Hwabyeong

Hwabyeong or Hwabyung (hangul: 화병, hanja: 火病) is a Korean somatization disorder, a mental illness which arises when people are unable to confront their anger as a result of conditions which they perceive to be unfair. Hwabyung is known as a Korean culture-bound syndrome. Hwabyung is a colloquial name, and it refers to the etiology 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 hwabyung. Hwabyung is similar to Amuk.

The word hwabyung is composed of hwa (the Sino-Korean word 火 for "fire" which can also contextually mean "anger") and byung (the Sino-Korean word 病 for "syndrome" or "illness"). It may also be called ulhwabyeong (鬱火病), literally "depression anger illness".

Symptoms

Physical symptoms include:

• palpitations
• anorexia
• dry mouth
• insomnia
• thoracic/chest pressure
• respiratory difficulties
• epigastric mass
• headache
• a whole-body sensation of heat (distinct from heat intolerance, a symptom of 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, [feeling of] unfairness)
• being easily agitated
• feelings of guilt
• feelings of impending doom

Diagnosed patients may also have a medical history of prior major depressive disorder, dysthymic disorder, anxiety disorders, somatoform disorders, or adjustment disorder 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 women with low socio-economic status.

Causes

Underlying causes may include:

• amuk
• prior instances of major depressive disorder
• prior instances of anxiety disorder
• prior instances of adjustment disorder
• prior instances of other somatoform disorders
• 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 the containment of anger in hwabyung disturbs the balance of the five bodily elements, resulting in the development of psychosomatic symptoms such as panic, insomnia, and depression after a long period of repressed feelings.

It is possible that hormonal imbalances such as those around the time of menopause may also be an underlying cause of hwabyung 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 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. 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 hwabyung include psychotherapy, drug treatment, family therapy, 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 hann-puri would be a mother who has suffered from poverty, less education, a violent husband, or a harsh mother-in-law, can be solved many years later by the success of her son for which she had endured hardships and sacrifices.