness involving individuals during their developmental years has gathered increased attention from researchers, policymakers, and the public, raising concerns about the negative effects of this condition on youth's well-being. In youngsters, the use of media devices, including social network platforms, video games, and interactive apps, continues to increase exponentially and the initial use of social network is about 10 years of age.1Ehrich J.H. Kerbl R. Pettoello-Mantovani M. Lenton S. Opening the debate on pediatric subspecialties and specialist centers: opportunities for better care or risks of care fragmentation?.J Pediatr. 2015; 167: 1177-1188.e2Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar,2McDool E. Powell P. Rberts J. Taylor K. Social media use and children's wellbeing. The IZA Institute of Labor Economics. Bonn, Germany.http://ftp.iza.org/dp10412.pdfDate accessed: May 24, 2020Google Scholar This is likely owing to the use of using these tools to build a social identity and develop new, unconventional forms of personal expression. A new severe and prolonged form of social withdrawal, called hikikomori from a Japanese word indicating self-seclusion, was observed typically among adolescents and youth transitioning to adulthood, living in economically advanced countries.3Pozza A. Coluccia A. Kato T. Gaetani M. Ferretti F. The ‘Hikikomori’ syndrome: worldwide prevalence and co-occurring major psychiatric disorders: a systematic review and metaanalysis protocol.BMJ Open. 2019; 9: e025213Crossref PubMed Scopus (25) Google Scholar,4American Academy of PediatricsAmerican Academy of Pediatrics the new morbidity revisited: a renewed commitment to the psychosocial aspects of pediatric care. Committee on Psychosocial Aspects of Child and Family Health.Pediatrics. 2001; 108: 1227-1230Crossref PubMed Scopus (111) Google Scholar The objective of this editorial is to raise awareness on the burden and risks faced by adolescents developing this emerging form of social withdrawal. The hikikomori phenomenon is part of the group of new morbidities causing children and adolescents to limit their activity owing to a chronic health condition with attendant psychological problems.4American Academy of PediatricsAmerican Academy of Pediatrics the new morbidity revisited: a renewed commitment to the psychosocial aspects of pediatric care. Committee on Psychosocial Aspects of Child and Family Health.Pediatrics. 2001; 108: 1227-1230Crossref PubMed Scopus (111) Google Scholar We further emphasize the importance of including new morbidities involving mental health and social participation in formal pediatric training, to enable new generations of pediatricians to identify and properly manage these disorders.5Pettoello-Mantovani M. Ehrich J. Romondia A. Nigri L. Pettoello-Mantovani L. Giardino I. Diversity and differences of postgraduate training in general and subspecialty pediatrics in the European Union.J Pediatr. 2014; 165: 424-426.e2Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar The term hikikomori describes individuals who have withdrawn from their community.3Pozza A. Coluccia A. Kato T. Gaetani M. Ferretti F. The ‘Hikikomori’ syndrome: worldwide prevalence and co-occurring major psychiatric disorders: a systematic review and metaanalysis protocol.BMJ Open. 2019; 9: e025213Crossref PubMed Scopus (25) Google Scholar The initial reports emphasized the close relation of the clinical manifestation with the local culture, as suggested by the name, which is a compound Japanese word made of 2 verbs indicating the attitude of an individual “to pull back” (hiku) and “to self-seclude” (komoru).6Kato T.A. Kanba S. Teo A.R. Hikikomori: multidimensional understanding, assessment, and future international perspectives.Psychiatr Clin Neurosci. 2019; 73: 427-440PubMed Google Scholar However, increasing reports from around the world provided a better understanding of this condition and suggested that hikikomori is a global health problem, which may exist as an independent primary diagnosis.7Martín-López L.M. Córcoles D. Gonzàlez A. Bellsolà M. Teo A.R. et al.Malagón-Amor ÁFamily features of social withdrawal syndrome (hikikomori).Front Psychiatry. 2020; 11: 138Crossref PubMed Scopus (17) Google Scholar,8Kato T.A. Kanba S. Teo A.R. Hikikomori: experience in Japan and international relevance.World Psychiatr. 2018; 17: 105-106Crossref PubMed Scopus (63) Google Scholar The elemental attribute of hikikomori is the social isolation; the distinctive element is the sociospatial self-segregation of affected individuals, who are predominately adolescents and marginally young adults.9Yong R.K. Fujita K. Chau P.Y. Sasaki H. Characteristics of and gender difference factors of hikikomori among the working-age population: a cross-sectional population study in rural Japan.Nihon Koshu Eisei Zasshi. 