It may be clear by now that ESW is a complex phenomenon and this is also true for its etiology. It is assumed that young people’s tendency to withdraw and seclude themselves has a multifaceted origin, which means that many potential factors are involved in the emergence and maintenance of the phenomenon. In this section, we provide an overview of the relevant factors beginning with psychiatric disorders that are associated with an inclination to seek prolonged social isolation (see also Kato et al., 2019; Masi et al., in press), after which we proceed to explore a number of environmental influences and societal issues that may be associated with ESW.
Psychiatric Disorders
Briefly, ESW can occur as a concurrent condition of other mental health problems. In the hikikomori literature this is often referred to as ‘secondary hikikomori’: in these cases, the persistent social withdrawal symptoms clearly occur within the context of another disorder. Some scholars assume that there is also primary or idiopathic hikikomori, which arises without a clear history of psychiatric comorbidity (Teo et al., 2015a). In these cases, a specific constellation of personal, family, and societal characteristics seems to be present that predispose the young person to exhibit ESW (e.g., Suwa & Suzuki, 2013). However, the boundary between primary and secondary types of ESW is not clear (Frankova, 2019) and with the growing acknowledgment of the dimensionality of most forms of psychopathology (APA, 2022), it has become increasingly difficult to rule out the presence and exact contribution of psychiatric conditions to ESW.
Table 1 provides a summary of what is known about the relationship between ESW and the five most plausible psychiatric conditions that are associated with persistent withdrawal tendencies, namely schizophrenia (and other psychotic disorders), social anxiety disorder, depression, autism spectrum disorder, and avoidant personality disorder. It can be concluded that ESW is associated with each of these disorders and for this reason scholars consider social withdrawal as an important transdiagnostic construct (Masi et al., in press; Porcelli et al., 2019). However, its exact role in various types of psychopathology is less clear: in some cases, ESW appears to be (an extreme variant of) a pathognomonic symptom of the disorder (e.g., schizophrenia, ASD), while in other cases ESW constitutes the ultimate consequence of a deranged disorder (e.g., social anxiety disorder, depression), which in turn can act as an antecedent variable accounting for the continuation of the psychiatric problem (Oliva et al., 2022).
Table 1 The relation between ESW and various psychiatric conditions Full size table
Societal Issues
Contemporary young people face a number of challenges that are closely tied to the way the current society is organized (Furstenberg, 2010; Settersten et al., 2006). For example, in the economic climate of capitalism and in specific neoliberalism, education is regarded as an important asset for developing and improving business and industry and as a result many young people currently feel pressured to aim for completing study at the highest possible educational level (Bessant et al., 2017). Furthermore, due to globalization, young people experience greater competition when applying for a job, whereas on the other hand employers mainly offer temporary positions to screen their work potential before giving them a permanent position, so that they are able to adjust quickly to changing market conditions (Churchill & Khan, 2021). Because of the extended investment in education and the more uncertain labor market position, young people have limited financial resources. This means that they are less in the position to acquire housing for themselves and hence are forced to live longer at home with their parents (Forrest & Yip, 2013; Sompolska-Rzechula & Kurdys-Kujawska, 2022). In the popular media, this has been labeled as the ‘full nest syndrome,’ a term that makes clear that the phenomenon can be accompanied by stress and tension for those involved (i.e., parents and offspring). A final struggle concerns the adequate handling of digital media, which are indispensable in today’s society. In particular the younger generations spend a considerable amount of time on electronic devices such as notebooks, iPads, and smartphones and it can be challenging for them to find good balance between real-life activities (school, work, sports, social activities, sleep) and the continuing flow of digital information and all the temptations of the virtual world (Dimock, 2018).
The strains posed by the current society may not only slow down young people’s progression into adulthood but also create the basic conditions for some of them to get stuck in their development and—in extreme cases—to gradually distance and withdraw themselves from the world. School absenteeism, school dropout, as well as freeter and NEET status can be first signs of adolescents and young adults who are on an aberrant trajectory. It is important to note that growing up in an individualized, competitive, and complex world should only be seen as a potential prerequisite for such a scenario: these strenuous features of society are especially taxing for young people who already face adverse personal circumstances, such as the presence of a psychiatric disorder (Gariépy et al., 2022; Gubbels et al., 2019) or socioeconomic inequality (Lörinc et al., 2020; Sosu et al., 2021).
