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Dr. Miguel Perez-Camacho Duque


Hikikomori Syndrome.

move within these disorders Today a brief introduction of the hikikomori which pioneered these studies and in this new social psychopathology Dr. T Japanese amaki Saito, who has nothing to do with called "Ninis" in Spain (or study or work) because they do not they want or to study or to work and live by the "silly soup at home from parents.). The

hikikomori ( sections of society) are teenagers and young adults who are overwhelmed by the Japanese company and feel unable to fulfill the roles social expected of them, reacting to social isolation. The hikikomori often refuse to leave the house of his parents and may be locked in a room for months or even years. Most of them are male , and many are also first-born. Such problems are centered ( although good, are not exclusive ) among middle-and upper, where the boy has his own room, which is considered a luxury in Japan. The Japanese word hikikomori isolation means in English. In traditional Japanese society was considered an insulation value.

While some people feel pressure from the outside world, and suffer from agoraphobia, a hikikomori reacts with a complete social isolation to avoid any external pressure. May be confined in their bedroom or another room in the house of his parents for long periods, often years. Usually have no friends, and mostly sleep during the day and watch TV or play computer overnight. All this makes them an extreme case of parasite singles ( Japanese expression to name those living on instant noodles, living in his parents' house for added comfort ).

The isolation from society usually begins gradually, before the hikikomori lock the door of his room. They are often sad, lost friends, become insecure, shy, and talk less. They are often teased at school, which may be the trigger for your privacy.

Most hikikomori maintain contact with the outside world only by the computer, television and online video games. However, in extreme cases, the hikikomori even this can be closed and remain for hours in the same position, staring at a fixed point, living in his imagination.


social phobia but does not meet the diagnostic criteria of DSM-IV -TR and ICD-10
Social Phobia F40.1 ICD-10
Social phobias often
begin in adolescence and revolve around the fear of being judged by others within a comparatively small group (unlike crowds) and lead to avoiding certain social situations. Unlike most phobias, social phobias occur with equal frequency in males and females. Some social phobias are restricted ( for example, eating in public, public speaking or meeting with the opposite sex ), others are vague and cover almost all social situations outside the family. The fear of vomiting in public may be important. Direct eye contact can be particularly troublesome in certain cultures. Social phobias are usually accompanied by a low estimation of himself and afraid of criticism. Can manifest itself as concern to blush, to have hand tremors, nausea or compelling need to urinate and sometimes the person is convinced that the primary problem is one of these secondary manifestations of anxiety. The symptoms can lead to panic attacks. Avoidance behavior is often intense, and in extreme cases can lead to almost complete social isolation.

Criteria for the diagnosis of F40.1

a. Marked and persistent fear of one or more social or performance situations in which the public person is exposed to people outside the family environment or to possible scrutiny by others. The individual is afraid to act in a way (or show anxiety symptoms) that is humiliating or embarrassing. B.

Exposure to the feared social situation almost invariably provokes an immediate anxiety response, which may take the form of a situational panic attacks more or less related to a situation. C.

The person recognizes that the fear is excessive or unreasonable. D.

Social or performance situations in public feared avoided or else are endured with intense anxiety or distress. E.

The avoidance, anxious anticipation, or distress in the situation (s) (s) or action (s) in public feared (s) interferes significantly with normal routine of the individual, occupational (or academic ) or social, or produce clinically significant distress. F.

In individuals under 18 years the duration of the symptom picture must be for at least 6 months. G.

The fear or avoidance is not due to the direct physiological effects of a substance (eg . Drugs, drugs ) or a medical condition and not better accounted for by another mental disorder (p. eg. Panic Disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, pervasive developmental disorder or schizoid personality disorder ).

h. If a medical condition or another mental disorder, the fear described in Criterion A is not associated with blind processes (eg . Fear is not due to stuttering, the tremors of Parkinson's disease or display abnormal eating behavior in anorexia nervosa or bulimia nervosa ).

Specify if: Generalized

: if the fears include most social situations ( also consider the additional diagnosis of disorder avoidant personality).

