SOCIAL ISOLATION AND SCHOOL REFUSAL: THE FIRST ADOLESCENT CASE OF HIKIKOMORI IN THE UNITED STATES

Objectives: To educate providers about the symptoms of Hikikomori syndrome using a rare case in the United States.Background and Aims: Hikikomori syndrome is an extreme case of social isolation and school refusal in adolescence once thought to be bound to Japanese culture. In recent years, a growing number of case reports have been described in countries outside of Japan. Here we present the first adolescent case of Hikikomori syndrome ever documented in the US.Materials and Methods: We describe a case of a 17-year-old Chinese-American male with Hikikomori syndrome. He was diagnosed using the proposed Hikikomori diagnostic criteria by Teo and Gaw (2010). He did not meet criteria for another psychiatric diagnosis.Results and Conclusions: Our patient presented with 18 months of increasing social isolation and school refusal that had culminated in complete withdrawal and living alone in his parentsu2019 old home. The onset of his isolation appeared to coincide with peer rejection at school. While initially resistant to engaging in therapy, his symptoms improved during a two-week hospitalization and he returned to living with his parents and attending school. Providers used limit setting to target his symptoms and psychotropic medications were not used. Hikikomori is an extreme example of social withdrawal and school refusal that sheds light on the growing problem of social isolation among adolescents. The recent rise in case reports of Hikikomori syndrome outside of Japan underscores the need for international epidemiologic studies and diagnostic clarification of this syndrome.