Meanwhile, Varnum and Kwon (2016) pointed out that ESW in young people critically depends on the availability of public resources. More precisely, they argued that from an evolutionary perspective, withdrawal from social life and declining from work for a longer period of time is not a strategy that will enhance one’s chances of survival. So, the fact that ESW does exist in a society is proof of wealth and abundant resources. Apparently, a solid social safety net and/or a family with sufficient financial assets are present (see also Nonaka & Sakai, 2021), which makes it possible for young persons to survive in spite of withdrawing from economic and social life. In societies characterized by a scarcity of resources, young people will need to deploy different methods to deal with their marginalized position, such as theft, prostitution, or drug trafficking, rather than displaying ESW as this would result in a quick elimination (Varnum & Kwon, 2016).
Environmental Influences
The Role of Family and Parents
As many individuals with ESW live their life within the shelter of their family, one wonders about the role of parents in the origins of this phenomenon. Putting it in other words, why would parents allow their offspring to refrain from school or work and stay at home most of their time, thereby preventing young people to build their own life? Part of the answer to this question may lie in the fact that a substantial proportion of the parents of young individuals with ESW have psychiatric problems themselves and as a result have less awareness of the problems of their children and/or are less capable of applying effective parenting behaviors. This possibility is illustrated in the study of Malagón-Amor and colleagues (2020) who investigated the family background of 190 adult participants (mean age 39 years) showing persistent social withdrawal. It was noted that 59.7% of the mothers (most commonly an affective or anxiety disorder) and 19.5% of the fathers (most frequently a psychotic or substance use disorder) had a psychiatric history (see also Umeda et al., 2012). Moreover, in 61.5% of the cases, dysfunctional family dynamics were clearly present. These families were characterized by high levels of conflict and instability, poor communication, excessive control, lack of empathy, and excessive criticism, which are all features that potentially endanger the development and emotional well-being of the individual family members (Hattori, 2006). In 20.7% of the cases, indications were even found for a history of maltreatment within the family. Finally, some indications were found that the adverse family-related variables were positively associated with severity indexes of ESW. Thus, the more dysfunctional the family interactions, the earlier the onset of the social isolation, the less cooperation with treatment, and the lower the overall daily functioning.
Another relevant study was conducted by Suwa et al. (2003) who examined the characteristics of Japanese families of adult children with ESW who were still living at home (mean age 30 years). Parents of offspring who showed clear social withdrawal symptoms (n = 27) and a control group of parents with offspring displaying no signs of social withdrawal (n = 20) completed a standardized scale for measuring general family features. The results revealed that the families of individuals with ESW mainly differed from the control families on the dimension of cohesion: the statistically significant lower scores reported by the parents in the ESW group indicated that there was little interaction between family members, in particular about problems and emotions (Suwa et al., 2003). In a similar vein, Nonaka et al., (2019, 2021) noted that while parents of persons with ESW essentially are equipped by a good behavioral repertoire (in terms of reinforcement and punishment strategies), they seem to be more detached from their offspring in the sense that they avoid to communicate about “the elephant in the room.”
Throughout development, internalizing psychopathology in young people has been associated with low levels of warmth—or its counterpart: high levels of rejection—and high levels of psychological control (Pinquart, 2017; Rose et al., 2018), and although evidence is currently lacking it is plausible to assume that similar parenting behaviors are relevant for young people’s persistent withdrawal tendencies. When zooming in on ESW, there are at least two specific parenting behaviors that may be of particular interest. The first one is overprotective parenting, which refers to parents who are highly vigilant, supervising, and controlling toward their children and discourage them to engage in autonomous behavior (Thomasgard & Metz, 1993). In the psychological literature, parental overprotection has been mainly linked to anxiety disorders (e.g., Van der Bruggen et al., 2008), but it is obvious how overprotection could also be involved in ESW, as this type of parenting is likely to promote dependency and hinder the young person to function separately from his/her parents. Interestingly, there is some support for the notion that overprotection is associated with social isolation and loneliness, which can be regarded as proxies of ESW (Burns et al., 2022).
