A quarterly publication of the Autism Research Institute
Winter 2025 | Number 1, Volume 39
A new report from Italy indicates that autistic traits or autism spectrum disorder (ASD) may play a significant role in hikikomori syndrome.
Hikikomori syndrome, a term used to describe severe social isolation, was first identified as a significant societal problem in Japan, but cases are now being documented around the world. Individuals with hikikomori syndrome isolate themselves at home, refusing to go to school or work, and often confine themselves to a single room in their home for months or even years at a time. In their study, Barbara Carpita and colleagues investigated possible correlations among hikikomori syndrome, autism traits or an ASD diagnosis, pathological computer gaming, and eating disorders. To collect online data, they recruited 2,574 students at the University of Pisa who filled out the Hikikomori Questionnaire-25 (HQ-25), the Adult Autism Subthreshold Spectrum Questionnaire (AdAS Spectrum), the Eating Attitude Test-26 (EAT-26), and the Assessment of Internet and Computer Game Addiction (AICA-S). They chose this population, they say, because of the high rate of dropouts among the university’s students.
Carpita and colleagues found that of the factors they analyzed, ASD or autistic traits had the strongest association with hikikomori syndrome.
The researchers found that hikikomori risk correlated with autistic traits or an ASD diagnosis, altered eating behaviors, and addiction to videogames. “Among these variables,” the researchers say, “the strongest significant factor appeared to be the presence of an autism spectrum, followed by the maladaptive use of videogames and lastly the presence of an eating disorder. These results highlight the importance of the autistic dimension as the main discriminant for hikikomori risk.” This association, they say, was further demonstrated by analyses showing that “AdAS spectrum total score and the majority of its domains (in particular, all the domains investigating social and communication difficulties, such as empathy and verbal/nonverbal communication issues) emerged as significant predictors of a hikikomori symptomatology.”
The researchers say, “This result supports the hypothesis that the presence of significant autistic traits, or of full-blown ASD, could be a vulnerability factor for the development of hikikomori, and that the core difficulties in interpersonal relationships and social communication of subjects in the autism spectrum may lead them to social isolation, up to its extreme pathological drift, the hikikomori syndrome.”
Interestingly, however, two autistic traits—inflexibility and adherence to routine—appeared to be protective against hikikomori. The researchers speculate that this may be because adherence to routines and a resistance to change may require individuals to maintain daily habits outside the home.
The researchers caution that their sample involved only university students, limiting its scope. In addition, they say that participants volunteered for the study and used self-reported questionnaires, which may have biased the results.
However, they conclude, “Globally, our findings support the association among hikikomori, autism spectrum, pathological computer game use, and eating disorder symptoms. From a broader viewpoint, our findings may be in line with the rising hypothesis of a possible neurodevelopmental basis for different psychiatric conditions, including, as in the case of this study, hikikomori.”
“Exploring the relationship among hikikomori tendencies, autistic traits, computer game use and eating disorder symptoms,” Barbara Carpita, Benedetta Nardi, Federico Giovannoni, Francesca Parri, Gianluca Cerofolini, Chiara Bonelli, Giulia Amatori, Gabriele Massimetti, Ivan Mirko Cremone, Stefano Pini, Enza Pellecchia, and Liliana Dell’Osso, CNS Spectrums, December 27, 2024 (free online). Address: Benedetta Nardi, [email protected].
