Stigma associated with the labeling of schizophrenia, depression, and hikikomori in Japan.

Jordan E. DeVylder, Zui Narita, Sachiko Horiguchi, Manami Kodaka, Jason Schiffman, Lawrence H. Yang, Ai Koyanagi

Research output: Contribution to journalArticlepeer-review


Labeling is a fundamental component of stigma, which allows the identification of features or behaviors that are then stereotyped and made into targets of discrimination. In Japan, the label applied to the condition known in the DSM and International Statistical Classification of Diseases and Related Health Conditions as “schizophrenia” was revised in 2002 from “mind-split disease” to “integration disorder,” intending to alleviate stigma associated with this condition. However, there has been little research examining the effect of the label itself on stigmatizing attitudes, particularly in relation to other mental health conditions, such as depression, or nonclinical cultural idioms of distress, such as hikikomori (i.e., social withdrawal or, literally, “pulling inward”). In this vignette study, we examined the influence of labeling on mental illness stigma by randomizing the label attached to a set of diagnostically ambiguous cases and assessing attitudes regarding these cases among an Internet-based sample of Japanese adults (N = 192). Using within-subjects analysis of variance, we found that both schizophrenia labels, “integration disorder” and “mind-split disease,” were similarly associated with the greatest levels of stereotype awareness but not any other components of stigma. The schizophrenia-labeled cases were also viewed as being more biologically rather than socially caused, compared to depression and hikikomori. Compared to hikikomori, all 3 clinical label conditions (both schizophrenia labels, plus depression) were rated as having a greater need for clinical treatment. Overall, there were no significant differences between the 2 schizophrenia labels on any outcome measure, whereas the nonclinical label was associated with less perceived need for treatment, greater social causation, and less perceived unpredictability.

Original languageEnglish (US)
Pages (from-to)472-476
Number of pages5
JournalStigma and Health
Issue number4
StatePublished - 2020


  • Japan
  • hikikomori
  • labeling
  • schizophrenia
  • stigma

ASJC Scopus subject areas

  • Social Psychology
  • Clinical Psychology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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