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The selected phenomenon of the digital society – Hikikomori syndrome

Annamária  Šimšíková

Abstract: The paper aims to identify and propose possible solutions in the case of perception of the level of professional competencies of first-year students of the follow-up study of teaching at the Faculty of Science, Palacký University Olomouc, from the perspective of their head teachers. Branch, diagnostic, information, managerial and communication competencies were selected. The theoretical part presents the characteristics of competencies from the perspective of selected authors, followed by an overview and characteristics of teacher competencies and a description of teacher competencies as means for successful development of professional skills. Furthermore, the organization of the first continuous pedagogical training at the Faculty of Science, Palacký University Olomouc is described. As part of the exploratory survey, a semi-structured questionnaire was created, which was attended by a total of 60 secondary and primary school teachers in the Olomouc Region. Its aim was determined by the way in which teachers evaluate the competencies of teacher students for their first continuous pedagogical training. The discussion shows the summary of the results of the questionnaire survey by the leading teachers of training. In the end the analysis of the importance of the implementation of pedagogical training at the Faculty of Science, Palacký University Olomouc is supplemented by subjects aimed at improving the current situation.

Keywords: Bio-psycho-socio-cultural model, diagnostics, hikikomori, intervention, psychiatric and social disorders.

1. Introduction

The worldwide restriction during the Covid-19 pandemic included isolation and preventing direct communication between risk groups and the environment or within families. Lockdown and home office were introduced. Höschl (2022) states that the given situations can be considered a model "hikikomori", and the need to use the Internet is close in nature to netholism and hikikomori.

Theoretical starting points - the concept of hikikomori

The term hikikomori, from the Japanese "to pull out" (hiku) and "to break away" (komoru), represents a severe form of social withdrawal. A hikikomori is defined as "a person who withdraws into isolation". For the first time, the hikikomori syndrome was observed in Japan among youth and adolescents in the 1970s. In the 1970s and 1980s, the hikikomori phenomenon in Japan was associated with truancy or "school refusal" - (futoko). Saitō (1998) described hikikomori individuals as those who become reclusive in their own homes, beginning in the second half of the third decade of life, and for whom other psychiatric disorders do not better explain the primary symptom of withdrawal. Since the mid-1990s, it has been known as "social withdrawal", and The Oxford Dictionary of English (2010) defines hikikomori as "an abnormal avoidance of social contact, usually by adolescent males" (Stevenson, 2010).

Hikikomori syndrome (HS) is a form of pathological social withdrawal or social isolation, the essential feature of which is physical isolation in the home (Kato, Kanba, Teo, 2019, p. 217). In Spain, the syndrome is known as (niño caracol) - "the snail", and also (la puerta cerrada) - "the closed door" (Ferrerós, 2021). In South Korea, we find a similar state of hikikomori as (Oiettolie) (Lee, Lee, Choi, Choi, 2013).

In September 2019, the government portal nippon.com published revised statistics registering 1.15 million hikikomori aged 15-64 (nippon.com, 2019). Saitō predicted an increase in the Japanese population affected by Hikikomori syndrome to 10 million inhabitants by 2020. (Cantero, 2020; nippon.com, 2019).

Cases similar to hikikomori have been reported in other countries. Concerning the trend, Kato and Kanba (2016) shift the original understanding - tying the syndrome to Japanese culture to "a syndrome tied to modern society", while the authors state in a 2018 paper that hikikomori "may have global health implications".

The hikikomori problem has been observed in Europe; for example, in Portugal, the first cases were reported in 2017 (Macedo, Pimenta et al., 2017). In Italy, more than 100,000 children between the ages of 14 and 25 do not study, do not work and refuse any contact with family and friends apart from the life they lead on the web. They stay in their rooms, often sleeping during the day and eating at night when no one sees them (Poletto, 2018). A statistical investigation of the hikikomori phenomenon in Italy was conducted by Marco Crepaldi, the results of which were published in 2019. The presence of hikikomori was also recorded in France (Skrzyniarz, 2019); in Barcelona, Spain, Hospital del Mar registered 164 hikikomori cases (Ferrerós, 2021).

In 2013, it was the first research clinic to investigate the hikikomori phenomenon created at Kyushu University Hospital in Japan (exploringyourmind.com, 2022). On May 22, 2014, the Center for Japanese Studies (CEJ) in Toulouse organised a study day, and the lectures were on the problem of social withdrawal and the hikikomori syndrome focus (Galanom, 2014).

From a theoretical point of view, we add that the research entitled A 12-month Study of the hikikomori syndrome of social withdrawal: Clinical characterisation and different subtypes proposal by the authors Malagón-Amor, Martín-Lopez et al. (2018), which is the first in Europe that focuses on hikikomori. The hikikomori phenomenon is also primarily addressed by Tamaki Saitō in Social Withdrawal: Puberty without End (1998), Marco Crepaldi in the publication Hikikomori: Young People Who Do not leave home (2019) and María Luisa Ferrerós in the publication Dame la mano (2021).

