Hikikomori is a severe form of social withdrawal that emerged in Japan during the late 1990s. At the time, it referred to the phenomenon where those transitioning to adulthood would physically isolate themselves in their rooms. Now, hikikomori is categorized as physical withdrawal within one’s home for at least six months that causes severe impairment to one’s life. Hikikomori can have serious consequences on an individual’s ability to live a normal life, and to better understand how to help those with hikikomori, knowing how to assess hikikomori is crucial.
Before 2018, there were two tools related to understanding hikikomori that were developed and tested in Japan. The Hikikomori Behavior Checklist and the NEET/Hikikomori Risk Scale. The Hikikomori Behavior Checklist was designed to be answered by a parent about their child and the NEET/Hikikomori Risk Scale focuses more on work attitudes and withdrawal. While these tools were a helpful first step, a more standardized tool was needed based on the psychological and social characteristics of hikikomori that could be evaluated by self-report.
With this gap in the literature, Dr. Teo and his team developed the 25-item Hikikomori Questionnaire. When first designing this measure, 59 draft questions were included that captured various attributes of hikikomori. Prior to this, Dr. Teo and his team had established common hikikomori characteristics outside of Japan. The common features that individuals with hikikomori shared were high levels of loneliness, avoidance of and weak social connections and moderate impairment to their everyday lives. With these themes in mind, questions were first drafted in Japanese and reviewed by experts in psychiatry and hikikomori. The scale was developed through a factor analysis, where out of the original 59 questions, common themes were identified. From this, 25 questions were narrowed down to cover the three overarching themes: Socialization, isolation, and emotional support. Since the development of this new tool for assessing hikikomori, it has been translated and validated in nine different languages and is available to the public. Now, the HQ-25 has become an important assessment tool in the world of hikikomori.
Alongside a self-assessment tool, while researching hikikomori, Dr. Teo helped develop a structured interview form for clinicians to use when assessing for hikikomori. This interview form, the Hikikomori Diagnostic Evaluation (HiDE), focuses on hikikomori symptoms in the past month and has two sections. The first section focuses on key features of hikikomori like social withdrawal. This section not only asks individuals how they feel about their social withdrawal, but also if they believe others in their lives have been concerned about them. This is important, as often those with hikikomori tend to deny their distress but can observe the distress experienced by those close to them. The second section offers the opportunity to learn more about the patient, through asking questions about their work, school, and personal interests. This tool is still in its early stages and the developers of the tool have called on other researchers to test its reliability and validity.
Both the HQ-25 and the HiDE are helpful tools to better understand if someone has hikikomori. The HQ-25 can be self-administered and might be a helpful first step to better understanding if someone’s symptoms are in line with hikikomori. More research is still needed to establish if hikikomori should be a clinical diagnosis, and therefor in diagnostic manuals like the DSM-5. However, regardless of its official status, it remains a serious form of social withdrawal, that can have negative health and mental health outcomes.