Abstract
Recent surveys demonstrated that the total number of school refusal in elementary, junior high and high school in 2010 reached about 170,000. In this context, school refusal means a protracted absence from school, typically more than 30 days per year, caused by psychological factors such as fear, anxiety and a sense of refusal. The prominent finding is the steep increase of the number of school refusals from the sixth grade of elementary school to the first grade of junior high school, which is almost three times higher than that in elementary school. Hikikomori is a phenomenon in which persons become recluses in their own homes, avoiding various social situations for at least six months. The latest nationwide surveys revealed that the number of ongoing hikikomori could be estimated at 230,000. These two phenomena, school refusal and hikikomori, have many commonalities, including underlying psychological factors, and could be closely related to each other. In this article, I report the current condition of both phenomena, explain the adolescent mentality commonly observed in school refusal and hikikomori, introduce a multi-axis approach to understand and support them, investigate the background psychiatric disorders and developmental disorders, and refer to the treatment of school refusal and hikikomori at general hospitals. The guidebook for school refusal and the hikikomori guidelines are useful to assess both conditions correctly and initiate treatment as early as possible.