2. Methodology

Within the theoretical study, we present the phenomenon of social withdrawal - the hikikomori syndrome. At the theoretical level, we provide a brief insight into the issue, specifically focusing on the characteristics of hikikomori while paying attention to causal factors and typologies of the phenomenon. The reason for choosing the topic is the fact that the hikikomori syndrome represents a problem of a multidimensional nature, it does not only concern the biological-psychological component of the personality but also the socialisation component of the personality and, at the same time, reflects the state and functionality of society. Social pedagogy, a field primarily focused on preventing pathological phenomena within the social environment, shows eminent interest in new pathological phenomena. Social pedagogy, as a particular pedagogical science under the conditions of the Slovak Republic, mentions the problems of modern society as an object of interest (Hroncová, Emmerová, 2008; 2009). The research aims to provide insight into the Hikikomori syndrome at its theoretical level. Based on the set goal of the research, we set out a research question of an exploratory nature of RQ: What are the status and characteristics of the Hikikomori syndrome within the framework of socio-pathological phenomena at its theoretical level?

We chose the type of research for the chosen topic - theoretical research. Since it was an investigation of a phenomenon, it was qualitative research, and the exploratory design of the work was chosen. The orientation of the research had an analytical-synthetic nature. The primary method of work was content analysis.

In order to collect meanings, the following methods were used: literary method, analogy, and at the same time, the processing method - analysis. We used the literary method when studying the sources. The research file consisted of available communications - text in verbal form, namely: monograph, yearbook, scientific studies, and professional articles. We obtained the research file from available printed sources. We obtained resources from platforms for science and research: Willey Online Library, Elsevier - Science Direct, Frontiers, Springer scientific portfolio and PubMed source. We also drew resources from the Center for Japanese Studies of the University of Liège or the university repository of Waseda University in Japan. We obtained information mainly from journal publications focused on psychology, psychiatry, therapy, and humanities, such as the International Journal of Environmental Research and Public Health, International Journal of Social Psychiatry, World Psychiatry, Psychiatry and Clinical Neurosciences, Psychiatry Research and others. We also included audio recordings from the TEDx conference in the research file. From podcasts broadcast on Czech radio Dvojka nozzles and French radio Ivoox. Contributions published on the official Italian website of the association for the hikikomori issue - hikikomoriitalia.it - were included among the potential sources. Social media sites Reddit and Facebook were also searched. For selecting the initial text documents, we determined the criterion - keywords: hikikomori, social withdrawal, psychiatric and social disorders, and therefore the set selection was deliberate. From the basic set, there were included just 75 communications to the research. We present the communications in the bibliography. Among the supporting sources, we include works by authors: Takahiro Kato, Shigenobu Kanba, Alan Teo, Naotaka Shinfuku, Norman Sartorius, Masaru Tateno, Tamaki Saitó, Paul Wong and Marco Crepaldi.

The processing method - content analysis - was primarily used to process the documents. Logical qualitative methods (analysis, synthesis, and induction) processed meaning units from theoretical sources. We also used the analogy method to evaluate the suitability of theoretical sources for research based on keywords. The direction of analysis of text documents was inductive based on the established criteria. Also, based on the determined criteria, selective coding was used to process text documents. We primarily focused on the phenomena expressed explicitly, and in the first analysis - informative reading, we obtained information about the headlines. As part of the second analysis - with the help of cursive reading, we familiarised ourselves with the contents of the text documents. We searched for other sources based on the informative value and focus of the content of the available sources. Our effort was to reach the moment of theoretical saturation.

Through relational analysis, we investigated connections and relationships between meaning units. Through the synthesis method, we grouped meaningful units, which resulted in the identification and content of categories: characteristics, causal causes, classification, diagnosis, and prevention. As far as qualitative research is concerned, we have ensured the credibility of the research by including quotations and paraphrases. Moreover, for transferability needs, we present the limits at the end of the thesis.

3. Results

Characteristics of hikikomori

A hikikomori individual is characterised by features such as a sense of shame (haji) (Farese, 2016), excessive dependence on family relationships (amae) (Doi, 1973), mistrust of others and mistrust of oneself, concern for the future (when thinking about one's social obligations) and depressive feelings (Kato, Kanba, Teo, 2019). Corresponding characteristics include selfishness, narcissistic tendencies, easy traumatisation and low resilience Kato, Hashimoto, Hayakawa (2016).

From a psychological point of view, a hikikomori individual can manifest:

• emotional-cognitive reactions: reduced motivation and activity (anhedonia), passive aggressiveness, indirect anger (Kato, Kanba, Teo, 2019), morbid moodiness and irritability (dysthymia) (Watabe et al., 2008).
• avoiding a behavioural response: escaping from the real world, withdrawing from social participation, social phobia, and escaping into the world of the Internet (Kato, Kanba, Teo, 2019).

