Gender differences in factors affecting Hwa-byung symptoms with middle-age people / 기본간호학회지

PURPOSE: This study was done to examine differences in the factors affecting Hwa-byung symptoms in middle-aged men and women. METHOD: There search design for this study was a descriptive survey design using a convenience sampling. Data collection was done using self-report questionnaires with 381 middle age people (169 men and 212 women) in Seoul and G city. ANOVA, t-test, Pearson correlation coefficients and stepwise multiple regression were used to analyze the data with SPSS Win 18.0 Program. RESULTS: There were significant differences in Hwa-byung symptoms and life stress between men and women. However anger rumination and mood states were not significantly different by gender. In multiple regression analysis, mood states, religion, and employment were significant predictors and explained 36% of Hwa-byung symptoms for men. In women, mood states, life stress, anger rumination and employment were significant predictors and explained 41% of Hwa-byung symptoms. CONCLUSION: Findings of this study provide a comprehensive understanding of Hwa-byung symptoms and related factors between men and women in Korea. However, further study with a larger random sample from various living environment is necessary.

Discrimination of Symptoms for Diagnosis of Hwabyung / 신경정신의학

OBJECTIVES: This study aimed to identify the essential symptoms for diagnosing Hwabyung. METHODS: We assessed 221 patients with depressive disorders, anxiety disorders, somatoform disorders, adjustment disorder, and so-called Hwabyung, using a structured diagnostic interview schedule that included the Korean version of SCID-I and the preliminary diagnostic criteria for Hwabyung. To select essential symptoms for diagnosing Hwabyung, we performed statistical analyses including factor analysis and logistic regression RESULTS: Statistical analysis revealed that sensations of heat, an epigastric mass, and something pushing up in the chest ; feelings of unfair treatment ; anger ; respiratory stuffiness ; palpitations; headaches ; sighing ;"haan" ; depressive mood ; frightening easily ; dry mouth; and many thoughts were the essential symptoms for a diagnosis of Hwabyung. CONCLUSION: Based on these results, we suggest a research diagnostic criteria for Hwabyung.

Symptoms to Use for Diagnostic Criteria of Hwa-Byung, an Anger Syndrome

OBJECTIVE: The aim of this study was to identify the characteristic symptoms which can be used for the diagnosis of hwa-byung, a culture-related anger syndrome in Korea. METHODS: The symptoms of the Hwa-byung Scale were correlated with the Korean versions of the Hamilton Depression Rating Scale (K-HDRS) and the State and Trait Anger Inventory (K-STAXI) in 89 patients, who were diagnosed as having major depressive disorder, dysthymic disorder, anxiety disorders, somatoform disorders, or adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria and who had self-labeled hwa-byung. Also, the symptoms of the Hwa-byung Scale were correlated with each other. RESULTS: The symptoms of the Hwa-byung Scale which were significantly correlated with the state anger of the K-STAXI but not with the depressive mood (item 1 of K-HDRS) included feelings of unfairness, subjective anger, external anger, heat sensation, pushing-up in the chest, dry mouth, and sighing. The symptoms which were significantly correlated with state anger and depressed mood included respiratory stuffiness, "haan" and hate. The symptoms which were not significantly correlated with depressed mood and state anger included going-out, epigastric mass, palpitation, headache/pain, frightening easily, many thoughts, and much pleading. These symptoms also showed higher correlation with each other in the correlation matrix. CONCLUSION: Our findings suggest that hwa-byung is different from depressive syndrome in terms of its symptom profile, and suggest what symptoms should be included in the diagnostic criteria of hwa-byung, an anger disorder.

