Hikikomori and modern-type depression in Italy: A new phenotypical trans-cultural characterization?

INTRODUCTION

Hikikomori is a Japanese term etymologically derived from 'hiku' (i.e. 'to pull back') and 'komoru' (i.e. 'seclude oneself'), which identifies those subjects who deliberately withdraw themselves by social life, remaining confined into their own home/room. The phenomenon is widely diffused in Japan, even though it is currently spread outside the Japanese culture. However, a universally shared and cross-cultural adaptation of Hikikomori definition, phenomenological and psychopathological characterization is still missing.

METHODOLOGY

An expert-guided opinion paper was here provided to clinical characterize the Hikikomori-like social withdrawal in the Italian context, by considering the transformation from a family-based society to a 'fluid' digital-structured culture, also discussing the concept of modern-type depression. This was provided deepening the principal current studies available in literature and giving an interpretation based on clinical experience in the Italian society. The work was supervised through a consensus by the most international expert of Japanese Hikikomori syndrome.

RESULTS

Current individual, family and social trajectories may potentially act as a mediator in favouring the occurrence of Hikikomori-like social withdrawal also in western countries, including Italy. Despite the differences between Japanese and Italian society and culture, the recent shaping of family structure and intra-familial dynamics, typical of the current post-modern society, may potentially influence the emergence of psychopathologies not typical of Italian culture. Unemployment and 'Not in Employment Education or Training' (NEET) conditions may represent another potential risk factor for economical/social marginalization of youngsters, together with the recent dramatic emergence of web-based psychopathologies.

CONCLUSION

A diagnostic culturally-adapted flow-chart is proposed for clinical characterizing Hikikomori in Italian context, which may help in proposing preventive strategies, ensuring early identification and prompt therapeutic interventions, particularly among youngsters.

Psychological Traits of Patients With Depression Comorbid With Chronic Pain: Are Complaint and Competitive Tendency Related to Pain?

BACKGROUND

Modern-Type Depression (MTD) is a category of depression that has been studied mainly in Japan; however, no study has attempted to determine its relation to chronic pain.

AIM

To determine possible associations between psychological traits related to MTD and the chronic pain of patients at psychiatric clinics.

METHOD

Two hundred and twenty-one first time patients who visited the psychiatric clinic at a Japanese university medical center or an associated clinic were enrolled. The Hamilton Depression Rating Scale was used to measure depressive symptoms. The 22-item Tarumi's Modern-Type Depression Trait Scale (TACS-22), Achievement Motive, and 20-item Toronto Alexithymia Scale were used to assess psychological traits related to depression and chronic pain. The clinical diagnosis of each patient was confirmed by use of the Structured Clinical Interview for DSM-IV Axis I Disorders, administered by experienced specialists. The medians of the psychological traits identified were compared between patients with or without chronic pain. Analysis was also done of patients with Major Depressive Disorder (MDD).

RESULT

Of the 221 patients, 139 had chronic pain. Patients with chronic pain had more severe depressive symptoms, Alexithymia, and high scores for the complaint trait of MTD. Seventy-three of the 221 patients met the criteria for MDD (53 had chronic pain). Patients with MDD comorbid with chronic pain had a higher competitive achievement score, severe depression, and difficulty identifying feelings.

CONCLUSION

Complaint and competitive traits were shown to be related to chronic pain in psychiatric settings. Further study will allow us to design multidimensional approach for patients suffering from depression.

Autism spectrum conditions in hikikomori: A pilot case-control study

AIM

Hikikomori, a form of pathological social withdrawal, has been suggested to have comorbidity with autism spectrum disorder (ASD). This study aimed to clarify how characteristics of hikikomori are associated with ASD, including undiagnosed autism spectrum conditions (ASC), in clinical settings.

METHODS

A total of 416 clinical patients were recruited through the Mood Disorder/Hikikomori Clinic at Kyushu University Hospital. A total of 103 hikikomori cases and 221 clinical controls without hikikomori conditions were extracted using a semi-structured interview, and completed a series of self-rated scales, including the Japanese version of the Autism-Spectrum Quotient (AQ-J).

RESULTS

Compared to non-hikikomori controls, hikikomori cases were more likely to have higher autistic tendency based on the AQ-J. The cases showed more severe subjective depressive symptoms based on the self-rated Beck Depression Inventory II, whereas no significant difference was found on interview-based severity evaluation using the Hamilton Depression Rating Scale. Comparison within hikikomori cases based on the AQ-J cut-off score revealed that hikikomori cases with high ASC were significantly more likely to have higher traits of modern-type depression, smaller social networks, and less social support.

