{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:58:36Z","timestamp":1783655916834,"version":"3.55.0"},"reference-count":45,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T00:00:00Z","timestamp":1682294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>In this work, we suggest that children\u2019s social withdrawal might be a precursor of Hikikomori, a phenomenon observed among adolescents and young adults. Hence, psychotherapy interventions with preschool children showing signs of social withdrawal might play a critical role in Hikikomori prevention. This paper presents the case of a five-year-old child treated with intensive psychoanalytic psychotherapy who began therapy due to his refusing to go to school and exhibiting isolating behavior from other children. Among other symptoms were regression, emotional tension, nightmares, and nocturnal and diurnal enuresis. Moreover, the relationship in the family was difficult, both between the parents and between the parent and the child. The intensive psychoanalytic treatment involved three weekly sessions for about a year, followed by six months with one weekly session. Besides illustrating the therapeutic process through clinical vignettes taken from the sessions, this paper also provides clues on how early social withdrawal can contribute to the construction of internal personality organizations that lead to social withdrawal up to self-reclusion (or Hikikomori).<\/jats:p>","DOI":"10.3390\/bs13050354","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T01:37:01Z","timestamp":1682386621000},"page":"354","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Social Withdrawal in Preschool Age: A Clinical Case in Intensive Psychoanalytic Psychotherapy"],"prefix":"10.3390","volume":"13","author":[{"given":"Fiorenzo","family":"Ranieri","sequence":"first","affiliation":[{"name":"Italian National Health Service, Department of Mental Health, UFSMIA Arezzo, 52100 Arezzo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5878-6769","authenticated-orcid":false,"given":"Yura","family":"Loscalzo","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, School of Psychology, University of Florence, 50135 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,24]]},"reference":[{"key":"ref_1","unstructured":"Sait\u014d, T. (2013). Hikikomori. Adolescence without End, University of Minnesota Press. Translation by Jeffrey Angels."},{"key":"ref_2","first-page":"339","article-title":"Social isolation associated with depression: A case report of hikikomori","volume":"198","author":"Teo","year":"2012","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_3","first-page":"668","article-title":"Claustration \u00e0 domicile de l\u2019adolescent. Hikikomori. [Home confinement of the adolescent. Hikikomori]","volume":"169","year":"2011","journal-title":"Ann. M\u00e9dico-Psychol. Rev. Psychiatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"148","DOI":"10.15557\/PiPK.2015.0023","article-title":"When social withdrawal in adolescence becomes extreme: The \u201chikikomori\u201d phenomenon in Italy","volume":"15","author":"Ranieri","year":"2015","journal-title":"Psychiatr. I Psychol. Klin."},{"key":"ref_5","first-page":"319","article-title":"Adolescenti tra abbandono scolastico e ritiro sociale: Il fenomeno degli <<hikikomori>> [Adolescents between school dropout and social withdrawn: The <<hikikomori>> phenomenon]","volume":"2","author":"Ranieri","year":"2016","journal-title":"Psicol. Clin. Dello Svilupp."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1177\/0020764020975800","article-title":"Hikikomori Risk Inventory (HRI-24): A new instrument for evaluating Hikikomori in both Eastern and Western countries","volume":"68","author":"Loscalzo","year":"2022","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1159\/000276522","article-title":"Beyond social withdrawal: Shyness, unsociability, and peer avoidance","volume":"33","author":"Asendorpf","year":"1990","journal-title":"Hum. Dev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1146\/annurev.psych.60.110707.163642","article-title":"Social withdrawal in childhood","volume":"60","author":"Rubin","year":"2009","journal-title":"Annu. Rev. Psychol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/0020764011423182","article-title":"Attachment and hikikomori: A psychosocial developmental model","volume":"59","author":"Krieg","year":"2013","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_10","unstructured":"Doi, T. (1973). The Anatomy of Dependence, Kodansha International. [1st ed.]."},{"key":"ref_11","first-page":"311","article-title":"A Cocoon with a View: Hikikomori, Otaku, and Welcome to the NHK","volume":"5","author":"Hairston","year":"2010","journal-title":"Mechademia"},{"key":"ref_12","first-page":"20","article-title":"Hikikomori as Disfigured Desire: Indulgence, Mystification, and Victimization in the Phenomenon of Extreme Social Isolation in Japan","volume":"9","author":"Bowker","year":"2016","journal-title":"J. Psycho-Soc. Stud."},{"key":"ref_13","unstructured":"Mahler, M.S., Pine, F., and Bergman, A. (1978). La Nascita Psicologia del Bambino [The Psychological Birth of the Child], Bollati Boringhieri."},{"key":"ref_14","unstructured":"Neumann, E. (1991). La Personalit\u00e0 Nascente del Bambino. Struttura e Dinamiche [The Nascent Personality of the Child. Structure and Dynamics], Red Edizioni."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1023\/A:1015218527147","article-title":"Early mother\u2013infant interaction as a precursor to childhood social withdrawal","volume":"32","author":"Gerhold","year":"2002","journal-title":"Child Psychiatry Hum. Dev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1002\/imhj.21417","article-title":"Associations between maternal interaction behavior, maternal perception of infant temperament, and infant social withdrawal","volume":"34","author":"Puura","year":"2013","journal-title":"Infant Ment. Health J."},{"key":"ref_17","first-page":"89","article-title":"Comportamenti di ritiro e psicopatologia dell\u2019et\u00e0 evolutiva","volume":"11","author":"Gritti","year":"2016","journal-title":"Ann.