European Psychiatry - Volume 33 - March 2016

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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.
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.
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.
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.
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