Prolonged social withdrawal (hikikomori) in a small European island state: a case report

Hikikomori, described as "prolonged social withdrawal," is a condition characterized by an individual's severe social isolation in their home for at least 6 months with consequent functional impairment or distress. It is mainly observed in adolescents and young adults. It was initially described in Japanese cultures, but has since been reported in other countries. This report is the first to describe a case of hikikomori in a male patient in Malta, an island nation in the central Mediterranean and one of Europe's smallest countries. He presented to psychiatric services incidentally after over 20 years of being voluntarily housebound. The social isolation occurred in the context of social anxiety with agoraphobia and an overreliance on the online world. We discuss the multidisciplinary team approach applied throughout the inpatient hospitalization period, with a focus on rehabilitation and functional improvement, while prioritizing the patient's wishes and preferences. This case reinforces the view of hikikomori as a culturally influenced syndrome, rather than a culturally bound one.