By Héctor Lozano Jiménez
General Health Psychologist · Director of Ocnos Psychology Clinic · COPAO AN 11777
Key idea: hikikomori is an intense and prolonged form of social withdrawal. It is not laziness, simple shyness or “spending too much time online”. When leaving the house feels too difficult, online therapy can be a realistic first step towards asking for help from a safer environment.
If you are reading this from your bedroom, with little desire to see anyone, the blind half closed and the feeling that going outside is simply too much, I want to begin with something important: you are not a lost cause.
And if you are the mother, father, sister, brother, partner or friend of someone who has been shut away for months, avoiding education, work, friendships or family life, I want to say something to you too: your exhaustion makes sense. Living close to someone who is withdrawing in an extreme way can bring fear, guilt, anger, sadness and a very painful sense of not knowing what to do.
Hikikomori is often misunderstood from the outside. At first glance, it may look like “comfort”, “laziness” or “internet addiction”. However, when we look more carefully, there is often far more going on: anxiety, shame, fear of judgement, depression, emotional shutdown, rejection experiences, tense family dynamics or a combination of factors that have gradually narrowed a person’s life until it feels almost contained within one room.
This article is written for three people at once: for the person who is isolated, for their family, and for anyone who suspects that something like this may be starting. My aim is not to attach a quick label, but to help you understand what may be happening and how psychological support can begin without demanding, from the very first moment, something that may currently feel impossible: leaving the house.
What is hikikomori?
Direct answer: hikikomori describes marked social withdrawal, maintained over several months, in which a person spends most of their time at home and their academic, occupational, family or social life becomes seriously affected.
From a clinical perspective, we speak of hikikomori when a person withdraws intensely into the home for approximately six months or more, and that withdrawal causes significant distress or functional impairment.
This means it is not enough for someone to be reserved, to be going through a difficult period or to enjoy being alone. What matters is the combination of duration, intensity and impact. Life gradually closes in: education, work, friendships, medical appointments, basic tasks, family conversations or any situation involving exposure to the outside world may be avoided.
Some people barely leave their room. Others do go out, but only to buy something quickly, to walk at night or to avoid meeting anyone they know. That is why the question should not simply be “does this person ever leave the house?”, but whether they have become trapped in a sustained form of social withdrawal that prevents them from living with a basic level of autonomy and wellbeing.
The way I often explain it in therapy is this: the problem is not being at home. The problem is when home stops being a place of rest and becomes the only place where a person feels they can emotionally survive.
Where does the word hikikomori come from?
Direct answer: hikikomori is a Japanese word linked to the idea of withdrawing, pulling back or shutting oneself away. The term became widely known in Japan in the late 1990s, particularly through the work of psychiatrist Tamaki Saitō.
For many years, hikikomori was associated almost exclusively with Japan. The popular image was often that of a young Japanese person shut away in their room, disconnected from social life and supported by their family. That image helped make the phenomenon visible, but it also oversimplified it.
We now know that extreme social withdrawal is not only a Japanese phenomenon. Cases and studies have been described in different countries, including Spain. This is why it is helpful to understand the term more broadly: the name is Japanese, but the human experience it describes can appear in very different cultural contexts.
It is also important not to reduce hikikomori to one age group. It can affect adolescents, young adults and older adults. In some cases, it begins after an academic, social or family crisis. In others, it develops more slowly, as a gradual withdrawal that the family may normalise until one day they realise that the person has had no real life outside the home for months or even years.
Hikikomori: origin and development of the concept
Hikikomori is not introversion, laziness or simply screen use
An important part of clinical work is avoiding rushed labels. Not everyone who spends a lot of time at home has hikikomori. Not every introverted person needs therapy. Not every teenager who plays online is experiencing extreme social withdrawal.
It is not simply introversion
An introverted person may enjoy solitude, but they usually maintain relationships, interests and a degree of choice. In hikikomori, withdrawal tends to involve distress or impairment.
It is not just internet use
The internet may become a refuge, a distraction or the only remaining form of contact. But the core issue is not the screen: it is the difficulty of participating in life beyond withdrawal.
It is not always depression
Depression may be present, but it does not explain every case. Social anxiety, trauma, shame, fear of failure, neurodivergence or family difficulties may also be involved.
