Childhood Trauma and Hikikomori in Social Anxiety Disorder: The Mediating Role of Cognitive Distortions.

BACKGROUND

Social Anxiety Disorder (SAD) and hikikomori share characteristics of social withdrawal. While childhood trauma is a known risk factor for both conditions, the specific mechanisms linking early trauma to hikikomori through cognitive pathways remain unclear.

AIMS: This study aimed to compare childhood trauma, cognitive distortions, and hikikomori levels in individuals with and without SAD and to examine the mediating role of cognitive distortions in the relationship between childhood trauma and hikikomori.

METHODS

A total of 171 participants were included in the study: 78 patients with SAD and 93 healthy controls (HCs). All participants completed the Childhood Trauma Questionnaire (CTQ-28), Cognitive Distortions Scale (CDS), and 25-item Hikikomori Questionnaire (HQ-25). Group comparisons were performed using t-tests and chi-square tests. Mediation analysis was conducted using the PROCESS macro (Model 4), controlling for age, sex, marital status, education level, and SAD.

RESULTS

The SAD group had significantly higher CTQ-28, CDS, and HQ-25 scores than the HCs group (p < .001). Mediation analysis revealed that childhood trauma was associated with hikikomori levels both directly (B = 0.33, p = .007) and indirectly through cognitive distortions (Effect = 0.15, 95% bootstrap CI [0.06, 0.26]). The total effect of childhood trauma on hikikomori was also statistically significant (B = 0.48, p < .001). The model, which controlled for age, sex, marital status, education, and SAD status, explained 42% of the variance in hikikomori severity (R2 = .42).

CONCLUSIONS

Our findings suggest that childhood trauma is associated with greater hikikomori symptoms, both directly and through the mediating effect of cognitive distortions. Therefore, cognitive distortions may be a potential intervention target for socially withdrawn individuals with a history of childhood trauma.