Special Article
Correspondence: Byoung Hoon Oh, MD, PhD, 696-6 Tanbuldong, Kwangju City, Kyungido 464-100, Korea
Tel: +82-31-797-5745, Fax: +82-31-763-5745, E-mail: drohh@chollian.net
Hwabyung (火病), is known as a Korean culture-related syndrome. In Korean, Hwa
(火) means anger as well as fire, and Hwabyung is referred to as an anger syndrome. There are two currently prevailing points of view regarding Hwabyung-the longitudinal view and the cross sectional view. The former corresponds to the traditional culture oriented view, in which the symptoms are interpreted dynamically, while the latter represents the viewpoint of modern medicine. Hwabyung is to be a chronic syndrome.
The prevalence of Hwabyung is 4-5% of the general population and it is frequently found in middle-aged or older women of the lower social class. Amongst the symptoms of Hwabyung, the presence of lump in the throat or chest was frequently mentioned by the patients. The etiology of Hwabyung has been variously described by patients as being anger and/or other anger-related negative emotional reactions, including "uk-wool" and "boon", which have been accumulating for a certain period of time. Rhi1 suggested that Hwabyung
developed through 4 stages shock, conflict, resignation and the final stage being haan. However, Min2 suggested that Hwabyung is actually a mixture of these.
In terms of the treatment and prognosis of Hwabyung, an integrated approach is required, which combines psychosocial therapy, including psychoanalytic therapy and cognitive-behavioral therapy, and drug therapy.
For quite some period of time, studies of Hwabyung have been carried out in many different disciplines, in order to clarify the concept, clinical features and aspects of Hwabyung. Nevertheless, no definite conclusion has yet been reached as to whether Hwabyung should be considered as a definite disease entity. Hwabyung is often manifested as a comorbidity of somatization disorder with major depression and of generalized disorder, according to the DSM IV criteria3. The question remains as to whether Hwabyung is specific to the Korean culture and whether its designation as a specific ailment is warranted. Indeed, the question as to whether Hwabyung is a culture bound syndrome or not has always been controversial. Further research on this issue is needed in the future. Therefore, it is necessary to study if anger related syndromes such as Hwabyung are found in other cultures. More extensive individual case studies and in-depth investigations seem to be desirable, which should also include the cross-cultural aspects of this disorder.
Rhi BY: Folk concept of mental illness and treatment (1), J Korean Neuropsychiatric Assoc 1970; 19(1): 35-45.
Min SK: Study on the concept of Hwabyung, J Korean Neuropsychiatric Assoc 1989; 28: 604-616.
American Psychiatric
Association: Diagnostic and Statistical Manual 4th Edition, APA, Washington DC. 1994.