Hwa-Byung syndrome in Korean women

The article I found was related to a research into treatment of patients suffering from the culture bound syndrome ‘Hwa-Byung’, which seems to afflict middle aged Korean women with low socioeconomic status and low education levels. The title of the article was “The Associations of Coping Mechanism with Arterial Stiffness in Hwa-Byung Patients”.  The authors introduce the paper by talking about how mental stress is connected to cardiovascular diseases, including arthrosclerosis, and its negative side effects can lead to atherosclerotic cardiovascular disease.  As an association had been made between stress and atherosclerosis, the authors felt is was important to investigate appropriate coping strategies to reduce/minimize the cardiovascular health risks.

The article discusses how Hwa-Byung patients displayed somatic and psychological symptoms such as depression, anxiety, chest tightness etc. The symptoms of Hwa-Byung patients overlap cardiovascular symptoms, confusing diagnosis. The low economic status was also deemed to be associated with the risk factors of cardiovascular disease among Hwa-Byung sufferers. The authors indicate that previous studies on the coping mechanisms of Hwa-Byung patients suggest that such people use ineffective coping strategies such as “active forgetting, accommodation, fatalism, emotional pacification and emotional support seeking”. They also tended to utilize negative passive mechanisms such as withdrawal and self-criticism.

The research was conducted on 50 patients who felt that they had Hwa-Byung syndrome. They were also assessed using a Ways of Coping Checklist (WOCC). Blood cholesterol samples were taken from fasting participants, as cholesterol is a risk factor for atherosclerosis. The results indicated that coping skills wee inversely related to social support seeking patients. The article then clarifies that the core concept of Hw-Byung is considered to have originated from a Korean cultural emotion “Hahn” which is a concoction of sorrow and anger feelings. This emotion is connected to psychosocial stress of family and economic discords. As Korean culture implies suppression of anger, the pathogenesis of Hwa-Byung may be considered a maladaptive coping mechanism for stress. The authors however acknowledge that in western medicine, the culture bound syndrome would be related to somatic disorders such as anxiety and depression.

The article concluded that social isolation is a predictor for atherosclerotic progression. Interestingly, the authors also suggest that in a catch 22, those who feel that they have Hwa-Byung syndrome may be isolating themselves by suggesting that they have the culture bound syndrome.

The article concludes by suggesting that coping styles and strategies are associated with cardiovascular issues and health education and improved adaptive coping strategies may help reduce the risk in patients with Hwa-Byung disease.


Lee, Yu Jin, Kyung Won Baek, Kyu Wol Yun, and Weonjeong Lim. “The Associations of Coping Mechanism with Arterial Stiffness in Hwa-Byung Patients.” Psychiatry Investigation 6, no. 4 (December 2009). Accessed July 17, 2013. http://dx.doi.org/10.4306/pi.2009.6.4.241.

This Post Has 1 Comment

  1. J. Brodie Timms-Fryer says:

    For me it is a toss up when it comes to culture. Is it something good? Bad? Is it actually something at all? For the most part I think it is something and it’s nature is purely situational. Culture, for me, is what is accepted and expected in a given society, inclusively and exclusively. Inclusively and exclusively because we can have overlapping cultural similarities not unlike a Venn diagram. Specifically, I say expected and accepted because we can use culture as a go-to answer to any question about some given cultural practice; it’s a culture thing! But as an observer and not really experiential, it is a convenient way to sum up a given sample of a population. For the case of Hwa-Byung syndrome in Korean women, I cannot wholly agree it is a cultural-bound syndrome.
    I think the post accurately displays this notion when it says: “The authors however acknowledge that in western medicine, the culture bound syndrome would be related to somatic disorders such as anxiety and depression.” This does elucidate a parallel in Western society of how it would be regarded in that context. Because of reason that it could be understood in such a way as a combination of the stress of anxiety and depression leaving the body more inclined to cardiovascular disease I can only accept this a particular sampling of a population that would and is more susceptible. Also, just by going on a 50 person sampling, the implication of the article in question has little to no practicality. Assuming that this is not the case and it is more widespread I would be more accepting that Korean women given the right demographic could be more susceptible to mental illnesses and cardiovascular complications but still not fully convinced. This syndrome may be a victim of unnecessary labelling of common medical problems giving the illusion that this solely effects particular Korean women.
    By not treating this as a CBS, the supposed symptoms could be treated accordingly and would probably result in positive responses. Leaving it as CBS may impede treatment if it is regarded as wholly different and something else entirely.

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