Hikikomori beyond Japan: Severe social withdrawal and gaming addiction in an Indian adolescent

ABSTRACT Hikikomori refers to a state of extreme social withdrawal that leads to marked impairment in daily functioning .Although originally described in Japan, increasing cases are being reported worldwide. We describe a 16-year-old boy from India who developed progressive social isolation following the COVID-19 lockdown, associated with excessive online gaming. Over two years, his gaming increased to six to seven hours daily, resulting in school dropout, poor self-care, sleep disturbance and irritability. He later developed suspiciousness and occasional muttering to self. Developmental history revealed longstanding inattention and hyperactivity. Medical evaluation was unremarkable. He scored 68/100 on the 25-item Hikikomori Questionnaire, indicating high risk. Treatment with risperidone and atomoxetine and structured psychosocial interventions led to significant improvement in psychotic symptoms; however, social withdrawal persisted at follow-up. The case highlights the emerging relevance of hikikomori in the Indian context and the importance of early, integrated intervention in such cases.