Approach Considerations

A severe form of social phobia and avoidant personality disorder, Hikikomori has been associated with adverse cardiovascular consequences including hypertension thus a physical exam and medical testing is important especially for persons with other risk factors such as physical inactivity and obesity.^[18]

Individuals who scored high on a measure of being concerned with halitosis (the Halitosis Consequences Inventory) appeared to be at a higher risk of social anxiety, underscoring the importance of screening if a person presents to a health care professional with complaints of halitosis.^[41]

Laboratory Studies

Basic laboratory studies are prudent to detect contraindications to medication treatment, as well as to screen for comorbid conditions such as anemia, low ferritin levels (especially in the presence of a sleep disorder), and hypothyroidism. Such studies might include a serum CBC count with differential, an electrolyte evaluation, liver function tests, metabolic screening and thyroid function tests.

Preliminary findings of one study show possible blood biomarkers that may reflect increased risk for Hikikomori—lower serum HDL-C in females and lower serum uric acid in males—which may reflect an underlying mechanism of oxidative stress and inflammation increasing risk of social phobia, thus indicating the importance of screening testing, especially for individuals at higher risk of cardiovascular complications, such as persons with an inactive lifestyle and obesity.^[38]

Imaging Studies

Neither single-photon emission computed tomography (SPECT) nor functional MRI (fMRI) is clinically helpful in the diagnosis or treatment response in individuals with social phobia. However, these techniques are useful for excluding structural brain disease (tumor or infection). These techniques are also being used investigationally in research protocols; it has been shown that social anxiety is a different disorder from generalized anxiety disorder in terms of symptomology and brain structure.^[42]

Cognitive distortions and self-monitoring in social situations result in hyperawareness of internal cues and intense arousal to the perceived negative aspects of social interactions. Studies have shown that the fear associated with the hyperawareness may be decreased or not occur at all with lesions in the area of the amygdala.^[43]

During adolescence, brain changes may increase risk for development of social anxiety disorder due to increased insular sensitivity to negative reward prediction error processing.^[44]

Other Tests

In general, social phobia is not associated with mitral valve prolapse, so echocardiography is unnecessary unless clinically indicated because of other symptoms or history.^[21]

Treatment & Management

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