Symptoms Of Hwa-byung Research Articles

Development of a Short-Form Hwa-Byung Symptom Scale Using Machine Learning Approaches

Background/Objectives: Hwa-byung (HB), also known as “anger syndrome” or “fire illness”, is a culture-bound syndrome primarily observed among Koreans. This study aims to develop a short-form version of the HB symptom scale using machine learning approaches. Methods: Utilizing exploratory factor analysis (EFA) and various machine learning techniques (i.e., XGBoost, Logistic Regression, Random Forest, Support Vector Machine, Decision Tree, and Multi-Layer Perceptron), we sought to create an efficient HB assessment tool. A survey was conducted on 500 Korean adults using the original 15-item HB symptom scale. Results: The EFA revealed two distinct factors: psychological symptoms and somatic manifestations of HB. Statistical testing showed no significant differences between using different numbers of items per factor (ANOVA: F = 0.8593, p = 0.5051), supporting a minimalist approach with one item per factor. The resulting two-item short-form scale (Q3 and Q10) demonstrated high predictive power for the presence of HB. Multiple machine learning models achieved a consistent accuracy (90.00% for most models) with high discriminative ability (AUC = 0.9436–0.9579), with the Multi-Layer Perceptron showing the highest performance (AUC = 0.9579). The models showed balanced performance in identifying both HB and non-HB cases, with precision and recall values consistently around 0.90. Conclusions: The findings of this study highlighted the effectiveness of integrating EFA and artificial intelligence via machine learning in developing practical assessment tools. This study contributes to advancing methodological approaches for scale development and offers a model for creating efficient assessments of Korean medicine.

Mediating Effect of Quality of Sleep Moderated by Meaning in Life on the Relationship between Hwabyung and Suicidal Ideation in Middle-Aged Korean Women.

The purpose of this study was to determine the role of the quality of sleep and meaning in life in the process by which Hwabyung symptoms affect suicidal ideation in middle-aged Korean women. A total of 265 women aged 40-65 years were enrolled in an online survey. The study variables were measured using the Hwabyung, quality of sleep, meaning in life, and suicidal ideation scales. The data were analyzed using the PROCESS Procedure for SPSS Release 3.5 (Model 14) program with a 95% bias-corrected bootstrap confidence interval. Hwabyung symptoms in middle-aged women had a significant direct effect on suicidal ideation, and an indirect effect through the quality of sleep was also statistically significant. Meaning in life was found to significantly moderate the indirect effect of Hwabyung on suicidal ideation through the quality of sleep. In other words, the greater the meaning in life, the weaker the effect of Hwabyung on suicidal ideation through the quality of sleep. The Hwabyung of middle-aged women caused a psychological crisis and was a great threat to physical health by lowering the quality of sleep. The low quality of sleep and the increase in suicidal ideation due to Hwabyung pose a great threat to the survival of middle-aged women. It was found that it is very important to find meaning in one's life as an effective way to reduce suicidal ideation in middle-aged women.

Acupuncture for Psychosomatic Symptoms of Hwa-byung, an Anger Syndrome: A Feasibility Randomized Controlled Trial.

Objectives: Emerging studies found the potential effects of acupuncture for treating chronic pain and mental disorders, namely, depressive and anxiety disorders. Acupuncture is widely used for treating culture-related anger syndrome, Hwa-byung. This pilot trial aimed to investigate the feasibility of a clinical trial testing acupuncture for the psychosomatic symptoms of Hwa-byung.Methods: A total of 26 patients with Hwa-byung planned to be randomly assigned to the acupuncture or sham acupuncture groups. About 10 treatment sessions were applied over 4 weeks. The 100-mm visual analog scale was used to measure the six major Hwa-byung symptoms: stuffiness in the chest, heat sensations, pushing-up in the chest, feeling a mass in the throat, feelings of unfairness, and hard feelings. The criteria for assessing the success of this pilot trial were defined as improvement in three or more of the six Hwa-byung symptoms after treatment, with an effect size >0.2.Results: A total of 15 patients were finally included and randomly assigned to the acupuncture group (n = 7) or the sham acupuncture group (n = 8). After 10 treatment sessions, the Cohen's d effect sizes for acupuncture compared to sham acupuncture were >0.2 for each one of the six major Hwa-byung symptoms, which met our a priori criteria for success. Also, the effect size for the somatic symptoms of “stuffiness in the chest” was 0.81 (95% CI −0.40, 2.20), referring to a large effect size.Conclusions: Our results suggest that acupuncture treatment would be regarded as an acceptable intervention for a full-scale study of psychosomatic symptoms in patients with Hwa-byung.Trial Registration: cris.nih.go.kr, identifier: KCT0001732.