It is not solved by “forcing them out”
Forcing someone without understanding the function of the withdrawal can increase shame, resistance or conflict. Reconnection usually needs to be gradual, safe and supported.
Levels of hikikomori and pre-hikikomori
Not every situation is the same. In clinical literature, levels of severity have been proposed according to how often the person leaves the house and how restricted their life has become.
In broad terms, a mild presentation may describe someone who still leaves the house on some days of the week, although their social life is very limited. A moderate presentation may involve leaving once a week or less. A severe presentation is closer to the image of someone who rarely leaves their room or only does so in very exceptional circumstances.
The term pre-hikikomori is sometimes used when social withdrawal has lasted between three and six months. This is clinically useful because it allows support to begin before isolation becomes more fixed. If a family waits years before asking for help, the pattern often becomes more rigid, more shameful and harder to change.
Important message: you do not need to wait until someone has been shut away for six months before seeking guidance. If isolation is already affecting education, work, sleep, hygiene, family life or mood, asking for help early may prevent the pattern from becoming entrenched.
Current data: what we know and what we do not know
Hikikomori is difficult to measure. Figures vary depending on the definition used, the age group studied, the country and the research method. For this reason, data should be interpreted carefully.
Pooled global prevalence estimated in a 2025 meta-analysis, with substantial differences between studies.
Frequently cited estimate in Japan for working-age people experiencing hikikomori.
Spain does not currently have a clear national official prevalence figure; evidence is mainly clinical.
A recent meta-analysis estimated a pooled global prevalence of 8.0%. However, this does not mean that “8% of the whole world has hikikomori”. It means that, when available studies are grouped together, this is the estimate that emerges, with important differences between samples and methods.
In Japan, one of the most frequently cited official figures is around 1.46 million working-age people in a situation of hikikomori. This challenges a common assumption: hikikomori does not only affect teenagers. It can also affect adults in midlife who have spent years withdrawn from social participation.
In Spain, the picture is more cautious. There is no clear, homogeneous national official prevalence figure. What does exist are clinical studies, especially case series from specialised teams, confirming that the phenomenon is also observed in our context.
Signs that may alert the family
Direct answer: the key sign is not that someone is solitary, but that the withdrawal continues over time, reduces daily functioning and begins to organise family life around the person’s isolation.
Some signs that should make a family pay attention include:
- Spending most of the day at home or in their bedroom.
- Dropping out of education, work or important responsibilities.
- Avoiding friends, relatives, phone calls, messages or visits.
- Going out very little, or only at times when they know they will not meet anyone.
- Reversing the sleep rhythm: sleeping during the day and staying awake at night.
- Neglecting hygiene, meals or basic daily routines.
- Reacting with irritation, shutdown or silence when help is suggested.
- The family beginning to organise the whole home around the withdrawal.
- Expressions of uselessness, hopelessness, intense shame or fear of being judged.
In therapy, families often say something like: “I don’t know whether knocking on the door is caring or intruding.” That sentence captures the strain of hikikomori at home. The family wants to help, but every attempt seems to make things worse.
What may be behind extreme social withdrawal?
Behind hikikomori there may be very different stories. Sometimes it appears after bullying, academic failure, a breakup, unemployment, public humiliation or a sense of not fitting in. At other times there is no single clear event, but rather a slow accumulation of anxiety, avoidance and loss of confidence.
There may also be a difficult cycle to break. The person avoids going out because going out triggers anxiety or shame. Avoidance brings relief for a few hours. But the next day, going out becomes even harder. Over time, avoidance becomes the only strategy that seems available.
The way I would put it is this: sometimes the person does not stop going out because they do not want to live. They stop going out because each step towards the outside world has become too threatening, too demanding or too shameful.
This is why each case needs careful assessment. A withdrawal maintained by social anxiety is not the same as one associated with severe depression, psychosis, trauma, substance use, undetected autism, very tense family dynamics or intense fear of judgement.
At Ocnos Psychology Clinic, we can assess whether the main focus should be anxiety, depression, family support, psychological assessment or a combined process. The aim is not to attach a quick label, but to understand the real function of the problem.
Comorbidity: why each case needs careful assessment
Hikikomori can appear alongside other mental health difficulties. Research suggests that comorbidity is common. It may coexist with depression, social anxiety, mood disorders, psychosis, neurodevelopmental conditions, personality difficulties, trauma, problematic internet or gaming use, and other clinical presentations.
