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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S18–S55

S23

Borderline personality disorder (BPD) is characterized by affec-

tive dysregulation and non-suicidal self-injurious behaviour (NSSI),

which is closely linked with reduced pain perception. Several

experimental studies revealed reduced pain sensitivity in BPD as

well as significant correlations between pain perception, aversive

inner tension and dissociation. Psychophysiological experiments

revealed no deficit in the sensory-discriminative pain compo-

nent in BPD. However, neurofunctional investigations point at

alterations of the affective-motivational and the cognitive pain

component in BPD. Preliminary evidence suggests that disturbed

pain processing normalizes when patients stop NSSI after suc-

cessful psychotherapeutic treatment. We could demonstrate that

pain leads to a decrease in affective arousal and amygdala activ-

ity in patients with BPD and to an increase in amygdala-prefrontal

connectivity. We are currently investigating the role of seeing

blood and the importance of self-infliction of pain in the context

of NSSI.

Disclosure of interest

The author has not supplied his declaration

of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.833

S18

Neural pathways of the association

between pain and suicide

K. van Heeringen

Unit for Suicide Research, Department of Psychiatry and Medical

Psychology, Ghent University, Gent, Belgium

Physical pain and psychological pain are risk factors for suicidal

behaviour, and understanding of the neural pathways linking pain

and suicide may contribute to suicide prevention. Neuroimaging

studies have shown changes in association with physical and psy-

chological pain andwith suicidal behaviour. Psychological stressors

such as social exclusion may trigger emotional pain that is associ-

ated with functional changes in the prefontal cortex, cingulate cor-

tex, thalamus, and parahippocampal gyrus. This functional network

shows considerable overlap with brain areas involved in physical

pain and suicidal behaviour. Changes in the brain motivation-

valuation circuitry may predict pain persistence and thus

contribute to the development of suicidal thoughts and behaviours.

Disclosure of interest

The author has not supplied his declaration

of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.834

Culture-society bound psychopathology

S19

Hikikomori and modern-type

depression in Japan

T. Kato

Kyushu University, Department of Neuropsychiatry, Fukuoka, Japan

Maladaptive social interaction and its related-psychopathology

have been highlighted in psychiatry especially among younger

generations. “Hikikomori” defined as a syndrome with six months

or longer of severe social withdrawal was initially reported in

Japan, and the prevalence rate has been reported as 1.2% in

Japanese population. The majority of hikikomori patients are ado-

lescents and young adults who become recluses in their parents’

homes for months or years. They withdraw from contact with

family, rarely have friends, and do not attend school or hold a

job. An international vignette-used questionnaire survey indicates

the spread of hikikomori in many other countries (Kato et al.

Lancet

, 2011; Kato et al.

Soc Psychiatry Psychiatr Epidemiol

, 2012).

In addition, our international clinical studies have revealed the

prevalence of hikikomori outside Japan (Teo et al., 2015). On the

other hand, a novel form of maladaptive psychopathology, called

modern-type depression has emerged in Japan (Kato et al.

J Affect

Disord

, 2011; Kato et al.

Psychiatry Clin Neurosci

, 2016).

In this presentation, I will introduce “Hikikomori” and “modern-

type depression” in Japan, and also propose novel diagnos-

tic/therapeutic approach against them.

Disclosure of interest

The author has not supplied his declaration

of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.835

S20

International research on social

withdrawal

A.R. Teo

VA Portland Health Care System, Center to Improve Veteran

Involvement in Care, Portland, USA

Introduction

Since the 1990s the term “Hikikomori” has emerged

as a way to describe amodern formof severe social withdrawal first

described in Japan. Recently, there have been increasing reports of

Hikikomori around the globe.

Objectives

To describe operationalized research criteria for

Hikikomori, as well as epidemiologic, diagnostic, and psychosocial

features of the Hikikomori in international settings.

Methods

Participants were recruited from sites in India, Japan,

Korea, and the US. Hikikomori was defined as a six-month or

longer period of spending almost all time at home and avoiding

social situations and social relationships, associated with signifi-

cant distress/impairment. Lifetime history of psychiatric diagnosis

was determined by the Structured Clinical Interview for the DSM-

IV Axis-I and Axis-II Disorders. Additional measures included the

Internet Addiction Test, UCLA Loneliness Scale, Lubben Social Net-

work Scale (LSNS-6), and Sheehan Disability Scale (SDS).

Results

Thirty-six participants meeting diagnostic criteria for

Hikikomori were identified, with cases detected in all four

countries. Avoidant personality disorder (41%), major depres-

sive disorder (32%), paranoid personality disorder (32%), social

anxiety disorder (27%), posttraumatic stress disorder (27%), and

depressive personality disorder (27%) were the most common

diagnoses. Sixty-eight percent had at least two psychiatric diag-

noses. Individuals with Hikikomori had high levels of loneliness

(UCLA Loneliness Scale M= 55.4, SD = 10.5), limited social networks

(LSNS-6 M= 9.7, SD = 5.5), and moderate functional impairment

(SDS M= 16.5, SD = 7.9).

Conclusions

Hikikomori exists cross-nationally and can be

assessed with a standardized assessment tool. Individuals with

Hikikomori have substantial psychosocial impairment and disabil-

ity, and a history of multiple psychiatric disorders is common.

Disclosure of interest

The author has not supplied his declaration

of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.836

Diagnostic process in psychiatry

S21

Transcultural issues in diagnostic

process

M. Kastrup (Speciallæge i psykiatri)

Copenhagen, Denmark

Diagnostic systems and methods must respond to patients’ diver-

sity in expressions of mental distress, social and cultural context