Hwa-Byung: a Korean culture-bound syndrome?

TLDR

The author reports three cases of Hwa‑Byung, a Korean folk illness perceived as a physical affliction yet presenting both physiological and psychological symptoms, often linked to interpersonal conflicts and anger. The study examines how depression contributes to Hwa‑Byung symptom formation and discusses its treatment implications. In the reported cases, patients described an epigastric mass that was not found on physical examination and a persistent fear of impending death that medical reassurance could not alleviate.

Abstract

The author reports three cases of Hwa-Byung, a Korean folk illness ordinarily understood by patients and families to be a physical affliction despite the fact that its manifestations include both physiological and psychological symptoms. In addition, the patient often recognizes interpersonal conflicts and anger as precipitating factors. In the three cases reported, the patients also identified an epigastric mass that was not present on physical examination. Symptoms were accompanied by a fear of impending death that was not easily dispelled by medical reassurance. The author discusses the role of depression in the symptom formation of Hwa-Byung as well as the treatment implications.