This changes the intervention significantly. If the withdrawal is maintained by social anxiety, therapy may focus on graded exposure, thoughts about judgement, shame and social confidence. If depression is present, work may focus on activation, hopelessness, sleep, self-care and risk. If psychosis, substance use or serious deterioration is suspected, medical or psychiatric assessment may become the priority.
For this reason, as a psychologist, I find it unhelpful to say “this can be fixed by taking the internet away” or “they just need to be forced outside”. The clinical question is not only what the person is doing. The important question is what function the withdrawal serves, what maintains it and what risks surround it.
How families experience hikikomori
Families often become trapped between two fears: pushing too hard or doing nothing. If they insist, the person may withdraw further. If they stay silent, guilt appears: the sense that they are allowing life to fade little by little.
Over time, the whole home can start to revolve around the withdrawal. Meals are left at the door. Family visits are avoided. People speak quietly. Difficult conversations are postponed. Every small gesture is analysed: whether the door opened, whether a message was answered, whether the person showered, whether they went out for five minutes.
The family may become exhausted, argue among themselves or send contradictory messages: one person pressures, another protects, another becomes angry, another gives up. None of this means that the family is to blame. It means the situation needs a more organised form of support.
Before trying to “get them out”, the home often needs stabilising
When the family learns to communicate with less criticism, less urgency and more clarity, the isolated person may feel less attacked. This does not solve everything, but it lowers the level of conflict and opens a door that was previously closed.
What can the family do without intruding?
Helping someone with hikikomori is not about finding the perfect sentence. It is about creating a context in which asking for help feels less threatening.
1. Speak during calmer moments
Do not start the conversation immediately after an argument, a slammed door or a sleepless night. Look for a calmer moment. The way you approach it matters.
Instead of saying “you have to get out of this room now”, it may help to say something like: “I am worried about you and I do not want to fight. I want to understand what you need and find a way of helping that does not make you feel attacked.”
2. Replace criticism with concrete observations
“You are doing nothing with your life” usually closes the door. “I have noticed that you have not been going out for weeks, that you are sleeping during the day and answering less and less; I am worried” tends to create more space.
3. Suggest small steps
When someone is very stuck, “rebuilding your life” is far too big. It may be more useful to suggest a minimal first action: replying to a message, talking for ten minutes, accepting a brief video call or allowing the family to consult a professional first.
4. Do not turn help into a power struggle
If every conversation becomes “you are going to do what I say”, the person may experience help as a threat. The aim is not to win an argument, but to build a minimum level of collaboration.
5. Seek guidance even if the person does not want help yet
Sometimes the first intervention begins with the family. This matters. You do not always have to wait until the isolated person clearly asks for help. The family can receive guidance on how to respond, how to communicate, what limits to hold and when to activate healthcare resources.
Brief checklist for families
- Has the withdrawal lasted more than three to six months and affected education, work or family life?
- Does the person avoid almost all social contact or only go out in a very limited way?
- Is there sleep reversal, personal neglect or clear loss of routine?
- Has the family stopped knowing how to speak without everything becoming tense?
- Has a low-pressure first step been offered, such as a brief video call?
- Is there a clear plan if suicidal thoughts, self-harm, aggression or severe deterioration appear?
- Does the family also have support, so they are not carrying everything alone?
- Do you know which resource to use in an emergency: 112, 024, primary care or emergency services?
Why online therapy can be the first step
Direct answer: online therapy can help because it lowers the initial barrier. It allows a person to begin from home, with less exposure, and gradually build the therapeutic relationship before attempting more difficult steps.
For someone experiencing hikikomori, asking for face-to-face help may feel like too much. Not because they do not want to improve, but because leaving home, travelling, sitting in a waiting room and speaking to an unfamiliar professional may activate exactly what they have been avoiding for months.
For this reason, in many cases, online therapy is not a second-best option. It can be the doorway in. It allows therapy to start from home, in a familiar environment, with less initial exposure and a more gradual structure.
NICE guidance on social anxiety recognises that when a person finds it very difficult or distressing to attend an initial appointment in person, first contact by telephone or internet can be considered. The Telepsychology guide from the Spanish General Council of Psychology also highlights the importance of suitability, privacy, safety, informed consent and a plan for urgent situations.