The Hikikomori rating system

Kato, Kanba Teo (2019) created a diagnostic set consisting of mandatory and optional criteria:

a) mandatory specifiers include:

• Physical withdrawal - social isolation in the home (Teo, Gaw, 2010; Kato, Kanba, Teo, 2019; 2020).
• Withdrawal from social participation, insufficient social participation (Teo, Fetters, Stufflebam, 2015), significant and persistent avoidance of social situations such as compulsory education, and employment, including part-time employment. Teo and Gaw (2010) also include other social interactions - outside the home, groups and friendships.
• Time point of view - this is a long-lasting condition, continuous social isolation (Teo, Gaw, 2010), when individuals spend most of their time (days, weeks, months) in their homes. Kato, Kanba and Teo (2020) specify that the isolation should last at least six months. According to Höschl (2022), the average time of isolation of a hikikomori individual lasts four years, ranging from a few months to 9 to 10 years. It is confirmed, for example, by a Japanese survey from 2010, where isolated cases were older than seven years (Tajan, 2017). Höschl (2022) states that an individual's isolation either naturally subsides or becomes a mental disorder after adulthood. Crepaldi (2022) points out that it is never a phase of life; it is possible to remain in the state of hikikomori for life.
• Significant functional impairment or suffering associated with social isolation, whereby the suffering hinders the social life of the individual (Teo, Fetters, Stufflebam, 2015; Kato, Kanba Teo, 2019; 2020).

Social withdrawal and avoidance significantly interfere with a person's routine, work, academic functioning, social activities or relationships (Teo, Gaw, 2010). After the initial feeling of relief after escaping the painful reality, feelings of loneliness sets in, and the condition leads equally to suffering.

We add other conditions that are essential in the evaluation of hikikomori:

Absence of a psychotic disorder (Kato, Kanba, Teo, 2019; 2020), i.e. the exclusion of the range of conditions that characterises disturbing contact with reality.
• Voluntariness - the person perceives withdrawal as ego-syntonic (Teo, Gaw, 2010); that is, it is a safety mechanism by which the behaviour of the individual control what he believes, axiological system, and goals.

b) optional specifiers additionally characterising manifestations of the phenomenon can include:

• Cultural background - sociocultural peculiarities. A sociocultural feature can be, for example, the Japanese emotional expression of shame (haji). Farese (2016) explains that if individuals feel that some personal "bad things" could become public knowledge, they prefer to "let it disappear". This action is considered a virtue in Japanese culture.
• Age - in many cases, the syndrome manifests itself in preadolescents (at the beginning of adolescence) and adolescents and the period of early adulthood between the ages of 15-39 (Yong, Nomura, 2019). In Italy, they recorded hikikomori cases at the age of 12 (Crepaldi, 2022). Older people can also be included in hikikomori (Kato, Kanba, Teo, 2019).
• Interaction - insufficient social interaction (Teo, Gaw, 2010). The person avoids direct social interaction with family or acquaintances. The individual engages in meaningful personal social interactions (conversations) with people outside the home either occasionally (2-3 days per week) or rarely (1 day per week or less) (Kato, Kanba, Teo, 2019). In connection with the given characteristic of the Hikikomori syndrome, it should be added that individuals do not show antisocial behaviour and, despite the tendency to avoid direct relationships, they remain involved in social interactions through digital technologies and therefore participate in a new indirect form of sociability (Crepaldi, 2018).
• Social interactions of hikikomori individuals often take place through digital communication technologies (e.g. social media, online games); therefore, Kato, Kanba and Teo (2019) proposed to reconsider the understanding of virtual relationships in virtual space, while these should not be counted as social interactions. Diagnostic criteria should distinguish between virtual relationships with people with whom personal interactions occur (e.g. Facebook) and virtual relationships without face-to-face interaction (through a fictitious avatar or online games), as the interaction is entirely different from the character as a person would interact personally. Ferrerós (2021) agrees that an accompanying hikikomori phenomenon may be the excessive use of connected digital technologies (especially video games and social networks).
• Communication. – with hikikomori, indirect communication (via websites and technologies) may be prioritised over direct communication. Online tools (social networking services and online games) provide hikikomori individuals with two-way indirect communication (Adamski, 2018). Online communication can worsen social withdrawal and hinder the development of social skills acquired in interpersonal interaction (Hamburger, Ben-Artzi, 2000).
• The peculiarity of hikikomori is the incidence according to gender; this phenomenon is four times higher in men than in women (Kondo, Iwazaki et al., 2007). The prevalence of hikikomori in favour of men can be explained by the fact that more cases of men have been reported in published cases.
• We believe including a specifier - rhythms - would be appropriate in diagnosing hikikomori. Individuals follow collective and private rhythms. According to Boë (2022), young hikikomori detach themselves from collective time, adopting personal rhythms that do not conform to other socially given rhythms. School rhythms, paradigms of social rhythms, can be disrupted during withdrawal from the world, and the connection between personal rhythm and collective pace may be absent for hikikomori people.

Causal factors of hikikomori:

The Ministry of Health, Labor and Welfare (MHLW) issued the first guideline for hikikomori in 2003, describing the various reasons that can lead to an individual leaving society (Ito, 2019). The basis of the occurrence of hikikomori in the 21st century may be bio-psycho-socio-cultural mechanisms. As part of the work, we present the causes from the personal area and social areas: Personality - physiological causes: Avoidance of social relationships can be caused by biological factors: genetic predisposition (Höschl, 2022), functional impairments that prevent movement, significant physical fatigue and pain. Other causes include skin diseases (Mriuchi, Ito, Kikuchi, 2015) and gastrointestinal diseases (Nomura, Shibuya, Osada, 2014). Exploringyourmind.com (2022) mentions factor - biomarkers increased level of activity of ornithine and serum arginase, or changes in acylcarnitines.