A second type of parenting that bears relevance to ESW is indulgent parenting, which is referring to pampering actions that have the purpose to ease and sweeten children’s life. Motives have to do with compensation behavior for negative family circumstances (e.g., divorce, less availability because of high workload), feelings of compassion (because of all the demands placed on young people), and intentions to act as a ‘good’ parent (in comparison to one’s own parent or other parents in the community; Wolford et al., 2020). Just like overprotective parenting, indulgent parenting may hinder the development of autonomy and impede the young person’s transition to adulthood (Cui et al., 2016). So far, no study can be found demonstrating that indulgent parenting is involved in ESW. However, in the ‘hikikomori’ literature, the role of ‘amae’ has been repeatedly discussed as a relevant family factor (Doi, 1973). Amae refers to the phenomenon of young people showing helpless, desperate, selfish, and demanding behaviors with the expectation that these will be accepted and satisfied by parents and others (Behrens, 2004). ESW might be seen as a radicalized form of amae: young people (fully) retire from society, vegetate at home, and parasite on the resources and care provided by their parents.
All in all, it can be concluded that adverse family processes seem to play a significant role in the development and maintenance of ESW: young people who display consistent withdrawal tendencies more often have parents who suffer from some kind of psychopathology, come from families characterized by less communication and cohesion, and are subjected to detrimental rearing practices (including low warmth/rejection, overprotection, and indulgence; Funakoshi & Miyamoto, 2015). An important note should be added to qualify this conclusion. That is, most research on this topic does not allow to draw conclusions on directionality and so it remains unclear whether deleterious family factors play a causal role in the origins of ESW, whether such family variables merely reflect a parental response to young people who already display strong withdrawal tendencies, or whether both scenarios apply, meaning that the link between family factors and ESW in offspring is bidirectional in nature.
Bullying and Peer Victimization
Bullying and peer victimization are essentially two sides of the same coin: the former term refers to the actor, while the latter refers to the recipient, but both are part of the same process that involves interpersonal behaviors which have the aim to physically, psychologically, or socially harm another individual (Eisenberg & Aalsma, 2005). The perpetrator—the young person who engages in bullying—may show a variety of actions, such as ostracism, verbal and physical aggression, and gossiping and tale telling (‘live’ or via electronic devices), that are all damaging for the victim. It is clear that bullying and peer victimization are associated with a variety of psychopathological outcomes and these also include social adjustment problems, such as withdrawal and loneliness (Arsenault, 2018; Hawker & Boulton, 2000; Moore et al., 2017).
A good illustration of a study examining the link between peer victimization and withdrawal has been provided by Barzeva et al. (2020). In this research project, a survey was administered to assess prospective relations between social withdrawal (child self-report and parent report), peer victimization, and a number of other relevant variables (i.e., social anxiety and peer acceptance) in a mixed cohort of community and clinically referred adolescents (N = 2772) who were assessed three times during a five-year period at age 11, 13, and 16 years. Peer victimization appeared to play a significant role in the formation of the withdrawn behavior of these youths: that is, earlier peer victimization was associated with higher levels of withdrawal at age 13 (child and parent report) and age 16 (only parent report), whereas withdrawal at age 13 also increased the risk for peer victimization at age 16 (only parent report), suggesting that there might be a reciprocal relationship between these variables. On the basis of the results, the researchers concluded that negative peer experiences can be considered as a central factor influencing social withdrawal during adolescence (see also Matthews et al., 2022).
Unfortunately, among all the evidence, few studies can be found that focused specifically on the link between bullying/peer victimization and ESW. One notable exception is an investigation by Krieg and Dickie (2011) who compared 24 participants with hikikomori (aged 14 to 32 years) and 60 control participants with regard to a number of psychosocial variables, including attachment, parental rejection, and—most pertinent here—bullying. The results indicated that the adolescents and adults with hikikomori more often reported to have experienced bullying, in particular during their early adolescent years. In another study, Beccaria et al. (2022) administered a survey to identify potential risk and vulnerability factors of social withdrawal in an Italian sample of 13- to 20-year-old students. These researchers found that a substantial proportion of the students reported experiences of disdain (19%), insult or teasing (15%), exclusion from the group (14%), and other forms of (cyber)bullying (7%) and this indicates that these negative peer interactions were one of the reasons for why they had decided to restrict social contacts, to the point of retreating at home.
Briefly, bullying and peer victimization are likely to promote withdrawal tendencies in young people and hence also seem to represent a factor that plays a role in the development of ESW (see also Choi et al., 2022). Such negative social experiences threaten the fundamental need to belong, undermine a person’s self-esteem, and have a negative impact on the perception of the meaning of life (Stillman et al., 2009).