The Associations of Coping Mechanism with Arterial Stiffness in Hwa-Byung Patients

OBJECTIVE: The goal of this study is to assess the relationship between stress coping mechanisms and the risk of atherosclerosis in patients with Hwa-Byung. METHODS: The Korean version of the Ways of Coping Checklist (WOCC) was administered to 50 patients with Hwa-Byung (49.1+/-10.1 years, 6 males). Brachial-ankle pulse wave velocity (baPWV) and serum cholesterol level were assessed in all participants. RESULTS: After controlling for age, sex, diagnosis of hypertension, Body Mass Index (BMI), and serum cholesterol level, the score of seeking social support in coping strategies was negatively correlated with right and left baPWV (r=-0.356, p=0.016; r=-0.373, p=0.012, respectively). In addition, the score of active coping mechanism was negatively correlated with both sides of baPWV (r=-0.383, p=0.009; r=-0.389, p=0.008, respectively). CONCLUSION: The seeking social support and active coping mechanism were inversely related to the severity of arterial stiffness in Hwa-Byung patients. Therefore, our result may suggest a possibility that coping strategies in Hwa-Byung patients are associated with the risk of atherosclerosis.

The Associations of Coping Mechanism with Arterial Stiffness in Hwa-Byung Patients

OBJECTIVE: The goal of this study is to assess the relationship between stress coping mechanisms and the risk of atherosclerosis in patients with Hwa-Byung. METHODS: The Korean version of the Ways of Coping Checklist (WOCC) was administered to 50 patients with Hwa-Byung (49.1+/-10.1 years, 6 males). Brachial-ankle pulse wave velocity (baPWV) and serum cholesterol level were assessed in all participants. RESULTS: After controlling for age, sex, diagnosis of hypertension, Body Mass Index (BMI), and serum cholesterol level, the score of seeking social support in coping strategies was negatively correlated with right and left baPWV (r=-0.356, p=0.016; r=-0.373, p=0.012, respectively). In addition, the score of active coping mechanism was negatively correlated with both sides of baPWV (r=-0.383, p=0.009; r=-0.389, p=0.008, respectively). CONCLUSION: The seeking social support and active coping mechanism were inversely related to the severity of arterial stiffness in Hwa-Byung patients. Therefore, our result may suggest a possibility that coping strategies in Hwa-Byung patients are associated with the risk of atherosclerosis.

Development of Hwa-Byung Scale and Research Criteria of Hwa-Byung / 신경정신의학

OBJECTIVES : The aim of this study was to identify the characteristic symptoms for diagnosis of Hwabyung (HB), a culture-related anger syndrome in Korea; to construct a rating scale for HB and test its validity and reliability; and propose diagnostic criteria for HB. METHODS : Subjects were male and female Korean patients, who were diagnosed following Structured Clinical Interview (SCID) as having depressive disorders, anxiety disorders and somatoform disorders and who reported as having self-labeled HB. A HB Scale was constructed with 22 of the most common symptoms of HB as identified by previous studies. The HB scale's inter-rated reliability was tested with 60 subjects. Its validity was tested by comparison between a HB only group(n=47) and depressive disorder only group (n=44). Logistic regression analysis was conducted to make a predictive model of HB. Based on these results diagnostic criteria for HB was proposed. RESULTS : Inter-rated reliability in each of all the items and the total score of the HB Scale were statistically significant. The HB scale differentiated HB from depressive disorder with statistical significance. In logistic regression analysis, the ability of the HB model to predict symptoms of heat sensation, ukwool/boon (feeling of unfairness), and subjective anger was high with sensitivity of 80.0%, specificity of 88.4%, accuracy of 84.1% and area under ROC of 0.92. Based on these results and information from previous research, diagnostic criteria of HB were formulated. CONCLUSION : The HB Scale was found to be reliable and valid. Consequently, diagnostic criteria of HB were proposed, to include subject anger, "kwool/boon" (Feeling of unfairness), expressed anger, heat sensation, hostility, "haan", pushing-up in the chest, epigastric mass, respiratory stuffiness, palpitation, dry mouth, sighing, racing thoughts, and lamentation.

