''Hwabyeong'' or ''Hwapyŏng'' (

hangul The Korean alphabet, known as Hangul, . Hangul may also be written as following South Korea's standard Romanization. ( ) in South Korea and Chosŏn'gŭl in North Korea, is the modern official writing system for the Korean language. The let ...

: 화병,

hanja Hanja (Hangul: ; Hanja: , ), alternatively known as Hancha, are Chinese characters () used in the writing of Korean. Hanja was used as early as the Gojoseon period, the first ever Korean kingdom. (, ) refers to Sino-Korean vocabulary, wh ...

: ) is a Korean

somatization disorder Somatization disorder is a mental disorder, mental and Abnormal behavior, behavioral disease#Disorder, disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic nervous system, somatic symptoms. It ...

, a

mental illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...

which arises when people are unable to confront their anger as a result of conditions which they perceive to be unfair. Hwabyeong is known as a Korean

culture-bound syndrome In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or cu ...

. Hwabyeong is a colloquial name, and it refers to the

etiology Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek (''aitiología'') "giving a reason for" (, ''aitía'', "cause"); and ('' -logía''). More completely, e ...

of the disorder rather than its symptoms or apparent characteristics. In one survey, 4.1% of the general population in a rural area in Korea were reported as having hwabyeong. Hwabyeong is similar to Amuk. The word hwabyeong is composed of ''hwa'' (the Sino-Korean word for "fire" which can also contextually mean "anger") and ''byeong'' (the Sino-Korean word for "syndrome" or "illness"). It may also be called ''ulhwabyeong'' (), literally "depression anger illness".

Symptoms

Physical symptoms include: *

palpitation Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart. Symptoms include a rapi ...

s *

anorexia Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gre ...

dry mouth Xerostomia, also known as dry mouth, is dryness in the mouth, which may be associated with a change in the composition of saliva, or reduced salivary flow, or have no identifiable cause. This symptom is very common and is often seen as a side eff ...

insomnia Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...

* thoracic/chest pressure * respiratory difficulties *

epigastric In anatomy, the epigastrium (or epigastric region) is the upper central region of the abdomen. It is located between the costal margins and the subcostal plane. Pain may be referred to the epigastrium from damage to structures derived from the fo ...

mass *

headache Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result ...

* a whole-body sensation of heat (distinct from

heat intolerance Heat intolerance is a symptom characterized by feeling ''overheated'' in ''warm'' environments or when the surrounding environment's temperature rises. Typically, the person feels uncomfortably hot and sweats excessively. Compared to heat ill ...

, a symptom of

hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism ...

) Psychological symptoms include: * being easily startled * externalization of anger, also known in Korean as "bun" (憤, "eruption of anger"), a Korean culture-related sentiment related to social unfairness * generally sad mood * frequent sighing * a feeling of "eok-ul" (抑鬱, eeling ofunfairness) * being easily agitated * feelings of guilt * feelings of impending doom Diagnosed patients may also have a medical history of prior major

depressive disorder A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the ''Diagnostic and Stat ...

dysthymic disorder Dysthymia ( ), also known as persistent depressive disorder (PDD), is a mental disorder, mental and Abnormal behaviour, behavioral disease#Disorder, disorder, specifically a disorder primarily of mood disorder, mood, consisting of similar cognit ...

anxiety disorders Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...

somatoform disorders A somatic symptom disorder, formerly known as a somatoform disorder,(2013) dsm5.org. Retrieved April 8, 2014. is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general ...

, or

adjustment disorder Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual ...

according to the ''Diagnostic and Statistical Manual of Mental Disorders'', fourth edition (DSM-IV) criteria. Diagnosed patients are most likely to be middle-aged,

post-menopausal Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...

women with low socio-economic status.

Causes

Underlying causes may include: * amuk * prior instances of

major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introdu ...

* prior instances of

anxiety disorder Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...

* prior instances of

* prior instances of other

somatoform disorder A somatic symptom disorder, formerly known as a somatoform disorder,(2013) dsm5.org. Retrieved April 8, 2014. is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general ...

s * repression of feelings of anger/resentment arising from past events Triggering causes are typically external events, including: * familial stressors, e.g. spousal infidelity or conflict with in-laws * witnessing acts/actions/phenomena that conflict with one's own moral and/or ethical principles The syndrome itself is believed to be the result of the continued repression of feelings of anger without addressing their source. In

holistic medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and alte ...

the containment of anger in hwabyeong disturbs the balance of the five bodily elements, resulting in the development of

psychosomatic A somatic symptom disorder, formerly known as a somatoform disorder,(2013) menopause Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...

may also be an underlying cause of hwabyeong in middle-aged women, the most often-diagnosed demographic.

Treatment

Western doctors are more likely to diagnose it as a kind of stress or depression. The ''

Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

'' currently lists hwabyeong among its culture-bound illnesses. Outside of Korea, informally hwabyeong may be mistaken as a reference to a psychological profile marked by a short temper, or explosive, generally bellicose behavior. To the contrary, hwabyeong is a traditional psychological term used to refer to a condition characterized by passive suffering, is roughly comparable to depression, and is typically associated with older women.Choi, M. (2011, August 22). Identifying and treating the culture-bound syndrome of Hwa-Byung among older Korean immigrant women: Recommendations for practitioners. Retrieved March 5, 2013, from EbscoHos

. It is important that when diagnosing hwabyeong, the culture of the patient is well understood. Since hwabyeong can often be misdiagnosed as depression, the symptoms and culture need to be clearly and thoroughly looked into. Once hwabyeong has been diagnosed, past treatments need to be reviewed. The treatments for the patient can then be a combination of pharmacological, and therapy-based interventions. The treatment methods used to combat hwabyeong include

psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...

, drug treatment,

family therapy Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychology and clinical social work that works with families and couples in intimate relationsh ...

, and community approaches. To be more successful, psychiatrists might need to incorporate the teachings from traditional and religious healing methods or the use of han-puri, which is the sentiment of resolving, loosening, unraveling, and appeasing negative emotions with positive ones. One example of han-puri would be a mother who has suffered from poverty, less education, a violent husband, or a harsh mother-in-law, that can be solved many years later by the success of her son for which she had endured hardships and sacrifices.

Symptoms

Causes

Treatment

See also

References

Further reading