Hwa-Byung Syndrome: The Cost of Repressing Emotions

Hwa-Byung syndrome is linked to Korean culture. It's a somatization disorder that appears when people can't or don't know how to handle states of anger caused by injustice.
Hwa-Byung Syndrome: The Cost of Repressing Emotions

Last update: 31 January, 2022

Hwa-Byung syndrome is often defined as a psychological disorder associated exclusively with Korean culture. However, the somatization of injustices is a clinical reality that anyone can suffer from. In fact, the act of suppressing emotions in a sustained manner over time is damaging for both physical and mental health.

Hwa-Byung syndrome has aroused a great deal of interest. To begin with, the Western world recognizes this syndrome and links it to a form of depression. In fact, in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ), it’s listed as a culture-bound disorder.

Korea describes it as a psychological disorder in its own right for a specific reason. This is the fact that, for almost two decades, cases of people demonstrating a series of specific mental problems linked to the emotion of anger have increased.

Hwa-Byung literally means ‘anger illness’ or ‘fire illness’. It manifests itself with physical symptoms, such as digestive problems, the sensation of heat, and tachycardia, along with psychological symptoms. Indeed, it’s a curious phenomenon that’s well worth looking at.

The psychological community believes that the Hwa-Byung is the result of the continuous repression of emotions. We must remember that this is a country where mental health is still a stigma.

girl thinking about hwa-byung anger syndrome

Hwa-Byung syndrome: definition, symptoms, and causes

The syndrome has been investigated in South Korea and it’s also said to be present in North Korea, although this hasn’t been confirmed. When we think of South Korea, we might think of K-pop or their emerging cinema that’s currently proving to be so successful worldwide. What we don’t tend to think is that it’s a country where, every year, more stars and public figures take their lives.

As a matter of fact, in South Korea, mental health problems are a stigma. In fact, nobody talks about their emotions, their problems, or their anxieties. Efficiency and high self-demand are the order of the day. Currently, this country is one of the ten most powerful economies in the world. For example, they dominate many sectors and their standard of living has improved a lot in recent decades. Nevertheless, it seems that in the case of dealing with psychological problems, their performance is weak.

Hwa-Byung syndrome first appeared in parallel with the development of this country as a world power. Indeed, it was at the beginning of the 21st century, that clinical cases of people with this pattern of mental and physical problems began to be described. In 2010, the psychiatry department of the Eunpyeong Metropolitan Hospital in Seoul carefully analyzed the condition in a study. Let’s take a look at the results.

What is it and how does it manifest itself?

Hwa-Byung is a mental disorder that appears when people can’t or don’t know how to manage their negatively valenced emotions due to conditions that they perceive as unfair. As a rule, they exhibit the following symptoms:

Psychological symptoms

  • Feelings of anger and constant frustration.
  • Irritability and moodiness.
  • Feelings of sadness and hopelessness.
  • Feelings of guilt for not knowing or being able to act on what bothers or worries them.
  • Feeling that they have no control over their lives.
  • Hypervigilance. Feeling that something bad is going to happen to them.
  • Nervousness.
  • Desire to cry.

Physical symptoms

  • Difficulty sleeping.
  • Digestive disturbances.
  • Sensations of heat and agitation.
  • Exhaustion.
  • Muscle pain.
  • Headaches.
  • Dizziness.
  • Chest pressure.
  • Trouble breathing.
  • Dry mouth.
  • Lack of hunger or need to overeat.

Cause of Hwa-Byung

The psychosocial reality behind the Hwa-Byung syndrome is extremely complex. As we mentioned earlier, it’s closely linked to South Korea’s own culture (in the absence of data from North Korea). From a Western perspective, this range of symptoms would be considered along the lines of mood disorder, depressive disorder, anxiety, etc.

Let’s see what the dynamics are that could be behind this syndrome:

  • Work and academic overexertion.
  • Family stressors (traditional values continue to collide with the modern world).
  • Living in a social setting where the individual feels that their own ethical and moral values conflict with what surrounds them.

Hwa-Byung is extremely common among middle-aged women of low socioeconomic status.

Serious woman with hwa-byung rage syndrome

How is this psychological condition treated?

Duke University developed a scale to assess and detect Hwa-Byung syndrome. In this study, the efficacy of the MMPI-2 was analyzed. It aimed at assessing four areas: general health, gastrointestinal symptoms, hopelessness, and anger.

However, the way of dealing with mental disorders in the East tends to be a world away from the techniques used in the West. For example, not everyone turns to psychological therapy, or to approaches aimed at treating depression or anxiety scientifically. In fact, in Korea, they often continue to lean towards traditional methods such as acupuncture. Indeed, this is an extremely common treatment to deal with emotions such as anger.

Therefore, it seems that these new world powers need to advance in their treatment of mental health. Because conceiving hopelessness, depression, anxiety, and stress as signs of weakness invalidates the real progress of any society. Therefore, it’s time that South Korea starts to give some much-needed space to this matter for the well-being of all of its citizens.

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  • Roberts ME, Han K, Weed NC. Development of a scale to assess Hwa-Byung, a Korean culture-bound syndrome, using the Korean MMPI-2. Transcult Psychiatry. 2006 Sep;43(3):383-400. doi: 10.1177/1363461506067715. PMID: 17090624.
  • Lin KM. Hwa-Byung: a Korean culture-bound syndrome? Am J Psychiatry. 1983 Jan;140(1):105-7. doi: 10.1176/ajp.140.1.105. PMID: 6847969.
  • Min SK, Suh SY. The anger syndrome hwa-byung and its comorbidity. J Affect Disord. 2010 Jul;124(1-2):211-4. doi: 10.1016/j.jad.2009.10.011. Epub 2009 Nov 1. PMID: 19880191.Roberts ME, Han K, Weed NC. Development of a scale to assess