[Psychiatric background of social withdrawal in adolescence]

In recent years, Japan's mental health welfare service personnel are encountering a growing number of adolescents in whom social withdrawal persists for extended periods. The provision of treatment and support for these individuals has become a challenge that needs to be addressed on a nationwide scale. This study was conducted to identify the guidelines for treating and assisting adolescents who manifest social withdrawal behaviors, and to clarify the psychiatrist's role. Of the consultation requests sent to the Yamanashi Prefectural Mental Health Welfare Center, cases of adolescents manifesting social withdrawal behaviors were classified into the following three groups and studied: (1) the Consultation Group (the subject himself/herself came to the center and made use of the consultation and assistance services), (2) the Non-Consultation Group (only the subject's family came to the center for consultation, and the staff were unable to meet him/her), and (3) the Consultation-after-Family Support Group (those subjects in the Consultation Group whom the staff could finally meet after one year or more of consultations with the family). As a result, we learned that adolescent cases of social withdrawal could be diagnosed and classified, in principle, according to the current diagnostic criteria (DSM-IV), and that, from here on, we aim to psychiatrically elucidate the pathology by focusing on international diagnostic criteria. We also showed that, compared with the Consultation Group, the Non-Consultation Group had a greater number of subjects with no employment history. The subjects within this group, moreover, tended to exhibit even more serious problems, and there was a possibility that the family structure and circumstances influenced whether or not the subjects visited the center for consultation. We also determined some of the issues related to assistance and support provided to individuals who fail to come to the center for consultation. Furthermore, we showed the possibility that psychiatry and psychiatrists play a wide variety of roles in dealing with the issue of social withdrawal in adolescence. These include: (a) cases in which a psychiatrist is called upon to provide diagnosis and treatment, (b) cases in which non-medical consultation service institutes play a central role in providing assistance in daily living and matters relating to employment, and a psychiatrist is called upon to provide adequate diagnosis and guidance, and (c) cases in which a psychiatrist collaborates and cooperates with private sector support groups.