Fiorenzo Ranieri
Paper presented at the conference “Solitude and Relationships”, organised by the Order of Psychologists of Tuscany on 22–23 January 2026 (proceedings available at:
https://www.fondazionepsicologi.it/quaderni/solitudine-e-relazioni-volume-2/)
Introduction
This contribution offers some reflections on the relationship that adolescents and young adults living in voluntary social withdrawal — commonly referred to in the literature as hikikomori — have with their own bodies. These observations draw on my clinical experience and on findings from the scientific literature. Further valuable insights emerged from the annual seminar The Hikikomori Phenomenon – A Psychoanalytic Perspective on Psychic and Social Withdrawal Across the Life Cycle, organised by the Martha Harris Study Centre in Florence and co-led with Dr Miriam Monticelli.
When we meet adolescents and young adults in social withdrawal, what strikes us is not only their absence from the world, but also a particular mode of bodily presence. The body is there — yet somehow withdrawn, suspended, as though it needed to pass unnoticed.
The phenomenon described in the literature by the term hikikomori refers to a condition of prolonged self-isolation, initially observed in Japan and now also widespread in Western contexts. Beyond the diagnostic debate — whether it should be regarded as an independent syndrome, an expression of other psychopathological conditions, or a condition situated along a continuum — clinical experience shows that withdrawal represents a complex defensive solution. Not simply a symptom, but an organisation.
Many pathways into withdrawal appear to have their roots in early forms of psychic protection. A child who does not find sufficient security in the environment may construct withdrawn mental spaces, internal refuges that protect against relational pain. During adolescence, when the body inevitably becomes exposed to the gaze and judgement of peers, these organisations may be reactivated. Experiences of exclusion, bullying, or demands perceived as excessive can rekindle earlier vulnerabilities. Withdrawal, then, is neither a whim nor simply a rejection of reality: it is an attempt at psychic survival.
Within this framework, the body assumes a central role.
The Body That Must Remain Silent
Once withdrawal becomes established, a radical transformation in the relationship with the body can often be observed. The body is no longer experienced as a vehicle for relationship, but as something to be neutralised.
Some young people neglect it to the point of making it almost invisible: poor hygiene, always wearing the same clothes, closed postures, hair covering the face. Others, by contrast, subject it to rituals of obsessive control: repeated washing, meticulous grooming, outward perfectionism. Two opposite modes responding to the same underlying logic: the body must not speak.
This polarisation — the neglected body or the purified body — may be understood as a trace of early experiences of care. Where the internal object has been experienced as neglectful, the subject may struggle to care for the self. Where, on the other hand, attention has been centred on control and perfection, the body becomes the object of constant surveillance. In both cases, what is missing is the dimension of the body as a place of encounter.
Shame is a dominant affect. Fear of the other’s gaze leads to avoidance of eye contact and the renunciation of forms of bodily self-expression. It is perhaps no coincidence that tattoos, piercings, and other forms of bodily expression appear to be uncommon among these patients: marking the body would mean attracting attention, whereas the primary defence is invisibility.
The Time of Darkness
A recurrent feature is an alteration of the sleep–wake cycle. Daytime is avoided and nighttime preferred. Sometimes windows remain closed so that light and darkness cannot easily be distinguished.
This is not merely biological dysregulation. Shared time is social time: inhabiting the night means withdrawing from synchrony with the world. It is a way of avoiding sharing the other’s time.
The Anaesthetised Body
A clinically interesting observation is the relative rarity of extreme self-harming behaviours in cases of more circumscribed social withdrawal. If self-harm is often an attempt to feel something or communicate pain, withdrawal seems instead to perform an anaesthetic function. It is as though the withdrawn organisation prevented pain from finding explicit bodily expression.
Paradoxically, risk-taking behaviours may emerge precisely when withdrawal begins to loosen. Coming out of the shell exposes the subject to an emotional intensity that is no longer filtered. The body, long inactive within the relational scene, is suddenly put to the test.
Sport and Zones of Continuity
A small group of patients continue to engage regularly in sport. Sport, particularly when structured by clear rules and defined roles, offers a form of relationship with controlled predictability.
In individual sports, the body may become an instrument of narcissistic reinforcement; in team sports, by contrast, a “zone of relational continuity” may be preserved, facilitating therapeutic work. In these cases, the body is not invisible, but functional.
The Body in Therapy
If the body is silenced in everyday life, in psychotherapy it begins to speak again with considerable force. In the first encounters, the averted gaze, muscular tension, and posture tell of a pain that cannot yet find words.
There is, however, a countertransference risk: the therapist may unconsciously collude with the patient’s need to exclude the body from the relational scene. The unthought body becomes the unseen body. A silent enactment develops, freezing the therapeutic process.
When, instead, the body is recognised — even through small concrete episodes, changes in appearance, or perceptual changes — a new symbolic space can emerge. Mutually recognising the body means recognising vulnerability and the possibility of change.
Extreme Invisibility
Some Japanese studies report cases in which socially withdrawn individuals who died in their homes remained unnoticed for a prolonged period. This is a deeply striking finding: the body that had been withdrawn from the gaze seems to continue to remain unseen even after death.
This liminal dimension — between visibility and invisibility — radically illuminates the function of withdrawal: not only to defend oneself from the world, but to position oneself at the margins of shared experience.
Conclusion
Keeping the bodily dimension of the withdrawn patient alive in the therapist’s mind means resisting the patient’s invisibility. The body is not a secondary detail of the hikikomori phenomenon: it is the place in which the conflict between presence and disappearance is played out.
Thinking about the body in therapy means restoring its relational status. It means reopening a space in which psychic life can once again inhabit a body that no longer has to remain silent.
Essential References
Cerutti, R., Spensieri, V., Siracusa, V. D., Gazzillo, F., & Amendola, S. (2021). Hikikomori: la sofferenza silenziosa dei giovani. Rivista di Psichiatria, 56(3), 129–137.
Kato, T. A., Kanba, S., & Teo, A. R. (2019). Hikikomori: multidimensional understanding, assessment, and future international perspectives. Psychiatry and Clinical Neurosciences, 73(8), 427–440.
Ranieri, F. (2018). Psychoanalytic psychotherapy for hikikomori young adults and adolescents. British Journal of Psychotherapy, 34(4), 623–642.
Ranieri, F., & Monticelli, M. (2023). Seeking the origins of psychic and social withdrawals: warning signs in the observations of young children. Infant Observation, 26(1–2), 45–62.
Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic, Neurotic, and Borderline Patients. London: Routledge.
Lemma, A. (2010). Under the Skin: A Psychoanalytic Study of Body Modification. London: Routledge.
Severo, C. T., Laskoski, P. B., Teche, S. P., et al. (2018). Conceptual and technical aspects of psychoanalytic enactment: A systematic review. British Journal of Psychotherapy, 34(4), 643–666.
Naitō, H., Kakiuchi, Y., Kakimoto, Y., & Osawa, M. (2024). Forensic characteristics of body abandonment by housemates in Japan. Cureus, 16(5).