The specific research on online therapy for hikikomori is still limited, but promising. Clinical case reports have already described structured online interventions that helped therapeutic engagement and gradual exposure in people who had spent years in withdrawal. This does not mean online therapy is a magic solution, but it can be a possible beginning.
What might the beginning of online therapy look like?
The first goal is not usually “go outside tomorrow”. The first goal is often much more basic: establish safety, build trust, understand the case and agree on small steps.
Assess risk
Before starting, it is important to assess suicidal thoughts, self-harm, aggression, substance use, psychotic symptoms, severe self-neglect or any sign of urgency.
Make contact in a low-pressure way
This may begin with a family consultation, an initial message or a short video call. In some cases, camera use may be optional at first if clinically appropriate.
Understand what maintains the withdrawal
It is not enough to say “you need to go out”. We need to understand what happens before, during and after attempts to leave, speak or be seen.
Agree on small goals
Replying to a message, regulating sleep, opening the door, speaking to a relative or going outside for a few minutes can all be clinically meaningful steps.
Work with the family
The family needs guidance: how to speak, what to avoid, what boundaries to hold and how not to maintain the problem through desperation.
Move to face-to-face care if needed
Online therapy can be the first doorway, but it is not always enough. If risk increases or the case requires it, care may need to escalate to face-to-face, medical, psychiatric, home-based or emergency support.
What is worked on in therapy?
Therapy is not about convincing the person to “just go out”. That is usually too simplistic and often counterproductive.
A therapeutic process may work on several areas:
- Understanding the function of withdrawal: what it avoids, what it relieves and what consequences it has.
- Reducing anxiety and shame: particularly where there is intense fear of judgement or social exposure.
- Rebuilding basic routines: sleep, hygiene, meals, movement, schedules and self-care.
- Training gradual steps: small agreed exposures or actions, without impossible leaps.
- Working with guilt or uselessness: especially when the person feels they have “lost years”.
- Improving family communication: reducing criticism, interrogations, tense silences and overprotection.
- Coordinating with other resources: primary care, psychiatry, emergency services, social services or education if needed.
From my perspective, therapy needs to be both practical and human. Practical, because we need observable goals. Human, because someone who has been isolated for months or years does not need to feel examined as if they have failed at life. They need to recover safety, rhythm, connection and direction.
Hikikomori in teenagers and young adults
In teenagers, hikikomori can be confused with “normal teenage behaviour”, screen problems or school refusal. This is why it is important to look at the whole picture: isolation, impairment, sustained avoidance, sleep changes, irritability, loss of contact with peers and family distress.
In these cases, the family should not be left alone. It may be necessary to coordinate with the school, paediatrics, primary care, child and adolescent mental health services or specialised professionals. If self-harm, thoughts of death, violence or unusual symptoms appear, help should be sought quickly.
Therapy may include work with parents, assessment of the young person, coordination with the educational environment and very gradual goals. Sometimes the first step is not going back to school immediately, but restoring sleep, connection, communication and a sense of safety.
Hikikomori in adults
In adults, hikikomori can remain hidden for years. Sometimes the family covers it up through shame. At other times it becomes normalised: “that is just how they are”, “they will come out eventually”, “they do not want help”.
However, as months and years pass, the problem often becomes more complex: confidence is lost, social skills deteriorate, dependency and guilt increase, and the family grows older while carrying a situation that becomes heavier over time.
There may also be unemployment, fear of interviews, debt, family conflict, loss of friendships or the feeling of having been left outside life. In these cases, intervention needs to be respectful, but also clear: waiting indefinitely does not always protect.
When online therapy is not enough
Online therapy can be a very useful first step, but it is not appropriate for everything or at every moment. Some situations require face-to-face, medical, psychiatric, home-based or emergency support.
Immediate help should be sought if any of the following appear:
- suicidal thoughts with a plan, intention or access to means;
- self-harm or serious threats;
- intense aggression or violence at home;
- psychotic symptoms, delusions, hallucinations or severe disorganisation;
- serious substance use;
- extreme neglect of food, hygiene, sleep or physical health;
- complete lack of privacy or safety during online sessions.
Important: if there is suicidal risk, serious threats, self-harm, violence, psychotic symptoms, intoxication, extreme self-neglect or immediate danger, the priority is not to wait for an online session.
