The overlooked majority of hikikomori: Latent profiles reveal a discrepancy between social anxiety and life functioning.

Hikikomori is increasingly recognized as heterogeneous; however, how behavioral functions relate to clinically important targets (e.g., functional impairment and social-evaluative anxiety) remains unclear. We identified latent hikikomori profiles by integrating behavioral topography and functions and characterized their clinical profiles. The study recruited Japanese adults aged 18-59 using an online panel, comprising 200 participants each in the hikikomori and control groups, respectively. Latent profile analysis was conducted using three functional indicators from the Hikikomori Functional Assessment Scale (social negative reinforcement, intrapersonal positive reinforcement, intrapersonal negative reinforcement) and an indicator of hikikomori behavior from the Adaptive Behaviors Scale for Hikikomori. Group differences were examined using Welch's ANOVA with Games-Howell post hoc tests. A three-profile solution was selected: Mild (11%), Moderate-withdrawal (52%), and Social-avoidance (37%). The Moderate-withdrawal profile showed clinically significant functional impairment without elevated social-evaluative anxiety compared to controls, indicating a paradoxical presentation of impairment without heightened fear of negative evaluation. The Social-avoidance profile showed the greatest withdrawal severity, elevated social-evaluative anxiety, lowest social support, and higher daily stressors. The Mild profile showed relatively lower impairment, reduced support quantity, and preserved support satisfaction. Hikikomori is thus not a unitary anxiety-avoidance condition. Profile-informed assessment may improve intervention selection, with anxiety-focused approaches being most relevant for the Social-avoidance profile, whereas reinforcement- and values-oriented behavioral strategies may be more appropriate for the Moderate-withdrawal profile. Longitudinal and multi-informant studies are needed to test profile stability and differential treatment responsiveness.