These requirements are that “(1) must be a distinct and well-defined syndrome. . . (2) recognized as a specific disease in culture. . . (3) expected, recognized and to some extent sanctioned. . . [and] (4) a higher incidence or prevalence. . . it must exist in societies where the disorder is culturally recognized” (Teo and Gaw 446). The first requirement of a culture-bound syndrome, which must be a “discrete and well-defined syndrome,” has been met. Although no consensus has been reached on a distinct definition of hikikomori, the Japanese Ministry of Health, Labor and Welfare has stated that the following criteria are the defining characteristics of hikikomori: “(1) a home-centered lifestyle ; (2) no interest or willingness to attend school or work; (3) duration of symptoms of at least 6 months; (4) schizophrenia, mental retardation, or other mental disorders were excluded; . . . (5) those who maintain personal relationships (e.g., friendships) were excluded” (Teo and Gaw