ABSTRACT
Social withdrawal in adolescence presents itself as a spectrum of phenomena ranging from the variant of the norm to severe psychopathology. According to recent data, this condition involves almost 100.00 youths, mostly male. This work summarizes the clinical characteristics of Serious Social Withdrawal (RSG), the possible paths of diagnosis and management, and its correlation with the phenomena induced by the COVID-19 pandemic. The main aspects of this phenomenon are self-reclusion at home for 6 months, with rare exits and early school leaving, reduction of direct communication with family members and external relations, partly substituted from virtual relationships via web. The typical onset is in pre-adolescence, with a second peak at the threshold of adulthood, occasionally associated with frustration, bullying or exposure to narcissistic traps. The family systemic function could be displaced by the social withdrawal. Primary and secondary social withdrawal differential diagnosis represents a complex and discussed topic also due to the potentially pathogenic role of social withdrawal itself. RSG does not appear in diagnostic manuals as a nosological entity "per se", but as a symptom of other pathologies (anxiety disorders, mood disorders, etc.) but it is placed in the intersection of individual, developmental, family and social trajectories. On one side the "evolutionary" role of RS can be linked to a temporary narcissistic reorganization in adolescence or could represents the onset of a structured disorder of affective and emotional functioning. Services and Mental Health Specialists may have difficulties to reach less severe patients or with lower efficient family networks. The difficulties of reorganizing the NPIA Services in the COVID-19 are discussed maintaining flexible and multidimensional interventions. The standard situation of the Services forces to structure the interventions based on the available resources, and not only based on clinical needs;earliness and integration of the interventions are related to a more favorable prognosis. In a second section, we discuss the specific characteristics of the reception, diagnosis and care pathways of patients with RSG in an out-patient and semi-residential setting, and in a hospital setting (from the A&E to admission to the Day Hospital). Italian Care Services organizational characteristics are heterogeneous, with diversified protocols, structures and paths. The prevention and an early and synergistic care and stable and formal collaboration agreements between health, social and educational skills are fundamental. The available diagnostic tools are discussed, as well as the criteria for the direct care project, based on necessity, coherence, feasibility, both to the minor and to the family and its environment, and their possible use by a mobile and competent team. The general and practical theoretical aspects of home and semi-residential interventions are outlined. The path and effectiveness indicators and their modification from the beginning of 2020, still in progress due to the distortions induced by the COVID-19 pandemic, are discussed. We focus on changes in the very concept of "school" and "presence", and to their meaning for narcissistically fragile, anxious or depressed subjects. Possible semi-residential, therapeutic, rehabilitative, intensive, complex and coordinated interventions are discussed in detail, with particular regard to their transitional role between acute and hospitalization, as an "enlarged psychic space". Finally, the existing experiences in the hospital, ward and A&E setting are mentioned. (PsycInfo Database Record (c) 2022 APA, all rights reserved)