ICD-10 F40.0 Agoraphobia

The term encompasses a range of phobias related to each other, sometimes overlapping, including fear of leaving home, to drive the car in city or highway, to the workplace , to enter shops or stores, crowds, public places and traveling alone in trains, buses or planes.

Although the severity of anxiety and intensity of avoidance behavior are variable, this is the most disabling of phobic disorders and some individuals come to be completely homebound. Many patients are terrified of the possibility you can pass out or left alone, unaided, in public. Are often present depressive symptoms and social phobias and obsessive, but not dominate the clinical picture. In the absence of effective treatment of agoraphobia is often chronic, although its intensity may be fluctuating.

reaction of parents

Having a hikikomori in the family usually is considered a psychiatric problem is internal, and many parents wait too long before seeking psychological therapy. Ade more, in Japan the child's education is the responsibility of the mother, by tradition, and the parent can leave the whole problem of hikikomori the mother, which feels overprotective with her son. Initially, most parents simply expect him to overcome its problems and return to society of their own volition.
They see it as a phase that the child has to overcome. In addition, many parents do not know what to do with hikikomori, and just wait because of the lack of other options. Not normally force ( or take long to do ) dramatically the child to re-integrate into society. Having a
hikikomori in the family is often embarrassing, in Japan and is considered an internal problem of the family. Schools and social workers can ask questions, but usually not involved in the situation.
Many parents of hikikomori make the decision to send them abroad, hoping that the change of scenery will help, but all they do is pass the problem to the host family, being the way it was learned problem in the West.

Effects on Hikikomori.

The lack of social contact these people and prolonged isolation have a profound effect on the mentality, loss of social skills and the references necessary moral. Often the world of television and video games become their frame of reference.
If finally hikikomori ( often after a few years ) returns to society of their own accord, has to face the problem of having lost many of their social skills as well as years of study, aggravating reintegration. They fear that others will discover their past as hikikomori , and are hesitant to people, especially if they are unknown.

Their fear of social pressure can become anger, and loss of frame social referencing may also lead to violent or criminal behavior. In extreme cases come to attack and offend parents, and serve as examples: In 2000, a hikikomori 17 years hijacked a bus and killed a passenger. Another case was that of a hikikomori that a young girl kidnapped and held captive for nine years. Another killed four girls to recreate scenes from a guro manga hentai (pornographic comic gore) These cases are generalized by making the public think that all hikikomori is so, or making certain issues relating with the bad habits of these youth.

is difficult to get exact figures on individual cases, as many families choose not to talk about this problem.

There are different opinions about treatment should follow a hikikomori, and opinions are often divided into a Japanese perspective and a Western. The Japanese experts usually suggest maintaining contact without invading their space and try to rejoin society in a very progressive, while Western doctors think they need to maintain a position of strength and even act directly and forcefully. Forcing Hikikomori to leave their confinement.

In any case, it is necessary psychological help, as many parents are overwhelmed by the problems of a hikikomori. Although some physicians and clinics specializing in helping young hikikomori , many of them and their parents still feel lack of support for their problems.

complete social isolation appears to be mainly a Japanese phenomenon, but young people around the world suffer the same social pressure and may be mocked, so often creates a similar behavior of hatred and aggression . Several cases are known in Spain and Argentina's young lovers of Japanese culture, impersonators hikikomori.

therapeutic differences between East and West:

Dr. Saito, Psychiatrist intended as a guide:

• calm at home and accept the state of youth.
• Communication.
• Passive treatment: the remedy is not forcing them out of the room, is a wrong approach.

On the other hand, Dr. Henry Grubbs, a clinical psychologist at the University of Maryland (USA), West is his namesake and the first to submit an academic study outside Japan, since it is a specific condition of this country, proposes:

• Method of direct intervention.
• Immediate action. If necessary, enter the force in the room. • Nuclear family
determinant as an aid mechanism.
Interim conclusion

This syndrome of social phobia is something but does not meet all the criteria of DSM-IV-TR. Has something of a Diogenes syndrome ( waste, neglect of personal hygiene and generally occurs in older ) atypical. And it is something much of an excess of permissiveness in the domestic family is already present in the East, West, North or South. And an obvious risk of mimicry for the West.


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