Effects of Paroxetine on Symptoms of Hwa-Byung / 대한정신약물학회지

OBJECTIVE: This study consists of a single open clinical trial to evaluate the treatment effects of paroxetine on symptoms of hwa-byung, a Korean culture-related anger syndrome. METHODS: Eighty-nine patients with depressive disorders, anxiety disorders, somatoform disorders, or self-labeled hwa-byung were treated with paroxetine (Paxil CR) 12.5-37.5 mg/day for 8 weeks. Treatment effects were evaluated using the Hamilton Depression Scale (HAMD), the State and Trait Anger Inventory (STAXI), and the Hwa-byung Scale. RESULTS: Scores on all items ; total score on the Hwa-byung Scale ; scores on state anger, trait anger, and anger-in ; total score on the STAXI ; and total score on the HAM-D decreased significantly after eight weeks of paroxetine treatment compared to baseline. CONCLUSION: Paroxetine was shown to be effective for treating symptoms of hwa-byung, a chronic anger syndrome.

Clinical Correlates of Hwa-Byung and a Proposal for a New Anger Disorder

This paper reviewed the studies on hwa-byung (HB), which literally means anger disorder and this is known as the culture-related chronic anger syndrome of Koreans. Based on these studies and a review of the literature on the anger syndromes of other cultures, I have proposed a new anger disorder. The rationale for this proposition is first that the clinical correlates of HB, including the epidemiological data, the etiological factors, the symptoms and the clinical course, are unique and different from those of the depressive disorders, which have been postulated to be similar to HB. Second, the symptoms of HB are characterized by pent-up anger and somatic and behavioral symptoms related to the release and suppression of anger. Third, a group of patients with only HB and who visit psychiatrists for treatment have been identified. Fourth, anger is thought to be the basic target of treatment for HB patients. Last, anger syndromes like HB have been identified, with various names, in other cultures. By reducing the cultural variation of HB and integrating the common clinical correlates of the syndromes related to anger, a new anger disorder for the mood of anger can be conceptualized, like that for other mood disorders for the corresponding pathological moods. The research diagnostic criteria for HB and the new anger disorder are also suggested. I propose that the new anger disorder to be included in the new international classification system as a member of the larger family of mood disorders. International collaborative studies are needed not only to identify such anger disorder in various cultures, but also to explore giving better treatment to these patients based on the bio-psycho-social model of anger disorder.

The Experience of Family Breakdown of Hwabyung Patient / 성인간호학회지

PURPOSE: This study aimed to describe the experience of family breakdown of Hwabyung patients in a socio-cultural context. METHODS: Data for this study came from 5 participants, 2 family members and 1 friend of participant by interviews and participant observations from January 2006 to April 2007. Sociology of everyday lives analyzing method were adopted. RESULTS: There were two processes of family breakdown ; sudden on set and progressive processes. The sudden breakdown was unpredictable death of a husband, the significant family member. On the other hand, their family structure and function were broken down through the husband, who repeatedly destructive and malicious behaviors. The experience of family breakdown of middle-aged women with Hwabyung in a socio-cultural context was weakened or severed family-relationships, exhaustion of economic sources, and the breakdown of participant's body. Participant's experience of family breakdown were influenced by Korean culture, the patriarchal social system and the clan-centered family system. CONCLUSION: Hwabyung is the result of a clan-centered family system and patriarchal system. The approach to Hwabyung should involve not only the person with the illness but also their family.

Neurocognitive Function in Patients with Hwa-byung and with Major Depressive Disorder