CONCLUSION

The present data suggest that hikikomori sufferers are more likely to have autistic tendency, and that hikikomori sufferers with high ASC may have much more difficulty in social communication and social interaction. In addition, those with high ASC may also have lower self-esteem and higher complaint tendencies as aspects of modern-type depression traits, which may relate to the occurrence of hikikomori. Thus, evaluating autistic tendencies is important for appropriate interventions in hikikomori. Further investigations should be conducted to validate our pilot findings using structured diagnostic systems of ASD.

Social status and modern-type depression: A review

BACKGROUNDS

Social hierarchy is one of the most influential social structures employed by social species. While dominants in such hierarchies can preferentially access rich resources, subordinates are forced into lower social statuses and lifestyles with inferior resources. Previous studies have indicated that the social rank regulates social behaviors and emotion in a variety of species, whereby individual organisms live within the framework of their ranks. However, in human societies, people, particularly young men, who cannot accept their own social status may show social withdrawal behaviors such as hikikomori to avoid confronting their circumstances.

METHODS

This article reviews the neural mechanisms underlying social status identified in animal studies with rodents and primates, and assesses how social rank affects animal's social behaviors and emotion which may be relevant to modern type depression.

RESULTS

Several brain regions such as medial prefrontal cortex are implicated in the formation of animal's social status, which leads to the differences in vulnerability and resilience to social stress.

CONCLUSION

On the basis of these findings, we propose that physical interventions such as voluntary exercise, diet, transcranial direct current stimulation, and psychotherapy, rather than psychotropic drugs, may be useful therapeutic approaches for modern type depression, which is a typical example of social status conflict and a phenotype of adjustment disorder to the traditional hierarchical social order.

Hikikomori : Multidimensional understanding, assessment, and future international perspectives

Hikikomori, a severe form of social withdrawal, has long been observed in Japan mainly among youth and adolescents since around the 1970s, and has been especially highlighted since the late 1990s. Moreover, hikikomori-like cases have recently been reported in many other countries. Hikikomori negatively influences not only the individual's mental health and social participation, but also wider education and workforce stability, and as such is a novel urgent global issue. In this review, we introduce the history, definition, diagnostic evaluation, and interventions for hikikomori and also the international prevalence of hikikomori outside Japan. We propose a hypothesis regarding the globalization of hikikomori based on domestic and international perspectives. In addition, we introduce our latest assessment system for hikikomori (including the latest version of the 'proposed diagnostic criteria of hikikomori for the future DSM/ICD diagnostic systems') and propose therapeutic strategies, including family approaches and individualized therapies. Finally, we present future challenges that may lead to solutions for an internationalized hikikomori.

Perceptions of traditional and modern types of depression: A cross-cultural vignette survey comparing Japanese and American undergraduate students

AIM

Depression is a heterogeneous disorder that has various subtypes. In Japan, however, a prevailing misunderstanding is that the term utsu-byo (clinical depression) indicates only the melancholic type. Consequently, a subtype called 'modern-type depression' (MTD), which has contrasting features to those of melancholic or traditional-type depression (TTD), is severely stigmatized in Japan these days. The present study conducted a cross-cultural comparison of perceptions of TTD and MTD between Japan and the USA to examine how the Japanese collectivistic culture contributes to negative biases toward MTD.

METHODS

Undergraduate students in Japan (N = 303) and the Midwestern USA (N = 272) completed the survey. They read two vignettes that described the conditions of fictional individuals with either TTD or MTD, and then reported their perceptions of each vignette.

RESULTS

Mixed analyses of variance revealed significant interactions between nation (Japan or the USA) and vignette (TTD or MTD) on most perception items. These interactions and subsequent analyses with Bonferroni corrections mainly indicate the following: (i) Japanese are more likely to suppose that conditions of MTD are milder compared with TTD; and (ii) Japanese are more likely to hold stronger aversive attitudes and weaker willingness to provide support toward people with MTD than toward those with TTD.

CONCLUSION

These results indicate that people with MTD are more likely to be accepted in the US independent culture than in the Japanese collectivistic culture. Discussion highlights that cultural diversity education potentially reduces stigma of MTD in Japan.