2020; 67: 237-246PubMed Google Scholar This form of physical isolation typically take place at home, where these persons spend most of the day avoiding exposure to any form of socialization (at school, sport centers, and similar socializing contexts) for days, weeks, or months.10Teo A.R. Gaw A.C. Hikikomori, a Japanese culture-bound syndrome of social withdrawal? A Proposal for DSM-V.J Nerv Ment Dis. 2010; 198: 444-449Crossref PubMed Scopus (141) Google Scholar Hikikomori seems to be more prevalent in males.11Malagón-Amor Á. Córcoles-Martínez D. Martín-López L.M. Pérez-Solà V. Hikikomori in Spain: a descriptive study.Int J Soc Psychiatry. 2015; 61: 475-483Crossref PubMed Scopus (53) Google Scholar,12Kondo N. Sakai M. Kuroda Y. Kiyota Y. Kitabata Y. Kurosawa M. General condition of hikikomori (prolonged social withdrawal) in Japan: psychiatric diagnosis and outcome in mental health welfare centres.Int J Soc Psychiatry. 2013; 59: 79-86Crossref PubMed Scopus (97) Google Scholar The relative novelty of this clinical phenomenon accounts for the absence of a clear standardized definition.13Stip E. Thibault A. Beauchamp-Chatel A. Kisely S. Internet addiction, hikikomori syndrome, and the prodromal phase of psychosis.Front Psychiatry. 2016; 7: 6Crossref PubMed Scopus (64) Google Scholar Whether hikikomori is a symptom of other psychiatric disorders or the direct cause of co-occurring major mental health disorders is currently debated.13Stip E. Thibault A. Beauchamp-Chatel A. Kisely S. Internet addiction, hikikomori syndrome, and the prodromal phase of psychosis.Front Psychiatry. 2016; 7: 6Crossref PubMed Scopus (64) Google Scholar Hikikomori could be considered a new primary psychiatric disorder in future versions of the Diagnostic and Statistical Manual of Mental Disorders, despite the presence of some clinical overlap with other mental disorders.3Pozza A. Coluccia A. Kato T. Gaetani M. Ferretti F. The ‘Hikikomori’ syndrome: worldwide prevalence and co-occurring major psychiatric disorders: a systematic review and metaanalysis protocol.BMJ Open. 2019; 9: e025213Crossref PubMed Scopus (25) Google Scholar,14Kato T.A. Tateno M. Shinfuku N. Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation.Soc Psychiatry Psychiatr Epidemiol. 2012; 47: 1061-1075Crossref PubMed Scopus (129) Google Scholar Published reports have clarified the pathologic features of hikikomori, and have built a consensus regarding its clinical characteristics, complications, and management.13Stip E. Thibault A. Beauchamp-Chatel A. Kisely S. Internet addiction, hikikomori syndrome, and the prodromal phase of psychosis.Front Psychiatry. 2016; 7: 6Crossref PubMed Scopus (64) Google Scholar Individuals with hikikomori present a severe social isolation characterized by a marked physical self-inflicted seclusion in their home. Typically, such isolation persist for a minimum of at least 6 months, being associated with major functional impairment or distress.8Kato T.A. Kanba S. Teo A.R. Hikikomori: experience in Japan and international relevance.World Psychiatr. 2018; 17: 105-106Crossref PubMed Scopus (63) Google Scholar During the period of 3-6 months of self-isolation at home persons may be classified as presyndromic individuals.8Kato T.A. Kanba S. Teo A.R. Hikikomori: experience in Japan and international relevance.World Psychiatr. 2018; 17: 105-106Crossref PubMed Scopus (63) Google Scholar,13Stip E. Thibault A. Beauchamp-Chatel A. Kisely S. Internet addiction, hikikomori syndrome, and the prodromal phase of psychosis.Front Psychiatry. 2016; 7: 6Crossref PubMed Scopus (64) Google Scholar The characteristics and duration of isolation at home are key diagnostic factors. Individuals who break their status of isolation at home 4 or more times during a week cannot be classified as hikikomori. Persons may manifest different grades of disease, depending on whether the frequency of leaving home (mild, moderate, or severe hikikomori). The behavior of individuals who do not leave home more than 3 times a week is considered as marked social isolation.8Kato T.A. Kanba S. Teo A.R. Hikikomori: experience in Japan and international relevance.World Psychiatr. 2018; 17: 105-106Crossref PubMed Scopus (63) Google Scholar,13Stip E. Thibault A. Beauchamp-Chatel A. Kisely S. Internet addiction, hikikomori syndrome, and the prodromal phase of psychosis.Front Psychiatry. 