Pathological and Non-Pathological Severe Social Withdrawal Trait Profiles: Cluster Analysis and Predictors of Psychiatric Symptoms in Italian University Students

BACKGROUND: In recent years, the concept of hikikomori has been redefined due to profound socio-cultural and digital changes, making it necessary to distinguish between pathological and non-pathological forms of social withdrawal. AIMS: This study aims to identify profiles of social withdrawal and describe their psychopathological correlates in a large sample of young Italian adults. METHOD: A cross-sectional study was conducted on 2,303 Italian university students (aged 18-35), recruited through an online survey, using validated instruments for the assessment of social withdrawal (HQ-11), emotional distress (DASS-21), loneliness, boredom, alexithymia, and problematic use of the Internet and video games. RESULTS: Four distinct profiles were identified using k-means cluster analysis based on HQ-11 and DASS-21 subscales scores. Two clusters showed low levels of social withdrawal, with varying degrees of emotional symptoms, while two clusters showed high social withdrawal: one characterized by the absence of significant psychopathology ("non-pathological severe social withdrawal") and one associated with high emotional distress ("pathological severe social withdrawal"). The latter group reported significantly higher levels of loneliness, boredom, alexithymia, and problematic Internet use. Logistic regression analysis showed that difficulty in identifying emotions, high-arousal boredom, and high emotional loneliness were associated with classification into in the pathological severe social withdrawal trait profile. CONCLUSION: The results support the heterogeneity of self-reported severe social withdrawal traits and highlight the importance of distinguishing between profiles with higher and lower levels of associated psychological distress. However, these profiles should not be interpreted as clinically diagnosed hikikomori.