Asian Journal of Psychiatry 30 (2017) 175–176

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Asian Journal of Psychiatry

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Letter to the Editor

Does hikikomori (severe social withdrawal) exist among young people in urban areas of China? MARK

The situation of hikikomori (severe and prolonged social withdrawal) appears to have changed from a culture-bound phenomenon in Japan to an
international concern. We agree with this observation and would like to share our experience in China in support of this assessment.
China has experienced rapid development and many individuals residing in cities are experiencing lifestyles similar to those in high-income
countries such as Japan. To examine the situation of hikikomori in China, where there are no services for socially withdrawn individuals and where
little attention is paid to them, we conducted a novel survey through Chinese social media platforms. We utilized Weibo, one of the most popular
microblogging and social media sites in China, as the main recruitment platform. Using Weibo’s paid advertising service, survey invitations were sent
to 206,139 users who were 13–39 years old and whose IP addresses were located in Beijing, Shanghai, or Shenzhen.
We assessed the severity of withdrawal behavior through three survey items: (1) physical isolation or withdrawal to a particular place; (2) lack of
social connectedness and interaction; and (3) duration of social withdrawal for three months or more (Teo and Gaw, 2010; Wong et al., 2015).
Participants were classified into physically isolated only group (meeting criteria 1 and 3 only), asocial only group (meeting criteria 2 and 3 only), and
hikikomori group (meeting all three criteria). We also examined the respondents’ online and offline social behavior (Williams, 2006), parent-child
relationship (Liu et al., 2011), dependence and interdependence characteristics (Hashimoto and Yamagishi, 2013), and risk behaviors (Li and Wong,
2015a).
Between October 2015 and May 2016, we collected 137 completed responses. Among them, 108 participants were categorized as comparison
(39.81% male; mean (SD) age = 24.08 (6.76) years), 13 as physically isolated only (38.46% male; mean (SD) age = 18.54 (4.48) years), 7 as asocial
only (28.57% male; mean (SD) age = 22.67 (2.73) years), and 9 as hikikomori (66.67% male; mean (SD) age = 24.44 (6.23) years). We found that
hikikomori, when compared to comparison participants, was more likely to be male, have less offline social capital, have visited a mental health
clinic (all p < 0.05) and have suicidal ideation (odds ratios = 4.76). Physically isolated only individuals were more likely to be at higher risk of
experiencing risk behaviors, including unwanted pregnancy and debt (all p < 0.05), and were more likely to be socially disengaged and experience
less care from their father (all p < 0.05) when compared to comparison participants.
Using a culturally and contextually appropriate recruitment strategy, we were able to reach out to hikikomori-like youth in three major cities in
China. Our withdrawn participants are a heterogeneous group and each group appears to have distinctive features (Teo and Gaw, 2010). Hikikomori
in China seems to exhibit a higher risk of suicidal ideation and psychopathology, while physically isolated individuals suffer from developmental
difficulties, experience more risky behaviors, and have poor family relationships. The findings provide further empirical support to Li and Wong’s
framework that suggests individuals with more severe social withdrawal suffer from more psychological difficulties (Li and Wong, 2015a) and Kato
et al. hypothesis that “some common psychopathological mechanisms may exist in the act of “shutting in” (pp.xx, in press in World Psychiatry).
Although our sample size is small, considering the exploratory nature of this study and the difficulty inherent in reaching socially withdrawn
individuals, we believe the findings provide early evidence of the phenomenon of hikikomori in China. We are concerned about the phenomenon in
China for several reasons. First, China has the second largest population of young people in the world. Second, due to the One Child Policy
(1979–2015), a large proportion of hikikomori are likely to be single-children. In a society where parents rely on their children to look after them in
old age, this phenomenon may have devastating financial, psychological, and societal effects on many single-child families. Third, the advancement
of information and communication technology may further contribute to youth disengagement and withdrawal, and exacerbate the “shutting-in”
psychopathological mechanism among young people in emerging adulthood. Lastly, educational attainment has long been perceived as a priority for
many young people in Asian societies. There is a preoccupation with academic-oriented subjects and an ignorance of multi-intelligences in young
people that lead to different pathways to success. This has led to even higher educational pressures on young people that may have created a
population who retreat to the security of social media, online gaming platforms, and social withdrawal as their only way out.
Taken together, we believe these reasons provide a rationale for psychiatrists and other professionals to closely study hikikomori and potentially
develop practices to intervene with young people experiencing severe social withdrawal in China. Examining the emerging international dimensions
of hikikomori is of vital importance due to the implications for marginalization, powerlessness, and civic apathy (Li and Wong, 2015b) among young
people in countries with an aging population.

Conflict of interest

None.

References

Hashimoto, H., Yamagishi, T., 2013. Independence, Rejection Avoidance, and Harmony Seeking Scales. PsycTESTS Dataset. American Psychological Association (APA).
Li, T.M., Wong, P.W., 2015a. Youth social withdrawal behavior (hikikomori): a systematic review of qualitative and quantitative studies. Aust. N. Z. J. Psychiatry 49 (7), 595–609. http://

http://dx.doi.org/10.1016/j.ajp.2017.10.026
Received 22 September 2017
1876-2018/ © 2017 Elsevier B.V. All rights reserved.
Letter to the Editor Asian Journal of Psychiatry 30 (2017) 175–176

dx.doi.org/10.1177/0004867415581179. PubMed PMID: 25861794.

Li, T.M.H., Wong, P.W.C., 2015b. Editorial Perspective Pathological social withdrawal during adolescence: a culture-specific or a global phenomenon? J. Child Psychol. Psychiatry 56
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⁎
Paul W.C. Wong , Lucia L. Liu
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
E-mail address: paulw@hku.hk
Tim M.H. Li
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
Takahiro A. Kato
Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Alan R. Teo,,
VA Portland Health Care System, HSR & D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R & D 66), Portland,
OR 97239-2964, United States
Oregon Health & Science University, Department of Psychiatry, Portland, OR, United States
Oregon Health & Science University and Portland State University, School of Public Health, Portland, OR, United States

⁎
Corresponding author.

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