-Univ. degli Studi Suor Orsola Benincasa"},{"key":"ref_18","first-page":"308","article-title":"Attacks on linking","volume":"40","author":"Bion","year":"1959","journal-title":"Int. J. Psychoanal."},{"key":"ref_19","unstructured":"Winnicott, D.W. (1965). The Maturational Process and the Facilitating Environment: Studies in the Theory of Emotional Development, Hogarth and the Institute of Psycho-Analysis. [1st ed.]."},{"key":"ref_20","first-page":"95","article-title":"A study of family functioning in hikikomori (social withdrawal)","volume":"6","author":"Koshiba","year":"2007","journal-title":"Hiroshima Univ. Study Health Preserv. J. (Koudaihokengaku)"},{"key":"ref_21","first-page":"49","article-title":"Hikikomori: Sindrome culturale internalizzante o ritiro volontario? [Hikikomori: Internalizing cultural syndrome of voluntary withdrawal?]","volume":"9","author":"Loscalzo","year":"2016","journal-title":"Counseling"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/bjp.12398","article-title":"Psychoanalytic psychotherapy for hikikomori young adults and adolescents","volume":"34","author":"Ranieri","year":"2018","journal-title":"Br. J. Psychother."},{"key":"ref_23","unstructured":"Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic, Neurotic, and Borderline Patients, Routledge. [1st ed.]."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). DSM-5. Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_25","unstructured":"Magagna, J.E. (2012). The Silent Child: Communication without Words, Karnac Books. [1st ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Muris, P., and Ollendick, T.H. (2023). Contemporary hermits: A developmental psychopathology account of extreme social withdrawal (Hikikomori) in young people. Clin. Child Fam. Psychol. Rev., online advanced publication.","DOI":"10.1007\/s10567-023-00425-8"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.jaac.2012.08.002","article-title":"Behavioral inhibition and risk for developing social anxiety disorder: A meta-analytic study","volume":"51","author":"Clauss","year":"2012","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1007\/s00787-016-0835-4","article-title":"Selective mutism and temperament: The silence and behavioral inhibition to the unfamiliar","volume":"25","author":"Gensthaler","year":"2016","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_29","unstructured":"Segal, H. (1997). Envy and Gratitude and Other Works 1946\u20131963, The Hogarth Press. [9th ed.]."},{"key":"ref_30","first-page":"591","article-title":"Playing: Its theoretical status in the clinical situation","volume":"49","author":"Winnicott","year":"1968","journal-title":"Int. J. Psycho-Anal."},{"key":"ref_31","unstructured":"Vallino, D. (2019). Fare Psicoanalisi con Genitori e Bambini, Mimesis. [1st ed.]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1080\/07351699309533925","article-title":"Making the thought thinkable: On introjection and projection","volume":"13","author":"Alvarez","year":"1993","journal-title":"Psychoanal. Inq."},{"key":"ref_33","first-page":"49","article-title":"On envy and how to interpret it","volume":"68","author":"Etchegoyen","year":"1987","journal-title":"Int. J. Psycho-Anal."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/bjp.12526","article-title":"Collaborative work with parents","volume":"36","author":"Magagna","year":"2020","journal-title":"Br. J. Psychother."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"De Masi, F. (2018). Working with Difficult Patients: From Neurosis to Psychosis, Routledge.","DOI":"10.4324\/9780429485268"},{"key":"ref_36","first-page":"109","article-title":"The power of alternative realities","volume":"14","year":"2021","journal-title":"Rom. J. Psychoanal. Rev. Roum. Psychanal."},{"key":"ref_37","first-page":"16","article-title":"Metapsychological and clinical aspects of regression within the psycho-analytical set-up","volume":"36","author":"Winnicott","year":"1955","journal-title":"Int. J. Psycho-Anal."},{"key":"ref_38","unstructured":"Waddell, M. (2002). Inside Lives: Psychoanalysis and the Growth of the Personality, Karnak Books. [1st ed.]."},{"key":"ref_39","first-page":"306","article-title":"The psycho-analytic study of thinking","volume":"43","author":"Bion","year":"1962","journal-title":"Int. J. Psycho-Anal."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Steiner, J. (2011). Seeing and Being Seen: Emerging from a Psychic Retreat, Routledge.","DOI":"10.4324\/9780203806364"},{"key":"ref_41","unstructured":"Harris Williams, M. (2018). The Tavistock Model: Papers on Child Development and Psychoanalytic Training, Karnak Books. [3rd ed.]."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1521\/pdps.2018.46.3.357","article-title":"Personality organization, personality styles, and the emotional reactions of treating clinicians","volume":"46","author":"Genova","year":"2018","journal-title":"Psychodyn. Psychiatry"},{"key":"ref_43","unstructured":"Finkelstein, S., Steiner, J., and Weiss, H. (1993). The Claustro-Agoraphobic Dilemma in Psychoanalysis\u2014Fear of Madness, Routledge. [1st ed.]."},{"key":"ref_44","unstructured":"Ranieri, F., and Monticelli, M. Seeking the origins of psychic and social withdrawal: Warning signs in the observations of young children. Infant Obs., in press."},{"key":"ref_45","first-page":"72","article-title":"Hikikomori: Debating a XXI century phenomenon from a clinical point of view","volume":"6","author":"Ranieri","year":"2018","journal-title":"Scand. J. Child Adolesc. Psychiatry Psychol."}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/13\/5\/354\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:22:32Z","timestamp":1760124152000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/13\/5\/354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,24]]},"references-count":45,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["bs13050354"],"URL":"https:\/\/doi.org\/10.3390\/bs13050354","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,24]]}}}