OBJECTIVES: Hwa-byung has been studied clinically for several years and introduced as Korean Culture-Bound Syndrome. However, the definition and the diagnostic method are not yet clarified, and there has not been any sufficient comparative study on this disease entity. This study was conducted to determine the clinical symptoms and the profile of the neurocognitive functions in Hwa-byung(HB) and Major Depressive Disorder(MDD), and We wish to identify any critical factors that differentiate the disorders. METHODS: A total of 102 participants were examined, including 34 participants with MDD, 34 with HB, and 34 healthy controls. The MDD and HB patients were recruited from among inpatients and outpatients at the National Medical Center for the period from May to December of 2004. As a major diagnostic tool of MDD, diagnostic reference of DSM-IV-TR was used and as HB's diagnostic tool, We used computerized neurocognitive function test. Psychiatric symptomatology was evaluated by the Beck Depression Inventory(BDI), and Symptom Checkist-90-Revision(SCL-90-R). Oneway ANOVA, Scheffe post-hoc test and Chi-Squre Tests were used for statistical analysis. RESULTS: The participants in three groups did not differ in terms of age, sex, and education. Assessment of BDI indicated that the MDD group had significantly higher total score than the HB group. MDD and HB groups showed significantly higher total scores on the SCL-90-R in comparison to the controls. The MDD group was found to have significantly more symptoms of depression than the HB group, based on the depression subscale of the SCL-90-R. The computerized neurocognitive function test suggest several results 1) Within the memory domain, it was found that one of the two memory tests in MDD and HB groups were significantly impaired in comparison to the control group. 2) Within the attention domain, it was found that only the MDD group was significantly impaired in comparison to the control group. 3) Within the higher cortical function domain, it was found that significant impairment exist in MDD group and HB group compared to the control group; the severity of impairment was found to be more profound in the MDD group than in the HB group. CONCLUSION: These results suggest that both HB group and MDD group have significantly decreased neurocognitive function than the control group, and neurocognitive function of the HB group is better than that of the MDD group.

Development and Effectiveness of a Program for Relieving 'Hwa-Byung' Symptoms / 간호학회지

PURPOSE: This one group experimentation was designed to develop a program for relieving 'Hwa-Byung'(HB) symptoms and examine its effects on HB symptoms, pain threshold emotions like anger, anxiety and depression. METHOD: The program consisted of three components the change of the cognitive thoughts, the formation of a supportive network, and induction of mind-body relaxation. Sixteen middle-aged women with HB were divided into three groups for group dynamics according to the time of the recruitment. Data was collected for nine months at three time points, before, immediately after, and one month later of its application. RESULT: There were statistically significant differences in the severity level of state anger, state anxiety, depression, and HB symptoms according to the time interval. The means of state anger and state anxiety were reduced after the intervention, but it was slightly increased one month later. The means of depression and HB symptoms were continuously reduced after the intervention and one month later. CONCLUSION: This was the first management program for HB women in Korea. A future study must be done with the research design formethodological strength revision of the program.

Korean Women's Causal Perceptions of Hwabyung / 여성건강간호학회지

PURPOSE: This study elicited Korean women's perceptions of the life situations that contribute to Hwabyung, a culture bound psychiatric illness in Korea, and delineated a typology of the perceived causative factors for this illness. METHOD: A purposive sample of 21 Korean women was recruited from a church, a senior center in Seoul and a clinic that provides traditional Korean and westernized medical services to patients in the Gyeonggi area. Inclusion criteria were: 1) the diagnosis of Hwabyung by a traditional doctor or "stress reaction and depression" by a westernized doctor; and 2) a score greater than 40 on the Hwabyung Self Report Instrument. Surveys using the HSRI and individual interviews using Q methodology were used. RESULT: The average age of the participants was 53.7 years (range 35-84). The mean score on the HSRI was 46.2 (range = 42-52). Data analysis showed that participants perceived three life situations to cause Hwabyung: vulnerable situation, lowered self esteem, and negative life events. CONCLUSIONS: Korean women, suffering from Hwabyung, perceived at least three different causal patterns for this illness. Nursing care plans should be tailored to meet these differences.

