Hwa-Byung translates into English as anger or fire disease. Often termed a Korean folk illness, it is characterized by physical and psychological symptoms that arise as the result of chronically suppressed anger. Reported most frequently by women, hwa-byung is believed to develop through an interaction of culturally supported emotional repression, avoidance of conflict and external expressions of anger, and the experience of chronic hardships and oppression.
Traditionally, Korean culture discourages outward displays of conflict and emotion, particularly those labeled as negative, with a cultural emphasis placed on personal temperance and the maintenance of harmonious interpersonal relationships. Consequently, negative emotions, such as anger, disappointment, and sorrow, are internalized. Hwa-byung may develop due to the accumulation of internalized emotions and their interaction with the hardships many Korean women report, such as stressful familial and marital relationships, domestic abuse, discrimination, inequity, and abject poverty/deprivation. Accordingly, hwa-byung has been suggested by some to be a culturally sanctioned idiom of distress through which Korean women are able to express their suffering. The prevalence of hwa-byung has been found to be highest in middle-aged women who have emigrated from Korea. It is believed that the psychological stress and difficulties that often accompany the immigration process are correlated to this increase in cases.
There are multiple symptoms associated with hwa-byung. As this is a complex and varied illness, persons with hwa-byung present with individually unique clusters of symptomotology and may report experience through a combination of biomedical and lay/cultural terminology. Classic somatic symptoms of hwa-byung include the sensation of a traveling epigastric mass that may interfere with respiration and/or digestion; disturbances in the body’s ability to regulate temperature, often experienced as an accumulation of heat felt in the neck, face, or head, and/or intolerance to environmental temperature changes; gastrointestinal symptoms including anorexia, stomach upset, constipation, and/or diarrhea; cardiac complaints such as heart palpitations, irregular heartbeat, and/or heart-pounding; and reports of diffuse, chronic muscle pain. Psychological symptoms of hwa-byung include anger, insomnia, anxiety, panic, and depression. Individuals experiencing symptoms of hwa-byung may seek treatment from a variety of providers including traditional healers, physicians, mental health professionals, and religious leaders.
Hwa-byung is classified as a culture-bound syndrome in the fourth edition, text revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR), and it is referenced, but not independently listed, in the ICD-10 Classification of Mental and Behavioral Disorders.