2016; 7: 6Crossref PubMed Scopus (64) Google Scholar The difficulty in establishing the epidemiology of hikikomori is the wide heterogeneity in the definitions of this disorder as well as the criteria adopted by various studies performed in different countries. For instance, while in Japan the duration of social withdrawal longer than 6 months is considered a distinctive diagnostic criteria, in other countries, including the Republic of Korea, Hong Kong, and some European countries, this time limit is decreased to 3 months.15Lee Y.S. Lee J.Y. Choi T.Y. Home visitation program for detecting, evaluating and treating socially withdrawn youth in Korea.Psychiatry Clin Neurosci. 2013; 67: 193-202Crossref PubMed Scopus (83) Google Scholar,16H-yee Chan T-wing Lo Quality of life of the hidden youth in Hong Kong.Appl Res Qual Life. 2014; 9: 951-969Crossref Scopus (39) Google Scholar Therefore, the lack of consensus on diagnostic criteria, together with various sociocultural features involving a variety of cross-cultural factors, may account for the variable prevalence rates reported by the studies performed in different geographic areas.3Pozza A. Coluccia A. Kato T. Gaetani M. Ferretti F. The ‘Hikikomori’ syndrome: worldwide prevalence and co-occurring major psychiatric disorders: a systematic review and metaanalysis protocol.BMJ Open. 2019; 9: e025213Crossref PubMed Scopus (25) Google Scholar The prevalence of hikikomori ranges from 0.87% to 1.2% in Japan, whereas in Hong Kong it is reported to be 1.9%, and 2.3% in Korea.15Lee Y.S. Lee J.Y. Choi T.Y. Home visitation program for detecting, evaluating and treating socially withdrawn youth in Korea.Psychiatry Clin Neurosci. 2013; 67: 193-202Crossref PubMed Scopus (83) Google Scholar,17Wong P.W.C. Li T.M.H. Chan M. Law Y.W. Chau M. Cheng C. et al.The prevalence and correlates of severe social withdrawal (hikikomori) in Hong Kong: a cross-sectional telephone-based survey study.Int J Soc Psychiatry. 2015; 61: 330-342Crossref PubMed Scopus (80) Google Scholar, 18Norasakkunkit V. Uchida Y. To conform or to maintain self-consistency? Hikikomori risk in Japan and the deviation from seeking harmony.J Soc Clin Psychol. 2014; 33: 918-935Crossref Scopus (28) Google Scholar, 19Koyama A. Miyake Y. Kawakami N. Lifetime prevalence, psychiatric comorbidity and demographic correlates of “hikikomori” in a community population in Japan.Psychiatry Res. 2010; 176: 69-74Crossref PubMed Scopus (143) Google Scholar In Italy, hikikomori is estimated to involve about 1.2% of the population between 0 and 18 years of age, and in Spain, reports show that in groups of persons affected by social withdrawal, individuals diagnosed as hikikomori are 12.6%.11Malagón-Amor Á. Córcoles-Martínez D. Martín-López L.M. Pérez-Solà V. Hikikomori in Spain: a descriptive study.Int J Soc Psychiatry. 2015; 61: 475-483Crossref PubMed Scopus (53) Google Scholar,20Hikikomori Italia. Chi sono gli hikikomori?.www.hikikomoriitalia.it/p/chi-sono-gli-hikikomori.htmlDate accessed: June 20, 2020Google Scholar,21Poletto L. Hikikomori: growing number of young Italians choosing reclusive lives. La Stampa.2019www.lastampa.it/esteri/la-stampa-in-english/2018/07/30/news/hikikomori-growing-number-of-young-italians-choosing-reclusive-lives-1.34035351Date accessed: June 20, 2020Google Scholar Similar data were observed in France.22Chauliac N. Couillet A. Faivre S. Brochard N. Terra J.L. Characteristics of socially withdrawn youth in France: a retrospective study.Int J Soc Psychiatry. 2017; 63: 339-344Crossref PubMed Scopus (36) Google Scholar,23Furuhashi T. Figueiredo C. Pionnié-Dax N. Fansten M. Vellut N. Castel P.H. Seishin Shinkeigaku Zasshi. 2012; 114: 1173-1179PubMed Google Scholar In the US, 1 study described hikikomori as a cross-national phenomenon that can be assessed by a standardized assessment approach, which may assist the identification of hikikomori individuals in groups of persons with substantial psychosocial impairment and disability.24Teo A.R. Fetters M.D. Stufflebam K. Tateno M. Balhara Y. Choi T.Y. et al.Identification of the hikikomori syndrome of social withdrawal: psychosocial features and treatment preferences in four countries.Int J Soc Psychiatry. 2015; 61: 64-72Crossref PubMed Scopus (106) Google Scholar Hikikomori coexists with a variety of psychiatric disorders, which are suggested to be preexisting risk conditions that give raise to this disorder.6Kato T.A. Kanba S. Teo A.R. Hikikomori: multidimensional understanding, assessment, and future international perspectives.Psychiatr Clin Neurosci. 2019; 73: 427-440PubMed Google Scholar,12Kondo N. Sakai M. Kuroda Y. Kiyota Y. Kitabata Y. Kurosawa M. General condition of hikikomori (prolonged social withdrawal) in Japan: psychiatric diagnosis and outcome in mental health welfare centres.Int J Soc Psychiatry. 2013; 59: 79-86Crossref PubMed Scopus (97) Google Scholar For instance, it is not unusual for patients with psychotic disorders to retreat into a situation of physical withdrawal and persons with depression or affected by depressed mood may present symptoms that may evolve in the form of withdrawal-like outcomes.12Kondo N. Sakai M. Kuroda Y. Kiyota Y. Kitabata Y. Kurosawa M. General condition of hikikomori (prolonged social withdrawal) in Japan: psychiatric diagnosis and outcome in mental health welfare centres.Int J Soc Psychiatry. 