Basic psychological needs and parental bonding in Italian adults at high risk of hikikomori (extreme social withdrawal): the distinctive association of Competence Frustration with symptom severity Virginia Pupi, Cinzia Bressi, Paolo Brambilla, Maria Gloria Rossetti, Cinzia Perlini, Francesca Girelli, Maria Diletta Buio, Niccolò Zovetti, Isabella Fanizza, Antonio Trabacca, Fabrizia Claudia Guarnieri, Roberto Sassi, Marcella Bellani, Antonella Delle Fave Frontiers in Psychology, 2026 This brief research report explored the relationships between hikikomori symptom severity (extreme social withdrawal), basic psychological needs of Competence, Autonomy, and Relatedness, and perceived parental bonding in Italian adults experiencing social isolation. Participants ( N = 33; M age = 27.83, SD = 7.46; 42.9% women) were individuals recruited online who scored above the high-risk cutoff for hikikomori on the Hikikomori Questionnaire-25 (HQ-25). They completed the Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS) and the Parental Bonding Instrument (PBI). Competence Frustration accounted for substantial variability in hikikomori symptom severity in this high-risk sample, explaining approximately 31% of the variance. Regarding perceived parental bonding, maternal Care was positively associated with Autonomy Satisfaction and negatively with Competence Frustration, whereas maternal Control was positively related to frustration of all three needs. Paternal Care was negatively related to Autonomy and Competence Frustration, while paternal Control was positively associated with Relatedness Frustration. Over 30% of participants perceived maternal bonding as Affectionless Control and paternal bonding as either Affectionless Control or Neglectful. No gender differences emerged. Findings suggest that Competence Frustration may represent a key psychological correlate of hikikomori symptom severity in this high-risk group. Moreover, distinct maternal and paternal patterns of perceived Care and Control were associated with need frustration and satisfaction, as well as with the hikikomori dimension of perceived lack of Emotional Support. Study limitations include small sample size, cross-sectional design, reliance on self-report measures, and potential selection bias toward help-seeking individuals. Replication in larger longitudinal samples is warranted to confirm these preliminary results.
Hikikomori (prolonged social withdrawal) and co-occurring psychiatric disorders and symptoms in adolescents and young adults: A scoping review Virginia Pupi, Cinzia Bressi, Paola Maria Porcelli, Maria Gloria Rossetti, Marcella Bellani, Antonio Trabacca, Paolo Brambilla, Antonella Delle Fave Comprehensive Psychiatry, 2025 Hikikomori, or prolonged social withdrawal, is a clinical condition usually emerging during adolescence or young adulthood, characterized by severe self-isolation in one's home, and often associated with other psychiatric disorders and symptoms. The study summarized evidence of hikikomori diagnostic criteria, clinical manifestations, and comorbidity with psychiatric disorders and symptoms in adolescents and young adults. A scoping review was performed following PRISMA guidelines, and four electronic databases were searched for original works in English, French and Italian, published after 2010. A total of 15 studies were selected, 7 involving adolescents, 4 young adults, and 4 participants from both age groups. Most studies relied on the diagnostic criteria proposed for hikikomori inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Differences in hikikomori and comorbidity profiles were identified between adolescents and young adults. Heterogeneity characterized hikikomori diagnostic criteria, comorbidity, demographic and clinical features of the study samples. Studies adopting more homogeneous samples, shared diagnostic criteria, consistent assessment tools and longitudinal designs are needed to better clarify the clinical features of hikikomori in young people. • Different hikikomori definitions orient research focus on different comorbidities. • Hikikomori-related comorbidity may differ between adolescents and young adults. • Hikikomori adolescents often show higher internalizing symptoms than peers. • Depression may be consequence of withdrawal in adolescence, risk factor in youth. • Identity distress and negative life events may lead to hikikomori in young adults.
Exploring the Impact of Sex and Gender in Brain Function: Implications and Considerations Roberta Gualtierotti, Cinzia Bressi, Barbara Garavaglia, Paolo Brambilla Advances in Therapy, 2024 INTRODUCTION: Sex and gender are crucial variables in understanding brain development and disease. Biological sex is determined by genetic and hormonal factors, whereas gender is a multidimensional construct shaped by social and cultural influences. The interplay of these factors contributes to sex-specific susceptibilities and disease progression in psychiatric and neurological disorders. However, sex and gender are often considered as a single variable, which can lead to biased data analysis and interpretation. This commentary aims to analyze how sex and gender influence brain structure and function, with implications for personalized medicine, research, and the development of gender-sensitive clinical guidelines. METHODS: Findings from various studies employing neuroimaging techniques and animal models are discussed, as well as the impact of biological sex, gender, environmental, cultural, and social factors on brain development, organization, and behavior. RESULTS: Evidence suggests that sex differences in brain structure and function are not only genetically determined but are also influenced by gender-related experiences and societal contexts. Importantly, discrepancies between male and female brains are reduced in gender-equal societies. Preclinical studies play a pivotal role in determining the influence of biological sex, independent of gender, in different disease models. CONCLUSION: The findings underscore the need to consider both sex and gender in research and clinical practice to avoid biases and promote equitable health outcomes. Moving forward, we advocate for gender-sensitive approaches to be integrated into brain research and in clinical guidelines to achieve personalized and precision medicine.
Developing a brief telematic cognitive behavioral therapy for the treatment of social isolation in young adults Maria Gloria Rossetti, Cinzia Perlini, Francesca Girelli, Niccolò Zovetti, Paolo Brambilla, Cinzia Bressi, Marcella Bellani Frontiers in Psychology, 2024 ObjectiveThe present study aims to present a novel cognitive-behavioral intervention protocol focused on treating social isolation through telematic interaction, thus overcoming common barriers characteristic of face-to-face interventions.MethodsWe examined current literature about face-to-face and telematic psychotherapeutic interventions for the treatment of social isolation in early adulthood. Current evidence is mixed, suggesting the need to develop novel interventions focused on patients’ cognitive functioning. Moreover, telematic interventions are promising candidates for overcoming common barriers intrinsic to the condition of social isolation.ResultsThe present 8-session model inspired by cognitive behavioral theoretical models and cognitive interventions currently present in the literature is thought to help socially isolated adult patients reduce clinical symptoms associated with the condition and lead to a reduction in the avoidance of social situations, leading to an improvement of the quality of life.ConclusionWe presented a telematic psychotherapeutic intervention aimed at helping adult patients suffering from social isolation who are unable to seek help from national health systems and face-to-face interventions, thus overcoming barriers intrinsic to social isolation. The present cognitive-behavioral treatment protocol has been developed in the context of a randomized clinical trial ongoing in Italy, aimed at implementing and testing the feasibility and effectiveness of multimodal digital interventions for treating social isolation.
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