Personality - psychological causes: Avoidance as a unique coping strategy is a natural response to stressful situations involving social situations and social judgments. Social withdrawal may not be a disorder, but it can eventually become a disorder due to the long-term state where it already acts as an extreme expression of the rejecting object (according to W. D. Fairbairn's theory from 1952). In hikikomori individuals, the strategy of avoiding a stressful situation is strengthened due to their low resistance or easy traumatisation (Kato, Hashimoto, Hayakawa, 2016; Kato, Katsuki, Kubo et al., 2019), as well as due to low or absent tolerance to frustration.

Personality traits: Selfishness and narcissistic tendencies may occur (Kato, Hashimoto, Hayakawa, 2016; Kato, Katsuki, Kubo et al., 2019).

Co-determining conditions can be psychiatric disorders. Comorbidity problems are an accompanying phenomenon of almost every psychiatric disorder; the coexistence of a non-psychotic phenomenon - the Hikikomori syndrome as a symptom of some psychiatric disorders - has been found. The research domain (RDoC) has been proven to determine hikikomori criteria (Insel, Cuthbert, Garvey et al., 2010). With the most significant frequency, hikikomori occurs together with a group of personality disorders (Teo, Gaw, 2010); it is a personality disorder that avoids risk; isolation is caused, for example, as a result of fear of criticism or rejection (Kato, Kanba, Teo, 2019). Hikikomori is a concomitant phenomenon of a group of disorders of the schizophrenic spectrum, schizophrenia (Watabe et al., 2008; Teo, Gaw, 2010), a group of psychotic disorders, here Watabe and his team refer to a group of obsessive compulsions and a pervasive developmental disorder. There are recorded cases of hikikomori as an accompanying phenomenon to a group of neurodevelopmental disorders - developmental, intellectual disorder and autism spectrum disorder (ASD), in which a deficit in social interaction and communication is manifested. There is a significant connection with the group of depressive disorders, especially major depressive disorder, where avoidance of social situations is caused by neurovegetative symptoms (Kato, Kanba, Teo, 2019).

Modern-type depression (MTD) can also be a factor in the occurrence of hikikomori, within which individuals typically tend to escape from society (Kato, Kanba, 2017). In connection with the anxiety/ avoidance disorder group (Teo, Gaw, 2010), there is a comorbidity of hikikomori with social anxiety disorder. Avoiding social situations may occur due to anxiety in social interactions or fear of embarrassment (Kato, Kanba, Teo, 2019). Teo, Stufflebam, and colleagues (2015) provide other anxiety-related disorders. Watabe and colleagues (2008) report the connection of hikikomori with the group of traumatic and stress-related disorders, where hikikomori is associated with, for example, a generalised anxiety disorder. Furthermore, there is a link between hikikomori and adjustment disorder. In this context, T. Kinugas brought the name (ichijisei) "idiopathic hikikomori" (Teo, Gaw, 2010). Within other mood disorders (Watabe et al., 2008; Teo, Gaw, 2010), hikikomori is often associated with dysthymia (Watabe et al., 2008). Last but not least, hikikomori is associated with a group of disorders associated with addiction (Pozza, Coluccia et al., 2019); for example, Kato, Shinfuku, and Tateno (2020) show in research that hikikomori could be comorbid with Internet addiction. Kato, Kanba, and Teo (2019) also mention a group of other mental disorders; Kato, Shinfuku et al. add that hikikomori can be considered a precursor symptom of suicide (In Okkels, Kristiansen, Munk-Jørgensen, 2017).

On the other hand, hikikomori could appear as a causal factor for a mental disorder; for example, it could be related to the group of "sleep pattern disorders" - wakefulness, insomnia, insomnia. Social-socialisation causes: One of the causes can be socialisation problems inability to establish contact. The stimulus for hikikomori withdrawal can be negative social experiences such as truancy, school refusal (futoko) (Kato, Kanba, Teo, 2019), social exclusion from social activities, rejection by peers, bullying (Höschl, 2022), as a result of which to the development of post-traumatic stress disorder (PTSD) (Kato, Kanba, Teo, 2019). Mild traumatisation can also occur as a result of negative experiences from childhood (Kato, Hashimoto, Hayakawa, 2016; Kato, Katsuki, Kubo et al., 2019; Höschl, 2022) or disappointment in love.

One of the most significant negative influencing factors is the family pattern and dynamics: socioeconomic status and parenting styles. The absence of the participation of one of the parents can also affect the development of hikikomori (Kato, Kanba, Teo, 2019). Excessive protective parenting (kahogo), as stated by Höschl (2022), or hyper-protection of one‘s parents, as stated by Batini, Corallino and the collective (2017), promotes clinical behaviour (amae) in individuals - excessive dependence on family relationships. It is considered an acceptable way of behaviour even in adulthood and is accepted by parents (Doi, 1973). Another negative is the family's pressure to fulfil the child's tasks in society (study, work), fulfilling the expectations that the child must surpass the parents and always have a better life and a better career (Crepaldi, 2022; Höschl, 2022). Höschl states that the trigger can be situations where the child's academic results are perceived as insufficient or the presence of other psychopathology of the parent (2022).

