The man who would not leave the house

A twenty-six-year-old man came to the clinic with his father. The son was studying at a local college five years ago but developed a dislike for attending college which gradually included a total dislike of leaving the house.

He would spend the whole time inside his bedroom but sometimes would sit in the living room or do some gardening inside the house. He became very anxious and distressed if he was asked to go outside the house either for prayers, shopping, or social gatherings. He describes having a rapid heart rate, and difficulty breathing and his head starts shaking noticeably when he tries to step outside the house. The symptoms would also appear when guests came to visit. His family tried to persuade him to see a doctor but he refused; it was only when a religious relative managed to convince him to get help.

This young man suffered from a severe form of social anxiety that had a significant impact on his life. Yet other forms of social anxiety can present differently, for example, Hikikomori, a condition in which a person stays at home and does not participate in society for six months or longer, without having other mental disorders which can cause this form of social withdrawal.

This condition was first proposed by the Japanese psychiatrist Dr Tamaki Saito in 1998 in his book 'Hikikomori – Adolescence without End'. Initially, Hikikomori was believed to be exclusive to Japan, where excessive dependence and overprotection of children were deeply ingrained in Japanese society. However, this phenomenon has been documented in other nations, including Oman. A recent survey from Japan conducted in 2022 estimates that 1.46 million persons have Hikikomori with a significant increase from previous years. This increase has been attributed to the Covid-19 pandemic when working from home and Online classes become the norm. Research also showed that people with Hikikomori had the highest risk of having gaming disorder and depression.

One might ask, do we need to worry about people who have Hikikomori or social anxiety if they are happy being at home and can enjoy their time through the internet? In my professional opinion, yes we do need to help people overcome their social anxiety because it will have several psychological, social, and economic impacts in the short and long term.

Young people who are housebound tend to be dependent on their parents for their income, often suffer from loneliness, have a higher risk of developing mental health problems, and may have difficulties meeting future partners and having a family. People who spend long hours on the internet eventually lose social skills such as meeting people in person and having a conversation with strangers. One may argue that you can still make friends online who would be available for you when you need their support yet we all know virtual friends are not a substitute for real ones.

Finally, If you know someone with Hikikomori or social anxiety please advise them to seek professional help so they can overcome this condition and be able to enjoy life.