[Psymobile and the phenomenon of the hikikomori]

Examining the hikikomori syndrome in a French sample of hospitalized adolescents with severe social withdrawal and school refusal behavior

While the term hikikomori (HKM) has spread internationally to describe a chronic and severe form of social withdrawal, its place in current nosography and its transposition into non-Asian cultures are still debated. A retrospective chart review was conducted to determine the rate and the clinical profiles of HKM among a French sample of adolescent inpatients. Data were obtained from 191 adolescents aged 12-18 years (M = 15.0, 44% boys) consecutively admitted in two inpatient units from January 2017 to December 2019. Using a retrospective diagnosis of HKM based on Teo and Gaw's criteria, we compared socio-demographic characteristics, clinical features, and treatment outcomes between HKM patients and those with other forms of social withdrawal and/or school refusal (SW/SR). At admission, 7% of participants met HKM criteria (n = 14, M = 14.3, 64% boys), one out of six adolescents with SW/SR. Among those with SW/SR, HKM + vs. HKM- participants had higher rates of anxiety disorder (Odd Ratio, OR = 35.2) and lower disruptive behavioral disorder (OR = 0.03). A minority of the participants with anxiety and depressive disorders met the HKM criteria (respectively, 15% and 9%), but those with HKM had a longer duration of symptoms, longer hospitalization, and required more daily care facilities at discharge compared to HKM-. While HKM syndrome could not be delimitated from anxiety disorder, it was associated with specific clinical features and treatment outcomes. The clinical characteristics observed were consistent with the features reported in Asian HKM adults, supporting face validity of this clinical concept in adolescent inpatients with different cultural contexts.

Characteristics of socially withdrawn youth in France: A retrospective study

BACKGROUND

Poor social interactions have been recognized as a symptom since the beginnings of psychiatry. As far as socially withdrawn youth (SWY) are concerned, studies were mostly conducted on patients seeking care. Our psychiatric outreach team called Psymobile was able to reach SWY patients who were not seeking mental health care.

AIMS

To identify the clinical and socio-demographic characteristics of SWY patients referred to our Psymobile unit.

METHOD

We carried out a retrospective study on the records of patients aged 18-34 years, who were referred to Psymobile for 'withdrawal', between April 2012 and December 2015.

RESULTS

In total, 66 patients were included in the study. SWY are predominantly male (80%) from large families or single-parent ones. About 42% had no prior contact with a mental health professional before being referred to Psymobile. The mean duration of withdrawal is 29 months. In all, 42% of SWY use cannabis and 73% present disorders of the sleep-wake schedule. About 71% maintain relations with their families and 73% go out occasionally. They are mostly diagnosed with schizophrenia (37%) or mood disorders (23%).

CONCLUSION

Over one-third of Psymobile patients aged 18-34 years were referred on grounds of social withdrawal. Our data may illustrate more accurately the situation of youth social withdrawal amid the general population than data from help-seeking patients or online questionnaires.