A structured support process for social reintegration of a patient with long-term hikikomori: A case report

Hikikomori is a condition characterized by remaining predominantly at home for at least 6 months, with marked social withdrawal and functional impairment. In prolonged cases, reduced self-care and physical comorbidities are common; however, access to necessary medical care is often limited. When a distrust of medical services and the refusal of psychiatric care are pronounced, psychiatric interventions alone may be insufficient. In such cases, it is important to use general medical care as an entry point to subsequent psychiatric and community-based support.

We herein report a case of hikikomori for more than 15 years in a man in his 50s. He first presented to general medical services after developing wound myiasis. Thereafter, while receiving physical treatment, he received stepwise support in a psychiatric ward, including support for hygiene behaviors, family support, and discharge planning. His resistance to bathing and grooming gradually decreased. After discharge, he moved into supported housing and began attending a supported employment program. During the 3-month follow-up, no recurrence of hikikomori was observed.

This case shows that in patients with long-term hikikomori for whom psychiatric interventions alone are difficult, a structured support process that links general medical, psychiatric, and community care in a stepwise manner may facilitate social reintegration. The process may be conceptualized in terms of the entry point, transition phase, and outcome.