2013; 59: 79-86Crossref PubMed Scopus (97) Google Scholar Social anxiety disorder and other anxiety-related disorders may trigger hikikomori, and anxiety in social interactions is a prominent comorbid psychiatric disorder among persons with hikikomori.25Teo A.R. Stufflebam K. Saha S. Psychopathology associated with social withdrawal: idiopathic and comorbid presentations.Psychiatry Res. 2015; 228: 182-183Crossref PubMed Scopus (37) Google Scholar Personality disorders, including avoidant, paranoid, dependent, schizoid, antisocial, borderline, narcissistic, and schizotypal, are reported to be risk factors for hikikomori. Severe physical fatigue and pain causing physical impairment when walking or moving may precipitate a hikikomori-like state.12Kondo N. Sakai M. Kuroda Y. Kiyota Y. Kitabata Y. Kurosawa M. General condition of hikikomori (prolonged social withdrawal) in Japan: psychiatric diagnosis and outcome in mental health welfare centres.Int J Soc Psychiatry. 2013; 59: 79-86Crossref PubMed Scopus (97) Google Scholar Therapeutic intervention for hikikomori is challenging. A multidimensional intervention is generally recommended in these patients, including a progressive approach centered on family support. It is unlikely that individuals with hikikomori will seek treatment spontaneously; therefore, in persons living with family members, the role of the family is of key importance. The initial approach, in close coordination with family members, is based on the first contact and assessment of the individual affected, followed by his or her direct support. These steps are followed by specific training interventions with intermediate-transient group activities (group therapy), and social participation trials.26Saito K. Hikikomori No Hyouka-Shien Ni Kansuru Gaido-Rain. Guideline of hikikomori for their evaluation and support. Ministry of Health, Labour and Welfare, Tokyo, Japan2010www.ncgmkohnodai.go.jp/pdf/jidouseishin/22ncgm_hikikomori.pdfDate accessed: June 20, 2020Google Scholar The goal is the alleviation of loneliness and the development of favorable conditions that allow increased social interactions and sociability.12Kondo N. Sakai M. Kuroda Y. Kiyota Y. Kitabata Y. Kurosawa M. General condition of hikikomori (prolonged social withdrawal) in Japan: psychiatric diagnosis and outcome in mental health welfare centres.Int J Soc Psychiatry. 2013; 59: 79-86Crossref PubMed Scopus (97) Google Scholar The hikikomori phenomenon affects adolescents or young adults who resolve to isolate from the outside world, often owing to preexisting risk conditions. They remain cloistered and particularly secluded in their bedrooms for days, months, or even years on end. This pathologic disorder has been described as a new independent condition, which can be included among the group of new morbidities.4American Academy of PediatricsAmerican Academy of Pediatrics the new morbidity revisited: a renewed commitment to the psychosocial aspects of pediatric care. Committee on Psychosocial Aspects of Child and Family Health.Pediatrics. 2001; 108: 1227-1230Crossref PubMed Scopus (111) Google Scholar The members of the European Paediatric Association working group on social pediatrics, would like to further emphasize the role of pediatricians in providing increased attention to the prevention, early detection, and management of the various behavioral, developmental, and social functioning problems represented by new morbidities,4American Academy of PediatricsAmerican Academy of Pediatrics the new morbidity revisited: a renewed commitment to the psychosocial aspects of pediatric care. Committee on Psychosocial Aspects of Child and Family Health.Pediatrics. 2001; 108: 1227-1230Crossref PubMed Scopus (111) Google Scholar which are increasingly encountered in pediatric practice.27Corsello G. Ferrara P. Chiamenti G. Nigri L. Campanozzi A. Pettoello-Mantovani M. The child health care system in Italy.J Pediatr. 2016; 177S: S116-S126Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar,28Ehrich J. Namazova-Baranova L. Pettoello-Mantovani M. Introduction to “Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations”.J Pediatr. 2016; 177S: S1-S10Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar" @default.
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• W3038904739 title "The Hikikomori Phenomenon of Social Withdrawal: An Emerging Condition Involving Youth's Mental Health and Social Participation" @default.
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