In addition to personal factors supporting the emergence of hikikomori, there are interacting factors resulting from society. It can be changed in the framework of the development of society - uncertainty in society, caused, for example, a result of the collapse of long-established systems in society, irregular employment, and unemployment (Kato, Kanba, Teo, 2019). Melman cites the cause of the decrease in the "gravity" of society in the sense that youth are growing up without prospects (In Suzuki, 2022). Michael Zielenziger notes the processes of social withdrawal in The Sun Syndrome: How Japan Created Its Own Lost Generation (2006). The nature of the society is also proving to be risky - an "internet society" in which, thanks to IT, it is possible to study and work without leaving home (Kato, Kanba, 2016); it brings possibilities such as "pure shopping" together with advanced delivery networks, various forms of entertainment, which provides the opportunity to lead a more isolated way of life. Momose (2014) adds that this situation is also supported by an inappropriately set up government social security system that provides young people with financial and social support. Another significant problem arising from the nature of society is being trapped by society. Kato and Kanba (2016) approach that due to the constant interconnectedness in society, where the demarcation between private and public space is absent, hikikomori represents an unconscious action - withdrawal to regain the lost space. The individual strives to requisition a mental space where he can safely be with himself. We add that the current social situation can also trigger the withdrawal of individuals. In this context, we can mention the Covid-19 pandemic, in which restrictive measures were introduced, sports activities were limited, nightlife was closed, and other stressful situations limiting free movement arose, which resulted in a lack of usual socialisation (Ferrerós, 2021).

Classification of hikikomori

Within the hikikomori syndrome, we encounter several of its divisions. Kunifumi Suzuki (2022) divides hikikomori into two basic types:

• Primary hikikomori - a subject who does not meet any of the diagnostic criteria for a psychiatric disorder that would allow the reporting of social withdrawal behaviour.
• Secondary hikikomori - a type of subject whose abstinent behaviour is manifested as a result of a characterised psychiatric disorder. Kato, Kanba, and Teo (2019) state the diversification of hikikomori into stages according to the level of severity and time. We list them in ascending order:
• Individuals frequently leaving their homes (4 or more days/ week) do not meet the criteria for hikikomori.
• Individuals occasionally leaving their home (2-3 days/ week) are characterised as (mild)
• Individuals rarely leaving their home or room (1 day/ week or less) are characterised as (moderate)
• Individuals who do not leave their homes are characterised as (severely)

Based on the time point of view, a division of hikikomori was created according to the period of isolation:

1. pre-hikikomori Kato, Kanba, Teo (2019) or also junhikikomori (Higuchi, 2006), or even semi-hikikomori (Su, Li, Wong, 2021), it is a continuous social withdrawal of at least three but not six months. Occasionally, he attends school and university but avoids social relationships.
2. hikikomori - continuous social isolation for at least six months (stays home almost daily).

The portal exploringyourmind.com (2020) provides four identified types of hikikomori from the aspect of socialisation:

• Pre-hikikomori: attends college or university courses while trying to avoid any other type of social interaction.
• Tachisukumi-gata: shows a solid social phobia and is paralysed by fear when faced with the outside world.
• Netogehaijin: literally "computer zombie" - a wholly isolated individual spending all his time with electronic equipment or in other virtual environments.
• Social hikikomori: refuses to work, study, has social relationships, mostly online relationships. We add that the given group is also "shakaiteki hikikomori". It is a standard version of hikikomori, complementing Hiroshi (2017). Sociologist Maïa Fansten (2015) presented four categories/ types of hikikomori from the behavioural aspect:
• Alternative pick-up – this is an "avoidant way of regulated adolescence", non-acceptance adapted to the typical dynamics of modern existence, and there is an effort to grow up differently. The mentioned kind of rebellion against society as an oppressive entity aimed at restricting freedom is experienced in a long way - a strong existence of depression.
• Reactive withdrawal - defined as a "symptomatic reaction to the situation" that happens when the individual is or has been marked by experiences in the family context, school or social environment. Withdrawal is therefore related to an event considered to be highly traumatic. At the same time, the intense reactions of anxiety, shame and stress created in individuals are subsequently generalised to all social contexts and strongly threaten their ability to create good social relationships.
• Resignation - "a way to escape from strong social pressure". Individuals cannot resist the pressure of social fulfilment resulting from society in general, competition for what is in society and parental expectations; as a result, they refuse to devote themselves to school, work or social career and decide to hide what they alleviate the suffering, at least partially.
• Retreat "Chrysalis" - "suspension of time, expressing the impossibility of being an autonomous adult individual". The individual seeks an escape from the duties and tasks of adulthood by isolating himself, while the feeling of the absence of an ability to deal with the tasks causes him to fear. He approaches existence with a flattening of the present, thoughts about Crepaldi (2017) states that individuals want to "freeze time" by adopting strategies such as changing sleep-wake rhythms.

Effects of hikikomori

The condition of hikikomori negatively affects the individual:

a) physical health (absence of physical movement, eating an unbalanced diet);

b) mental health (can induce the emergence of MDT. Another negative is that the initial phase of feeling relief in social withdrawal is replaced by a feeling of loneliness, which leads to a state of suffering (Kato, Kanba, Teo, 2019);

c) change of daily rhythms (Boë, 2022; Crepaldi, 2017), insomnia (sleep during daytime hours, activity during nighttime hours);

d) social participation of the individual, and inclusion (Höschl, 2022), absence and loss of direct social contacts, relationships, and friends). Kato, Kanba and Teo (2019) state that hikikomori also has an impact on the social environment:

e) family environment;

f) more comprehensive education;

g) stability of the labour force

Thus, the Hikikomori syndrome represents a multidisciplinary scientific problem, intersecting with medicine, sociology, anthropology, education, politics, economics and culture (Castelpietra, Nicotra, Leo, 2021).

