Pathological Social Withdrawal (Hikikomori) in Indian Adolescents: A Case Series

Hikikomori, a form of pathological social withdrawal, has gained international recognition beyond its initial description in Japan. The COVID-19 pandemic has heightened awareness of social withdrawal behaviors globally, yet data from India remains limited. We present three cases of adolescents aged 16 years who met the updated diagnostic criteria for hikikomori: marked social isolation at home for ≥6 months with significant functional impairment. All three cases presented with concurrent psychiatric comorbidities, including major depressive disorder, obsessive-compulsive disorder, and social anxiety disorder. Duration of social withdrawal ranged from 8 to 24 months. Functional impairment was evident across educational, social, and occupational domains. Treatment response was partial despite multimodal interventions including pharmacotherapy and cognitive-behavioral therapy. These cases met updated hikikomori criteria and fit secondary hikikomori, with persistent withdrawal despite symptom relief, implying need for targeted exposure-based, family-informed, and engagement-focused care. COVID-19 context likely precipitated but did not fully explain persistence, supporting a pathological pattern in a high-expectation family milieu. These cases demonstrate the clinical presentation of hikikomori in the Indian context, highlighting the need for early recognition and specialized interventions for pathological social withdrawal in adolescents.