In Spain, call 112 in a life-threatening emergency. For suicidal thoughts or suicidal risk, the Spanish Ministry of Health’s 024 helpline offers free, confidential support 24 hours a day. The 024 helpline does not replace face-to-face care when this is necessary.
Official resources and reliable sources
These resources may be useful for families and affected individuals. They do not replace professional assessment, but they can help you know where to turn, especially when risk is present.
| Resource | What it is for | Link |
|---|---|---|
| 112 Emergency Services | Life-threatening emergencies, immediate danger or situations requiring urgent intervention. | Call 112 |
| 024 Spanish Ministry of Health | Support for people experiencing suicidal thoughts or behaviour, as well as relatives and close contacts. National, free, confidential and available 24/7. | 024 helpline |
| Spanish General Council of Psychology | Guide for Telepsychology practice: safety, consent, privacy, suitability assessment and limits of online therapy. | Telepsychology guide |
| NICE | Clinical guideline on social anxiety, including flexible access and first contact by telephone or internet when attending in person is very difficult. | NICE CG159 |
| WHO | International guidance on telemedicine and digital health implementation. | WHO telemedicine guide |
| Fundación ANAR | Support for children, teenagers and families. Useful when withdrawal affects a minor or emotional risk signs appear. | Fundación ANAR |
| SALUD MENTAL ESPAÑA | Information, guidance and a network of associations for people with mental health difficulties and their families. | SALUD MENTAL ESPAÑA |
| Teléfono de la Esperanza | Emotional support in situations of crisis, loneliness or psychological distress. | Teléfono de la Esperanza |
How we can help at Ocnos Psychology Clinic
At Ocnos Psychology Clinic, we work from Palmones in Campo de Gibraltar, offering both face-to-face and online care. If you live in Campo de Gibraltar, Gibraltar or nearby areas, you can start with an initial consultation and consider which format is most suitable.
If you are in Algeciras or another nearby area, online therapy may also be a practical way to begin when travelling to the clinic feels too difficult at first.
In a situation of hikikomori, it does not always make sense to demand that the person comes to the clinic from day one. Sometimes the path begins with an online session, a family consultation or a brief first conversation to understand what is happening.
The key is to begin safely, realistically and without humiliating the person. The aim is not to force them to “return to life” all at once, but to build the first steps so that life can begin to feel possible again.
Frequently asked questions about hikikomori
What is hikikomori?
Hikikomori is an intense and prolonged form of social withdrawal in which a person spends most of their time at home, avoids education, work or relationships, and experiences significant impairment or distress over several months.
Where does the word hikikomori come from?
The word comes from Japan and is linked to the idea of withdrawing, pulling back or shutting oneself away. It became widely known in the late 1990s, particularly through the work of psychiatrist Tamaki Saitō.
Is hikikomori the same as being introverted?
No. Introversion is a way of relating to social energy. Hikikomori involves marked social withdrawal, loss of functioning and personal or family distress.
Does hikikomori only happen in Japan?
No. Although the term originated in Japan, current research describes the phenomenon in different countries. In Spain, there is no clear national official prevalence figure, but clinical series confirm cases in our context.
Can online therapy help in cases of hikikomori?
Yes, in many cases it can be a useful first step because it reduces the barrier of leaving home. However, safety, privacy, risk and the suitability of online therapy for that specific case must always be assessed.
What can the family do if the person does not want help?
The family can seek professional guidance even if the isolated person is not yet ready to attend. This can help relatives learn how to communicate, what boundaries to hold, what mistakes to avoid and when to activate healthcare resources.
When should urgent help be sought?
Urgent help should be sought if there are suicidal thoughts with a plan, self-harm, violence, psychotic symptoms, intoxication, extreme self-neglect or any situation of immediate danger. In Spain, call 112 in a life-threatening emergency.
Does online therapy always replace face-to-face therapy?
No. It can be a very useful first doorway, but some cases require face-to-face, medical, psychiatric, home-based or emergency support. This decision should be made after professional assessment.
The first step does not have to be leaving the house
If you recognise yourself in this article, or if you are worried about someone in your family, you do not have to wait until everything gets worse. We can begin with an initial online consultation, a family consultation or an assessment to understand what is happening.