Diagnosis of hikikomori

According to Höschl (2022), the following personality types belong to the endangered groups:

a) with a tendency to addiction;

b) with a tendency to introversion;

c) with a tendency to social withdrawal;

d) with disorders of interpersonal relations;

e) with communication disorders;

f) in the period of puberty during primary generational defiance to the previous generation – oppositional defiance to parents;

g) individuals susceptible to diagnoses (autism, Asperger syndrome).

The occurrence of hikikomori can be captured in a given country across the board through:

• social network services, such as #HikikomoriParliamone (www.facebook.com, e.d.a), on the media platform Reddit, where data collection is carried out through an online questionnaire (www.reddit.com/r/hikikomori, e.d.). In 2018-2020, Pereira-Sanchez and his team conducted an international Twitter-hikikomori study in which they analysed public conversations related to hikikomori on the Twitter media platform through mixed quantitative social media methods (Pereira-Sanchez, Alvarez-Mon, 2021).
• government surveys include epidemiological surveys (Koyama, Miyake, Kawakami et al., 2010) and telephone epidemiological surveys (Wong, Li, Chan et al., 2015).
• self-report format (Kato, Shinfuku, Sartorius et al., 2011; Kato, Shinfuku, Sartorius et al., 2012).

The Hikikomori syndrome represents several interconnected dimensions. Therefore its multidimensional assessment is required within the diagnosis framework. Aspects of hikikomori can be evaluated based on a bio-psycho-social-cultural model, representing the causal non-psychiatric and psychiatric factors. At the same time, we want to stress that we paid attention to causal factors in the work above; here, we will briefly summarise the areas of the model. The non-psychotic state of hikikomori can be assessed based on psychological factors such as loneliness, shame, low trust, low self-esteem, sociocultural factors such as an interdependent society, weaker adopted values, and biological factors such as inflammation, oxidative stress and microglia. The level of psychiatric status of a hikikomori can be assessed based on factors such as depression (anhedonia, suicidal thoughts, loss of motivation), personality disorders (avoidant, narcissistic, schizoid), PTSD and trauma (psychological pain), social anxiety (anxiety, fear, phobia, escape), autism spectrum disorders (problems with social communication and social interaction), schizophrenic psychoses (self-deception, hallucinations). Kato, Kanba, and Teo (2019) add that aspects are further evaluated in the diagnosis: age of onset, triggering life events, and severity of hikikomori conditions (duration of withdrawal, frequency of leaving home, contact with family members and friends).

Individual dimensions can be diagnosed with already existing relevant diagnostic tools. For example, the diagnostic set for the hikikomori phenomenon needs to be completed; research and the related development or verification of diagnostic tools are ongoing in this area.

In addition to biological assessments, psychological tools can be used for the diagnosis of hikikomori: the semi-structured interview system for the diagnosis of hikikomori (Teo, Fetters, Stufflebam et al., 2015), the structured clinical interview for axis I and axis II DSM-IV disorders, the Internet addiction test, the scale of social networks Lubben (LSNS-6) and the Sheehan Disability Scale, the UCLA Loneliness Scale (SDS) (Teo, 2016), or a clinical interview with SCID I/II diagnostic criteria (Teo, Stufflebam, Saha et al. 2015). Psychometrics is used, for example, to capture the tendency of Internet addiction (Tateno, Teo, Shiraishi et al., 2018). One of the tools is the trust game, in which the characteristics of behaviour can be assessed, unconscious decision-making can be evaluated, and interpersonal relationships can then be estimated.

To measure hikikomori from the psychometric properties, social support and problematic internet use, a diagnostic tool - questionnaire (HQ-25) was developed and validated in Japan (Teo, Chen, Kubo et al., 2018). It is a 25-item questionnaire in which the respondents' opinions and attitudes does record on a Likert scale from (strongly disagree - 0) to (completely agree - 4). Based on the HQ-25 questionnaire, Amendola, Presaghi, Teo and Cerutti (2022) created an Italian version with good psychometric properties. The tool measures psychoticism, personality dysfunction, social support and problematic internet use. The tool uses a three-factor model (socialisation, isolation, and social support). The results were published in Psychometric Properties of the Italian Version of the 25-Item Hikikomori Questionnaire.

Prevention of hikikomori

Primarily hikikomori can be solved through cooperation in education, administration, partner support and support organisations. Secondary hikikomori requires priority medical measures (Suzuki, 2022).

Universal prevention can be ensured through various forms of support:

• mental health care centres (Kato, Kanba, Teo, 2018), such as a public community support centre (Kato, Kanba, Teo, 2019).

