The findings suggest that emotional neglect, dysfunctional or absent parent-child interactions, and the inhibition of self-expression may be underlying causes of Hikikomori in Japanese children. All of the clients presented with an inability to trust others and exhibited inhibited self-expression, loss of secure attachment, estrangement, and a phobia of humans. A full 71 percent of clients had dual personalities, which were expressed both overly and covertly. Ninety-one percent of clients reported a history of emotional neglect by parents who were described as unresponsive or insensitive to their children’s emotional needs. Clients reported that they learned to be quiet and invisible at all times and reported feeling emotionally abandoned. The treatment protocol involved the use of psychotherapy for dealing with past trauma, beginning with prolonged therapeutic conversations about trust and safety. The author notes that in order to adapt to emotionally dysfunctional parents, the clients repressed their original identities and created false front identities. Treatments should focus on the recovery and healthy attachment of the original identity. Optimistic prognoses are expected with early intervention. Participants were 25 male and 10 female clients whose symptoms met the government criteria for Hikikomori. Their conversations and clinical records were analyzed for clinical features, childhood experiences, personal and family history, and treatment history. The analysis relied on the Dissociative Experiences Scale (DES). Further research on Hikikomori, particularly treatments, is called for given the prevalence of this disease in Japan. Tables, references