Exploring the Nature of "Hwa-Byung" Using Pragmatics / 간호학회지

PURPOSE: While most psychiatrists diagnose Hwa-Byung as a chronic psychogenic disorder associated with familial, financial and personality, the purpose of study was to shed light on the nature of Hwa-Byung through pragmatics. Hwa-Byung is characterized as 'Hwa' which means fire 'Byung' which means disease. This condition cannot be empirically experienced, rather it is represented by suffering internally (in the mind). It also could find an aspect of somatization, and self-diagnosing. METHOD: As patients themselves diagnose Hwa-Byung, pragmatical approach was taken to analyze the context of the learning through their communication with others. The case examples resulted from in-depth telephone counseling with a client who is housewife with Hwa-Byung over a period of time at the Women's Hot Line. RESULT: The study showed that the client experienced continuous improper attacks by her husband. She expressed improperness by applying her personal emotions to social-justice reasoning. CONCLUSION: 'Hwa' means lack of mutual intimacy in this research. By expressing this 'Hwa', the client would like to recover mutual intimacy with her husband.

The Concept of Hwa-Byung in Nursing / 간호학회지

The purpose of this study was to study how nurses interpreted the meaning of Hwa-Byung. It was carried through a review of literature, and the result is expected to explore ways that nursing intervention can promote the understanding of Hwa-Byung. The literature review focused on cultural psychology and psychiatrists' views toward Hwa-Byung. After that, it was reconfirmed concept of Hwa-Byung in nursing devived from historical analysis of the examples of Hwa-Byung from a true record of the Cho-Sun Dynasty(CD ROM, 1997). Characteristics of patients with Hwa-Byung include 'Hwa', an aspect of somatization, and self-diagnosing. It also could find that Hwa-Byung is characterized as 'Hwa', 'somatization' and 'self-diagnosis(subjectiveness)' according to a true record of the Cho-Sun Dynasty(CD ROM, 1997). The conceptual definition of 'Hwa', 'somatization' and 'self-diagnosing (subjectiveness)' are as follows. The core concept of Hwa-Byung, 'Hwa,' has the property of 'fire', and equals the feeling of injustice. Hwa-Byung means congestion of 'Hwa'. Therefore Hwa-Byung is the accumulation of being mistreated and mortified. The feeling of mistreatment comes from subjective experiences, which cannot be in harmony with the values, beliefs and rights of the patients. The situations that they have to endure again and again, though they are the sufferers, connote suppressed aggression and powerlessness endured over time. Suppressed aggression subordinated hostility, hatred and revengeful thoughts; powerlessness subordinates frustration, resignation, and fatalism. Somatization is another form of expressing 'Hwa' through physical symptoms. The somatization of clients with Hwa-Byung plays a role in expressing non-verbalized and suppressed emotions within themselves. The clients who experiences Hwa-Byung think that they know the cause of their illness and self-diagnose their problem as Hwa-Byung. Therefore, the feeling of unfairness which is the premise of Hwa-Byung infers 'subjectiveness' In conclusion, nursing's concept of Hwa-Byung is the accumulation of feelings of being mistreated and mortified. Hwa-Byung is the internalized 'Hwa' from enduring again and again. The feeling of being mistreated comes from subjective judgements about unfairness that cannot be harmonized with the clients' values, beliefs and rights. Those who can express their 'Hwa' only through their bodies imply suppressed aggression and powerlessness.

Symptoms of Hwabyung / 신경정신의학

OBJECTIVES: This study was to investigate the characteristic symptoms of socalled hwabyung, a syndrome related to anger. METHODS: One hundred and fifteen normal healthy volunteer and 279 patients with anxiety disorders, somatoform disorders, major depressive disorder without psychotic features, and dysthymic disorder completed a self-rating questionnaire which include the Korean version of SCL-90, and selected Korean culture-related symptoms, and the severity of hwabyung. The data was statistically analyzed with t-test, chi2-test, Spearman correlation test and cluster analysis. RESULTS: The symptoms of hwabyung group were severer than in non-hwabyung group, and hwabyung was characterized by the symptoms of chest stifling/oppression, impulse to go-out, a pushing-up sensation in the chest, weeping, mortification, heat sensation, sighing, depersonalization, many dreams, hate, shame, paranoid feeling, easily being frightened, blurred vision, fearfulness, destructive impulsiveness, absent mindedness, cold sensation, pleading, irritability, intolerance to the heat and facial flushing as well as typical neurotic symptoms such as anxiety states, depression and obsessive-compulsiveness. CONCLUSION: These results suggest that an anger disorder can be conceptualized.