Kato, Kanba, and Teo (2019) further state:

• telephone consultations,
• creation of "meeting spaces" for people with hikikomori,
• Support for job placement for clients suffering from hikikomori,
• private institutions providing support to clients and parent
• 's associations. For example, in Italy, the awareness project Hikikomori Italia Associazione Nazionale was established in this direction in 2013. Since 2017, it has been operating as a national association whose primary goal is to raise awareness of the public and institutions about the hikikomori issue, the creation of a national network for those interested in the issue - psychologists, teachers and experts (www.hikikomoriitalia.it, e.d. b). It is part of the association Hikikomori Italia Genitori, which supports parents and relatives of children with problems of social isolation (www.hikikomoriitalia.it., d. c).

Intervention and therapy

Since secondary hikikomori is not the domain of social pedagogy, we refer to it marginally in our work. Intervention and therapy for an individual with comorbid hikikomori type consist of biological pharmacotherapy intervention. At the same time, psychotherapy is provided - in the form of psychoanalysis. The psychodynamic psychoanalytical approach is part of individual or group psychotherapy to solve problems with interpersonal relationships in the family, school, or workplace. Psychological support in groups focuses on learning contact with people and social and communication skills (Kato, Kanba, Teo, 2019).

Psychosocial intervention can be used to help rehabilitate an individual to a healthy state of being without the use of pharmaceutical assistance. It aims to change a person's behaviour and relationships to healthier social interaction. Psychosocial intervention can be used in cases of mental disorders, eliminating negative behaviour, especially harmful addictions. The key to the success of a psychosocial intervention is to educate the sufferer and their family or support system about the condition and access to treatment. Several types of intervention styles are associated with psychosocial intervention, all of which fall under two main lines: cognitive therapy (remedies) and behavioural therapy (Psychosocial Intervention: Definition & Examples, 2022). Psychosocial intervention is used within the framework of work with an individual with the type of primary hikikomori.

Kato, Kanba, and Teo (2019) add that a precise individualised approach should be followed when working with an individual based on assessments.

As part of the environmental intervention, the following procedures can be implemented:

• removal of risk factors by the parent;
• removal of risk factors by peers;
• work with the child himself to expand the behavioural area and reactions to deal with difficult life situations (psychotherapy) (Höschl, 2022).

In 2010, the MHLW issued guidelines for hikikomori recommending a four-step intervention:

• family support, first contact with the individual and his evaluation;
• individual support;
• training with an intermediate group situation (such as group therapy);
• social participation test (Saitō, 2010).

Options for the 1st level of support can be added here: Within the 1st level of support, a "home visit" program can be implemented. The social work of an expert (for example, a social worker) consists of visiting a household to develop an intervention study, based on which subsequent steps of work with the client will be determined (Lee, Lee, Choi, Choi, 2013).

Forms of therapeutic support are provided based on the results of the multidimensional assessment of hikikomori. Kato, Shinfuku, Sartorius, and Kanba (2017) state that therapies are implemented based on multidimensional therapeutic approaches.

The family approach when working with the hikikomori problem represents a key landmark in the contact of professional help with a hikikomori individual, as the client himself rarely seeks professional help. The goal of family interventions - work with the family is to remove prejudices against the existence of a mental condition, acquire appropriate knowledge and techniques for dealing with hikikomori individuals, react appropriately and intervene in time in the direction of eliminating the pathological phenomenon (Kato, Kanba, Teo, 2019).

For family intervention, "systemic family relationship therapy" can be implemented (Maglia, 2020). Another option is a mental health education program based on the MHFA manual by Kitchener, Jorm, and Kelly (2013). It is intended for parents and individuals of hikikomori; the goal is to identify, understand and respond to signs of mental illness and crisis, including suicidal behaviour. The course consists of five steps:

1. access to the person, assessment and assistance in any crisis;
2. hearing the person without judgment;
3. provision of support and information;
4. encouraging the person to seek appropriate professional help;
5. support of further support.

Within the 1st level of support, intervention can be provided through the intervention tool - community strengthening and family education (CRAFT) (Sakai, Nonaka, 2013).

In addition to psychosocial intervention, online intervention can be used; for example, the online game Pokemon Go released in 2016, appears to be effective in the initial stages of the hikikomori condition; it involves the client leaving home in an attempt to find a Pokemon (Teateno, Skokauskas, Kato et al., 2016). The game uses location information and augmented reality.

In conclusion, we present selected forms of hikikomori therapy:

Art therapy – (kintsugi) technique: traditional Japanese art (joining broken ceramics using lacquer mixed with powdered gold) is promoted by former hikikomori artist Atsushi Watanabe. Art represents a space for the sublimation of emotional pain, mediating negative, antisocial feelings through a socially acceptable and positive process and presents a philosophy of resilience. The breaking does not mark the end of the object or something to be hidden, but on the contrary highlighted because it is part of the history of the given object (Holtaway, 2021).

Animal therapy – is a program for clients who are not inclined to have direct contact with others (Wong, Yu, Li et al., 2019).

Robot therapy – Sony Aibo robotic animal (Kerepesi, Kubiyi, Jonsson et al., 2006).

