Hwa-byung is now listed as one of culture-bound syndromes in the appendix of the Revised Diagnostic Manual (DSM-IV) published by the American Psychiatric Association. The DSM-IV edition describes Hwa-byung as: "A Korean folk syndrome literally translated into English as "anger syndrome" and attributed to the suppression of anger. The syndrome include insomnia, fatigue, panic, fear of impending doom, dysphoric affect, indigestion, anorexia, palpitation, generalized aches and pains, and a feeling of a mass in the epigastrium." There have been debates as to whether or not Hwa-byung is considered as a Korean culture-bound syndrome, or a clinical syndrome of "anger disease" that is more universal in nature, but is called differently in different ethnic cultures.
Of interest is the findings that most Hwa-byung patients were aware that the cause of Hwa-byung is psychogenic in nature. When they were asked what they think caused the symptoms, most answered that the symptom stems from suppressed Hwa (anger and fire) for too long. In the survey, when they were asked what kind of difficulties they thought were associated with their personal Hwa, their problems were multiple. 72% of them said they were having troubles with their spouses in the form of such things as extramarital affairs, alcoholism, and domestic violence. 68% had in-law problems, and 35% felt their difficulties with children could be attributed to Hwa. In addition, social factors were cited: 65% were related to poverty, 58% some kind of life hardship, and 32% unfair blame and criticism
Luke Kim, M.D., Ph.D. is a clinical professor of psychiatry at University of California School of Medicine. He is a board member of Friends of Korea organization in Sacramento, California, and a friend and supporter of Korean Quarterly newspaper.
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