A Psychiatric Study on Hahn / 신경정신의학

OBJECTIVE: This study aimed at identifying the etiological background, symptomatic expressions, defense styles and coping strategies related to hahn. METHOD: The subjects were given a questionnaire for demographic data, life experiences and psychological and physical symptoms, Bond's questionnaire of defense style, and Weisman's scale for coping strategies and scales for severity of hahn and hwabyung. The subjects were 110 normal healthy adults and 151 patients with neurotic disorders, diagnosed with ICD-9. RESULTS: More vivid hahn was found in the married women, the less educated, and those from a low socio-economic state. In the area of etiological life experiences, hahn is significantly related with an unhappy and frustrated marital life, unsatisfactory filial Piety, Poor family background, poverty, little education, a hard life since childhood, betrayal, failure in business, personality problems, injustice in society and resignation to fate. Hahn, unresolved and accumulated, was believed to cause various psychological and physical illnesses. In many cases hahn was corhad been dealt with by simple suppression and being dependent on religious faith or sharing and communicating with people. More people considered hahn as one of the etiologies of hwabyung, a chronic anger syndrome. Hahn of patients with hwabyung was more serious than that of those without hwabyung. Symptoms of hahn were - in addition to various symptoms of depression, anxiety and other neurotic conditions or somatization - a mass in the epigastrium, sighing, something pushing-up in the chest, paranoid ideas and hyprochondria sis nor hygochondriacal ideas. On the other hand, hypersensitivity and irritability were less significant. Defense styles and coping strategies related with hahn were somatization, splitting-projection, passive-aggressiveness, incorporation, primitive idealization, stimulus reduction, self-pity and shared-concerns and dependency. CONCLUSION: These results suggest that hahn is an unique emotional condition which is characterized by culture-related somatization symptoms, paranoid ideas and hypochondriasis, in addition to general neurotic symptoms such as depression and anxiety and related somatic symptoms.

A Study on the Diagnosis of Hwabyung / 신경정신의학

OBJECTS: The aim of this study was to find out the differences in co-morbidity of DSM-III-R diagnosis and in symptom patters between Hwabyung and non-Hwabyung groups. METHODS: The DSM-III-R diagnosis and somatic symptoms related with Hwabyung were studied in 287 patients with depressive, anxiety and somatization disorders: patients were divided into two groups, Hwabyung and non-Hwabyung groups according to the opinions of themselves and their neighbors. Diagnostic criteria was DSM-III-R and instruments for collecting data were Korean version of DIS-III, which included culturally related 21 additional items in somatization disorder. RESULTS: Hwabyung was more prevalent in women and in older ages. Hwabyung group had higher categorized scores of somatization disorder, panic disorder and major depression than non-Hwabyung group. Odds ratio showed that somatization disorder, dysthymia and panic disorder had highest possibility to co-exist with Hwabyung. Somatic symptoms which proved to be characteristics in Hwabyung were headache, blurred vision, palpitation, lump in throat, stomach rumble, chest tightness and stifling, pushing-up in the chest, urinary frequency, facial flushing, frequent sighing, heaviness in the head, shaking in head and pain on eyeballs. factor analysis with somatic symptoms yielded 4 factors. Discrimination analysis with scores of flour factors and categorized scores of DSM-III-R diagnosis showed that somatization factor II (pushing-up in the chest, heaviness in the head, and chest tightness and stifling), major depression and generalized anxiety were most highly related variables with Hwabyung which discriminate Hwabyung from non-Hwabyuag in 73.5% accuracy. CONCLUSION: The results suggest that Hwabyung is an atypical psychiatric syndrome combined with characteristic somatization symptoms, depression and anxiety.