Hwa-byung

a culture-related anger syndrome in Korea

Tina CasagrandUniversity of Missouri

“I’m almost getting Hwa-byung.”

- My roommate’s mother whenever she feels stressed.

Symptoms

“Uk-wool/boon” = perception of unfairness.

“Hwa” = Fire; long-term, insidious discontent.

Subjective anger, expressed anger and feelings of hate. A sensation of heat (yang).

Major depression and anxiety. Guilt.

“Pushing up” in the chest, heaviness in the head, respiratory stuffiness, palpitations, mouth dryness, sighing, talkative/many thoughts, and much pleading. Impulsive need to leave.

Demographics

4.1 – 4.9% of the general Korean population

More frequent in: Women Middle-aged Lower

socioeconomic status

Cultural Context

• Familial collectivism• Confucian society• Women oppressed• “HB might be a

means of expressing misery and despair

without stigma.”

Mental Context

“Haan” or “Hahn” = emotional complex unique to Korean culture, that involves mixed feelings of missing someone,

sorrow, endurance and regret, along with feelings of hatred and revenge.

Genetics and Evolution

Related to Neurasthenia, a Chinese culture-bound syndrome, related to the imbalance of yin and yang. It may have the same root as Hwa-byung.

In Cloninger’s Temperament and Character Inventory reflects temperament dimensions in inherited genetic factors. (Character dimensions are environmentally or culturally determined.)

Serotonin

Central serotonin system is commonly related to aggression/anger, depression and anxiety.

Recently documented to modulate behavioral reactions to “unfairness.”

Treatment

**In Korean society, mental treatment is stigmatized.

“Interventions may include coping strategies through increased self-awareness of causes, social support for the women, and lifestyle changes that promote health.”

Ethnic music therapy and drama

Psycho-social and pharmacological treatments

Paroxetine to control psychosomatic symptoms

Why treat?

• “Currently there are 18.2 million Asians in the United States or 5.8 per cent of population, up from one per cent in 1965.”

– The Telegraph• Women have been shown to have Hwa-byung even after they

immigrate.• Stress is tied to plaque buildup on inner arterial walls.

Sources

Choi, M. and H. Yeom. 2011. Identifying and treating the culture-bound syndrome of Hwa-Byung among older Korean immigrant women: recommendations for practitioners. Journal of the American Academy of Nurse Practitioners 23:226-232.

Kim, S. K. and S. Suh. 2010. The anger syndrome hwa-byung and its comorbidity. Journal of Affective Disorders 124:211-214.

Lee, J., S. K. Min, K. Kim, B. Kim, S. J. Cho, S. Lee, T. K. Choi and S. Suh. 2012. Differences in temperament and character dimensions of personality between patients with Hwa-byung, an anger syndrome, and patients with major depressive disorder. Journal of Affective Disorders 138:110-116.

Lee, Y. J., K. W. Baek, K. W. Yun, W. Lim, W. Lim. 2009. The associations of coping mechanism with arterial stiffness in Hwa-Byung patients. Psychiatry Investigation 6:241-244.

Lin, K., J. K. C. Lau, J. Yamamoto, Y. Zheng, H. Kim, K. Cho, and G. Nakasaki. 1992. Hwa-Byung: a community study of Korean Americans. The Journal of Nervous and Mental Disease 180:386-244.

Park, J., S. Park, C. Cheon, B. Jang, S. Lee, S. Lee, S. Chung, J. Kim, C. Jeon, J. Park, Y. Shin, S. Ko. 2012. Effect of oriental medicine music therapy on patients with Hwa-Byung: a study protocol for a randomized controlled trial. Trials http://www.trialsjournal.com/content/13/1/161.

Park, Y., H. S. Kim, H. Kang, J. Kim. 2001. A survey of Hwa-Byung in middle-age Korean women. Journal of Transcultural Nursing 12:115-122.