Social isolation associated with depression: A case report of hikikomori

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46 Scopus citations


Background: Social isolation is associated with significant morbidity and mortality. A severe form of social isolation or social withdrawal, called hikikomori in Japan, has been described, but controversy over the etiology and universality of the phenomenon remains. Method: Case report. Results: Diagnostic assessment by structured clinical interview and psychometric tools revealed hikikomori and underlying bipolar disorder, in which the patient's social withdrawal occurred exclusively during major depressive episodes. The patient declined pharmacotherapy, but his hikikomori and depression went into remission after 25 sessions of cognitive behavioural therapy targeting his social isolation. Conclusions: This is the first reported case of hikikomori in the Americas. It illustrates the association between hikikomori and a mood disorder, and suggests the importance of international study of the prevalence and potential treatment strategies for severe social isolation.

Original languageEnglish (US)
Pages (from-to)339-341
Number of pages3
JournalInternational Journal of Social Psychiatry
Issue number4
StatePublished - Jun 2013
Externally publishedYes


  • Bipolar disorder
  • Hikikomori
  • Social isolation
  • Social withdrawal

ASJC Scopus subject areas

  • Psychiatry and Mental health


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