Internet and Use of Digital Media
In contemporary society, the use of devices such as smartphones, tablets, and computers and, in its wake, the employment of the internet have all become widespread. In particular for the younger generations, screens and a computerized world are an important element in life. The use of the digital devices and the internet certainly has a number of positive features that may stimulate young people’s development, but there are also a number of downsides (e.g., Bremer, 2005; Guan & Subrahmanyam, 2009), and these become clearly evident in people with ESW.
For one thing, the common availability of computer devices and the advancement of the information and communication technology via the internet allow people to stay at home and to conduct all kinds of daily activities virtually instead of physically. For example, during the COVID-19 pandemic, people in many countries faced one or multiple lockdowns, but while they were restricted to their houses in order to prevent the spread of the virus, the digital technology enabled them to continue their life by engaging in telework, telehealth, online learning, and online shopping (Mouratidis & Papagiannakis, 2021). Thus, all these ‘e-activities’ will make it possible for persons with ESW that some of the primary necessities of life can still be met, even when the social withdrawal is so persistent that one is never leaving the house anymore.
Young people may use social media channels (e.g., Facebook, Instagram, Tiktok) to satisfy their need to belong (Bozzola et al., 2022), but there is debate on whether technology-mediated social interactions have the same potential as live social interactions.
Relevant in this regard is the ‘displacement hypothesis,’ which postulates that social problems and associated negative feelings such as loneliness and depression arise when people displace real-life relationships with online ones. Evidence for this notion was provided by Kraut et al. (1998) who followed a sample of 169 persons (in 73 households) during their first two years online. The researchers not only found that greater internet use was associated with a decline in ‘live’ social participation, but more importantly the data also demonstrated that greater employment of the internet in the long run resulted in an increase of depression and loneliness. Especially when employed to deal with social inadequacies or to escape from the social world, the use of the internet seems to be problematic and is likely to have detrimental consequences (Nowland et al., 2018).
The latter often applies to individuals who display ESW. For example, in a study of Lee et al. (2013), 41 young people with persistent social withdrawal (mean age 16 years) who had been referred to a home visitation program were compared to 239 age-matched control with regard to their (excessive) internet use. The results indicated that the computer use of youth with ESW was more than two times longer than that of control youth. More than half of them (56%) displayed problematic use of the internet and a further 9% even exhibited behavior that could be qualified as an ‘addiction’ as their internet use had increased to such a frequent and intense level that it interfered significantly with the daily functioning. In the control group, these percentages were considerably lower, namely 36% and 3%. Another investigation by Tateno et al. (2019) obtained similar findings in a non-clinical sample of college and university students (N = 478) who completed a survey, which contained questions about internet use as well as standardized scales measuring ESW (hikikomori) symptoms, smart phone addiction, and internet addiction. It was found that participants at risk for ESW not only spent more time on the internet but also displayed higher levels of smartphone use and internet addiction as compared to participants who were not at risk for ESW. Furthermore, small to modest but statistically significantly positive correlations were noted between ESW symptom levels and both types of digital addiction, indicating that stronger social withdrawal tendencies are accompanied by more problematic usage of internet and smartphone.
It should be noted that the directionality of the link between the superfluous use of internet and digital media and ESW is far from unidirectional. On the one hand, there is the contention that excessive employment of the internet and other digital equipment (e.g., smartphone) plays a causal role as it is undermining and diminishing young people’s social behavior and as such promoting withdrawal tendencies. On the other hand, it has also been argued that the frequent employment of internet and digital technology is an effect that occurs in young people who for some reason (obviously this includes the presence of psychopathology; Carli et al., 2013) have become marginalized by their peers, at school or at work, and by society in general. Both scenarios seem valid, pointing in the direction of a reciprocal relationship and suggesting that excessive internet usage is an important maintaining factor in the withdrawal behavior of contemporary young people (Kato et al., 2020b). Meanwhile, there are also echoes in the literature suggesting that the internet and digital media are a positive element in the life of persons with ESW. For some of them, digital platforms constitute a ‘social lifeline’ through which they can actively interact and communicate with others in an easy, anonymous, and less risky way (because face-to-face contact with other people requires more skills; Wong, 2020a, 2020b).