Hikikomori as a Transdiagnostic Phenomenon: Links with Autism, Anxiety, and Internet Use

In recent decades, clinicians and researchers have become increasingly aware of a form of extreme social withdrawal lasting at least six months, known as hikikomori[1]. The term was coined in the late 1990s by Japanese psychiatrist Saitō Tamaki to describe individuals who withdraw almost entirely from social life, isolating themselves within their home – often in a single room – refusing school or work, and avoiding face-to-face relationships. While some remain connected through the internet, gaming, or social media, their offline social world becomes markedly restricted.

Beyond isolation, hikikomori may involve significant functional impairment, fear of social interaction, psychological distress, and – rarely – aggressive behaviour toward family members. Although it is not formally classified as a psychiatric disorder in the DSM-5 or ICD-11, it is increasingly recognised as a clinically relevant condition frequently associated with other mental health disorders and neurodevelopmental conditions.

Beyond Japan: A Global Phenomenon

For many years, hikikomori was considered specific to Japanese society, possibly linked to intense academic pressure and rigid social expectations. However, international research – including studies conducted in the Netherlands and Italy – confirms that similar patterns of prolonged social withdrawal occur globally. What began as a culturally specific observation has evolved into a recognised international mental health concern, particularly among adolescents and young adults.

Rather than being culture-bound, hikikomori is now understood as a transdiagnostic entity – a phenomenon that crosses diagnostic categories (Tolomei et al. 2023).

Carpita et al. (2024) suggest that hikikomori may represent:

• An attempt to retreat from perceived societal failure

• A maladaptive coping strategy in response to anxiety or depression

• A clinical condition intertwined with neurodevelopmental vulnerabilities

Although classically described as remaining confined to one’s room or home, recent conceptualisations propose a continuum of severity (MacLellan & Takano 2026). Some individuals may reduce social participation without being completely housebound.

Prevalence estimates range from 1.1% to 6.7%, suggesting that hikikomori is not rare. Moro et al. (2025) argue that it is likely underestimated and represents an increasing challenge for families, educators, and healthcare systems.

Hikikomori and Autism Spectrum Disorder (ASD)

One of the most consistent findings across studies is the association between hikikomori and ASD.

Research suggests that ASD and hikikomori share several characteristics:

• Social communication difficulties

• Reduced socio-emotional reciprocity

• Preference for solitude

• Smaller social networks

• Increased loneliness

Functional neuroimaging studies have identified overlapping alterations in brain regions related to social functioning in both conditions (Moro et al. 2025).

In a Dutch study by Muris et al. (2025), adolescents and young adults with suspected ASD (75% of whom later received a DSM-5 diagnosis) showed significantly higher levels of hikikomori symptoms compared to non-clinical peers. Individuals with ASD were nearly 10 times more likely to exceed the clinical threshold for hikikomori.

Importantly, autistic traits remained significantly correlated with hikikomori symptoms even after controlling for comorbid psychopathology. This suggests that the association is not merely due to anxiety or depression – it may reflect deeper social-cognitive vulnerabilities.

A More Severe Phenotype?

Dell’Osso et al. (2025) examined university students grouped into healthy controls, individuals with hikikomori tendencies, individuals with significant autistic traits, and those presenting both. Participants with both autistic traits and hikikomori tendencies showed the most severe presentation, suggesting that comorbidity may exacerbate each condition.

In such cases, social withdrawal and autistic features may reinforce one another in a self-perpetuating cycle: reduced social engagement limits opportunities to develop adaptive strategies, which in turn increases anxiety and avoidance.

Some researchers have proposed that hikikomori may represent a particular presentation within the autism spectrum itself—a hypothesis that warrants further investigation (Dell’Osso et al. 2023).

Internet Use and Internet Gaming Disorder (IGD)

Another crucial dimension of hikikomori is its relationship with excessive internet use and Internet gaming disorder (IGD). According to Dell’Osso et al. (2023):

• ASD is positively correlated with IGD.

• Individuals with ASD may experience the internet as a safer, more structured environment for interaction.

