Executive Dysfunction and Memory Impairments in Hikikomori: A Neuropsychological Case-Control Study from Oman.

BACKGROUND

Hikikomori, a form of prolonged social withdrawal, has been widely studied in East Asia but remains underexplored in the Middle East. Cultural and social factors may influence its cognitive profile, necessitating localized research.

AIM: To compare cognitive performance between Hikikomori cases and non-cases in Oman using the Cambridge Neuropsychological Test Automated Battery (CANTAB), focusing on executive function, memory recall, and processing speed.

METHODS

A case-control study was conducted in 2024 with 150 participants (54 Hikikomori cases, 96 controls) recruited from a tertiary hospital in Oman. Hikikomori cases were classified using a broad HiDE-I definition, which included pathological, at-risk, and resemblance Hikikomori categories. CANTAB was used to assess key cognitive domains. Independent t-tests and linear regression analyses were performed to compare outcomes.

RESULTS

Hikikomori cases showed significant impairments in visual processing accuracy (p < 0.001), response latency (p = 0.004), immediate recall (p = 0.031), delayed recall (p = 0.009), and planning efficiency (p < 0.001) compared to non-cases. Adjusted regression analyses-controlling for age, gender, education, income, employment, marital status, and governorate-confirmed that Hikikomori status was significantly associated with lower visual processing accuracy (β = -0.453, p = 0.001), slower response latency (β = 0.266, p = 0.001), poorer immediate (β = -0.201, p = 0.019) and delayed recall (β = -0.255, p = 0.003), and reduced planning efficiency (β = -0.453, p = 0.001). No significant differences were found for spatial working memory tasks.

CONCLUSION

Hikikomori individuals in Oman exhibit significant deficits in executive function, memory recall, processing speed, and visual attention, even after adjusting for socio-demographic factors. These findings underscore the importance of early neurocognitive screening and tailored interventions. This is one of the first studies to explore Hikikomori's cognitive profile in the Middle East.