Hwa-Byung in Korean Women

*The scholarly, peer reviewed article I used was Identifying and treating the culture-bound syndrome of Hwa-Byung among older Korean immigrant women: Recommendations for practitioners written by Myunghan Choi and Hye-A Yeom.  According to this article, Hwa-Byung is a medically relevant psychiatric term and literally means anger disease in Korean.  This disease is found in 4% to 11.9% of older Korean immigrant women.  It manifests itself due to suppression of anger, frustration, hate, animosity, and with any other negative feeling toward their family.  The most obvious symptoms include depression, anxiety, palpitations, lumps in the upper chest, and feelings of impending doom.  Hwa-Byung is usually self-diagnosed by Korean women but rarely is medical attention sought after as seeking psychiatric counseling or mental health services are negatively stigmatized in Korean society. 

When medical attention is sought after, there is usually a misdiagnosis of depression since the symptom presentations are greatly similar.  Proper assessment of Hwa-Byung should include the patient’s social, cultural, and life histories.  The use of a medical bilingual interpreter is also extremely helpful.  However, as most Korean women are uncomfortable talking about their age, education, and marital status, the use of a private demographic information questionnaire to be filled out prior to the appointment is very useful.

As stated in the article, “The unique features of Hwa-Byung that differentiate it from other mental illnesses are that patients acknowledge that they have Hwa-Byung; they have felt guilty for having it; they have been submissive or obedient; they have hidden their anger or negative feelings; they have sighed often; they have generalized anxiety; they have felt something was pushing up inside their chests; they had often felt their heart pounding; and yet they have extreme resilience and no suicidal ideation or attempts.”  The Hwa-Byung scale, which has been used for years in South Korea with great success, is available for use and should be used by medical professionals everywhere.

Treatment for Hwa-Byung should be a combination of both pharmacological and nonpharmacological interventions.  However, if improvement is not reported after 6-8 weeks a referral to a psychiatric specialist or mental health services should be completed.  Other signs that the patient should be immediately referred to a specialist include that of serious major depression, suicidal intent, persistent self-neglect, or severe pulmonary or cardiac symptoms. 

 *Culturally speaking, Hwa-Byung can manifest simply because the individual does not seek medical attention upon first onset of stress or anger as psychiatric illness are greatly stigmatized in the Korean culture.  As the stress is held onto and bottled up, it can turn to anger.  This anger will most likely be suppressed and will accumulate over time to eventually develop into Hwa-Byung.  This makes sense as Hwa-Byung has a development duration of approximately 10 years.  The Korean woman suffering from Hwa-Byung may also not seek medical attention as her first cultural responsibility is that of daily house chores.  Biologically, Hwa-Byung normally only occurs in older first generation Korean immigrants and middle-ages or older women in Korea.  This disease can be individually self-diagnosed and is more acceptable to Koreans than depression.  It can be caused by a multitude of different causes.  Basically, anything that causes the individual to become greatly stressed over a period of time can cause the eventual manifestation of Hwa-Byung. 

 *Persons with Hwa-Byung in Korea often seek treatment through Christianity.  The power and control that they seem to lack in their daily lives can be found in Christianity.(2)  In Korean culture, the most common treatments of Hwa-Byung include that of pharmacists, traditional herb physicians, shaman rituals, traditional medical physicians, and psychiatric treatments.(3)  


(1)Choi, M., & Yeom, H. (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(5), 226-232. doi:10.1111/j.1745-7599.2011.00607.x http://za2uf4ps7f.search.serialssolutions.com.proxy1.cl.msu.edu/directLink?&atitle=Identifying+and+treating+the+culture%E2%80%90bound+syndrome+of+Hwa-Byung+among+older+Korean+immigrant+women%3A+Recommendations+for+practitioners.&author=Choi%2C+Myunghan%3BYeom%2C+Hye%E2%80%90A.&issn=10412972&title=Journal+of+the+American+Academy+of+Nurse+Practitioners&volume=23&issue=5&date=2011-05-01&spage=226&id=doi:10.1111%2Fj.1745-7599.2011.00607.x&sid=ProQ_ss&genre=article accessed July 17, 2012.

 (2)Hwang, Y. H. (1995). A study of hwa-byung in korean society: Narcissistic/masochistic self-disorder and christian conversion. Princeton Theological Seminary). ProQuest Dissertations and Theses, p 225. http://ezproxy.msu.edu/login?url=http://search.proquest.com/docview/304221703?accountid=12598, accessed July 20, 2012.

 (3) Min, Sung Kil (2004). Treatment and Prognosis of Hwabyung. Psychiatric Investigation, 1(1), 29-36. www.psychiatryinvestigation.org/html/pdfdown.asp?pn, accessed July 20, 2012.

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