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.

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.

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.

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.

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.

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.

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.