• Hikikomori individuals may rely on online connections to compensate for limited  in-person contact.

While digital environments can offer cognitive stimulation and alternative forms of interaction, they may also increase vulnerability to problematic or addictive patterns.

Tolomei et al. (2023) found that over half of socially withdrawn adolescents exceeded cut-off scores for internet addiction, and 42.4% met criteria for IGD. These findings suggest that excessive internet use may both contribute to and result from social withdrawal.

Social Media Use: A Complex Relationship

Recent research by Gavin, Brosnan, and Joiner (2025) distinguishes between pathological and non-pathological hikikomori.

Following the COVID-19 pandemic and the normalisation of remote work and study, some individuals remain home-based without experiencing distress or functional impairment. This has led to the concept of “non-pathological hikikomori”.

Key findings include:

• Pathological hikikomori used more social media platforms than non-pathological individuals.

• Full-stage hikikomori (6+ months) used fewer platforms than those in earlier phases.

• Differences were not in time spent, but in patterns of use.

Pathological hikikomori engaged more actively through platforms such as TikTok and YouTube, sending and receiving more targeted and stylised messages. These findings highlight a nuanced reality: physical withdrawal does not necessarily imply social disengagement. Online interaction may remain active, though qualitatively different from face-to-face contact.

Depression, Anxiety, and Suicidality

Hikikomori rarely occurs without psychiatric comorbidity.

Tolomei et al. (2023) found that all adolescents in their socially withdrawn sample met criteria for additional psychiatric conditions, most commonly anxiety disorders, mood disorders, and ASD. Alarmingly, 32.5% reported suicidal ideation or behaviour, and 20% had attempted suicide.

Katsuki et al. (2020) similarly reported that hikikomori individuals with high autistic traits exhibited more severe depressive symptoms, smaller social networks, reduced social support, and features of “modern-type depression,” including lower self-esteem.

These findings underscore that hikikomori is not merely a lifestyle preference but may represent a serious public mental health issue requiring careful assessment and intervention.

Primary or Secondary Condition?

Some researchers distinguish between:

• Primary hikikomori: social withdrawal without an identifiable psychiatric disorder

• Secondary hikikomori: withdrawal occurring in the context of another condition

However, Tolomei et al. (2023) argue that this distinction depends heavily on the depth and quality of psychiatric evaluation. In clinical samples, most socially withdrawn youth meet criteria for additional disorders. Hikikomori may therefore be better conceptualised as a complex behavioural syndrome arising from multiple interacting vulnerabilities rather than as a standalone diagnosis.

A Developmental Perspective

Hikikomori most commonly emerges during adolescence or early adulthood – a developmental period characterised by identity formation, educational transitions, and expanding social demands.

For individuals with autistic traits, social anxiety, or perfectionistic tendencies, these demands may become overwhelming. Withdrawal may initially serve as a coping strategy that reduces immediate stress. Over time, however, avoidance reinforces anxiety, diminishes social confidence, and deepens loneliness, creating a self-sustaining cycle.

Can Hikikomori Improve?

Encouragingly, evidence suggests that hikikomori can improve with:

• Early recognition

• Comprehensive psychiatric assessment

• Treatment of comorbid conditions

• Family involvement

• Gradual and supported social reintegration

Given the high rates of suicidality and problematic internet addiction, timely intervention is essential.

More Than Just “Staying at Home”

Hikikomori is not simply a preference for solitude or a byproduct of digital culture. It is a complex and potentially severe form of social withdrawal that intersects with ASD, anxiety, depression, internet gaming disorder, loneliness and social cognition differences.

While not all home-based lifestyles are pathological, hikikomori becomes clinically significant when isolation is prolonged, distressing, and functionally impairing.

As research continues, a nuanced perspective—one that integrates developmental psychology, psychiatry, and digital behaviour—will be essential for supporting vulnerable young people in an increasingly complex social world.

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[1] Hikikomori  (Japanese 引きこもり or ひきこもり), meaning "pulling inward" or "being confined".