Abstract
With up to 1,400,00 Japanese youth affected, “Hikikomori,” or social withdrawal, has become alarmingly common in Japan. Children of traditional middle and upper middle class families, whose parents are civil servants, teachers, farmers, corporate executives, and business owners, are highly likely to develop Hikikomori. Despite near-epidemic proportions and media prominence, few systematic studies have addressed the condition. This case study describes the clinical phenomenology, etiology, and treatment methods of thirty-five clients at a private clinic in Japan. All patients presented with a loss of secure attachment, and two-thirds had dual personality systems. Their primary clinical feature was inability to trust or relate to others. Families appeared outwardly functional, however, clients reported histories of emotional neglect and abuse. To adapt to emotionally dysfunctional parents, they repressed original identities and authentic feelings and created false front identities. Emotional neglect, absence of parental-child communication, and inhibition of self-expression may underlie Hikikomori. Successful treatment depends on the recovery and healthy attachment of the original identity. Although a progressive condition, treatment prognosis is good with early intervention.