4. Discussion

The main idea of the work is that the Hikikomori syndrome can be considered one of the predictors of the state of society. The syndrome of social withdrawal paradoxically appears in Society 5.0, as UNESCO puts it - in a "super-intelligent society" striving for a sustainable, inclusive socioeconomic system powered by digital technologies (2019). Despite the assumption that a society with the mentioned attributes provides an inclusive environment for self-realisation, it exhibits a phenomenon whose distinctive feature is the impossibility of asserting oneself in society. We consider the mentioned trend critical from the point of view of knowledge. We find an analogy of the existence of the socio-pathological phenomenon of hikikomori in the studies of John B. Calhoun, known as "Utopia of mice" or "behavior sink" from 1947, specifically in phase C (days 315-560) (Budkowski, 2016). "Among the males, there were numerous behavioral disorders ... pathological shyness ... Some individuals moved around the enclosure only when the other animals were sleeping. Only at that time, they went to feed and drink. A new generation of mice tried to integrate into society but was drastically expelled. The social roles of the group have already been divided. Well-nourished mice lived to a great age and did not release these functions to the young. The overabundance of young males who did not find employment in society led to aggressive attacks among themselves as well..." (Blahová, 2015). We believe that hikikomori represents the type of behaviour of a part of the population recorded in phase C (days 315-560) in Calhoun's study of 1947. We recommend paying attention to this idea from the point of view of social sciences.

Further in the work, we find that hikikomori represents a multidimensional problem; it shows similarities with other psychosocial disorders and social phenomena. For this reason, it is necessary to specify the differences when classifying it and selecting the phenomenon's fundamental attributes.

Here is a comparison with several examples of disorders and social phenomena:

• taijin kyofusho - a disorder involving a solid fear of interpersonal relationships, and personal interactions, a culture-bound syndrome (Nakagami, Russ, Taijin, 2017). Ramirez (2018) states that an individual fears that their appearance, smell, or other perceived flaws offend others. The main feature is the fear of being insulted or hurt in an unpleasant social interaction or because of perceived physical flaws (Kirmayer, 1991).
• Agoraphobia - anxiety disorder, manifested by an intense fear of public spaces, of situations such as transport in public transport, and movement in department stores (Heretik, 2015). The individual feels unreal (derealisation), as a result of which he tries to avoid situations.
• Netholism – addiction to the Internet, addictive, impulsive disorder. Disruption of interpersonal relations occurs due to a change in the hierarchy of values - the retreat of reality in favour of virtual reality. Höschl (2022) states that the difference between netholism and hikikomori lies in tolerance, addiction to the Internet, i.e. the need to increase consumption of social networks, relapse and withdrawal syndrome. The mentioned aspects are absent in hikikomori, while the problem of social isolation is in the foreground. While the use of the Internet appears to be a destructively influencing factor concerning the non-social, in the case of hikikomori in isolation, it appears to be a helpful therapeutic communication tool, i.e. a communication channel with the broader environment.
• student apathy – a form of partial withdrawal, student apathy that leads to early graduation, while young people remain active in society in other areas. Hikikomori is distinguished by its complete withdrawal from society (Suzuki, 2022).
• kodoku-shi - "death by loneliness" affects the older generation; individuals live alone after the death of a partner without social interactions, remaining undiscovered for days, weeks, or months after death. It is believed that hodoku-shi live in a state of hikikomori for several months before death, Kato, Shinfuku et al. (In Okkels, Kristiansen, Munk-Jorgensen, 2017).
• kajitetsudai - "domestic helpers" and (shufu) "housewives" who are absent from social interactions with people outside their immediate family are in a state similar to hikikomori (Kato, Kanba, Teo, 2019).
• NEET - according to Eurostat, this is a person between the ages of 15 and 24 who is not employed and has not participated in any education or practical skills training (work/apprenticeship) during the past four weeks (Lelkes, Kmeť et al., 2019). The main characteristic is inactivity (Batini, Corallino et al., 2017). The phenomena of NEET and hikikomori have a joint spectrum of characteristic features (Uchida, Norasakkunkit, 2015), such as hyper-protection by one's parents (Batini, Corallino et al., 2017), while the difference between the phenomena lies concerning social life. A NEET enjoys a physically social life, maintaining social relationships, while a hikikomori physically distances itself.

We do not have all the theoretical materials at our disposal as a possible limit of the work, as several sources have been charged. However, a lack of erudition in cultural specifics and psychology or limiting the scope of work can also be considered a study limitation.

Conclusion

Every individual realises withdrawing from the social environment engulfed by stimuli into his home due to the requisition of mental space. Suppose the individual perceives the withdrawal as ego-syntonic, is carried out voluntarily, lasts longer than six months, interferes with the routine, reduces the individual's social contact and ultimately causes suffering. In that case, this is a pathological phenomenon - Hikikomori syndrome. In Europe, Hikikomori syndrome began to receive attention due to the Covid-19 pandemic. Hikikomori can often have a comorbid character, but it can appear as a non-psychotic phenomenon arising from personality factors and the influence of the social environment. The phenomenon harms the individual but also the family environment. If the collective nature of hikikomori is prominent in the social environment, it can impact the education system and the stability of the workforce. Since the problem of hikikomori is multidimensional, the diagnostic tools still need to be completed, but the existing diagnostic tools can catch them. One of the tools is the HQ-25 questionnaire, which the non-expert public can also apply. Psychosocial intervention techniques and other therapeutic procedures are used to prevent the hikikomori problem.

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Informace o autorovi

Mgr. Annamária  Šimšíková

Pedagogická fakulta, Univerzita Mateja Bela, ,

Ružová 13

97 411  Banská Bystrica

Slovak republic

annamaria.simsikova@umb.sk