A review for the definition of the concept and symptoms of Hwa-Byung

IntroductionHwa-Byung is a unique syndrome based on social-cultural background of South Korea. However, the definition of Hwa-Byung has not been established. For example, Hwa-Byung Diagnostic Interview Schedule(Kim, Kwon, Lee & Park, 2004) and Hwa-Byung Scale(Kwon et al., 2008) that are generally used in clinical practices defined Hwa-Byung differently. According to this, there is a slight difference in the symptoms that are measured.ObjectivesThe purpose of our study is to establish the concept and symptoms of Hwa-Byung.MethodsFirst, we review DSM-4, previous literatures and concept of Hwa-Byung in assessment tools. Through this, core features and characteristic symptoms are consisted. Second, a concept of Hwa-Byung that this study constructed is reviewed by clinical psychologists and Korean oriental psychiatrists. Finally, concepts and symptoms are defined.ResultsComprehensive definition of Hwa-Byung is established. Hwa-Byung was identified as a syndrome with symptoms that exploded in the form of anger because emotions such as anger could not be resolved. psychological symptoms include resentment, the baggage of mind, or a representative symptom of han. And physical symptoms include feeling heavy, heat, rush, lumps in the neck or chest. Finally, these physical and psychological symptoms are associated with distinct stressful events.ConclusionsOur study defined the concept and categorized for physical and emotional symptoms of Hwa-Byung. This result suggests that it can contribute to the development and revision of the Hwa-Byung assessment tools.DisclosureNo significant relationships.

The Effectiveness of Adlerian Therapy for Hwa-Byung in Middle-Aged South Korean Women

Middle-aged South Korean women are at greater risk of developing hwa-byung (South Korean anger syndrome) as compared to men and women of other age groups. In this study, we developed and evaluated the effectiveness of a group counseling program informed by Adlerian individual psychology. Outcome measures included hwa-byung symptoms, depression, and anxiety. We used a cohort-controlled design that compared an intervention condition ( n = 22) and a wait-list control group ( n = 16), with a 4-week follow-up. Group comparisons showed statistically significant treatment effects for all three outcome measures, which were maintained at follow-up. Mediational analyses revealed that changes in hwa-byung symptoms and depression were mediated by increased social interest. The findings support the effectiveness of a group Adlerian program for middle-aged South Korean women in alleviating hwa-byung symptoms, depression, and anxiety.

The Relationship between Hwabyung Symptoms and Quality of Life among Middle-Aged Women

The Relationship between Hwabyung Symptoms and Quality of Life among Middle-Aged Women

Effect of the Emotional Freedom Techniques on anger symptoms in Hwabyung patients: A comparison with the progressive muscle relaxation technique in a pilot randomized controlled trial

ContextHwabyung is a psychosomatic disease resulting from the suppression of anger over an extended period. The Emotional Freedom Techniques (EFT) are meridian-based psychotherapy known to cure many psychosomatic diseases, and progressive muscle relaxation (PMR) is a therapeutic method that relieves physical and psychological tension by repeated tensing and relaxation of the muscles. ObjectIn this study, we compared the effects of EFT and PMR in patients with Hwabyung. Design40 patients were enrolled and randomized to receive 4 weeks of group sessions with either EFT (n = 20) or PMR (n = 20). Evaluations were conducted pre- and post-treatment and at 4-week and 24-week follow-ups after session end. Main Outcome MeasuresThe Hwabyung Scale, Visual Analogue Scale of Hwabyung Symptoms (VAS-HS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and State-Trait Anger Expression Inventory (STAXI) were administered as self-report tools. The analysis excluded 8 patients who never attended treatment and 1 patient meeting the exclusion criteria. ResultEFT (n = 15) and PMR (n = 16) improved Hwabyung symptoms (−13.95% and −11.46%, respectively), state anxiety (−12.57% and −12.64%, respectively), and depression (−32.11% and −18.68%, respectively) (p < 0.05 for all). Trait anger improved in EFT group (−13.4%, p = 0.004). There were no significant differences between the groups (p > 0.05) except for trait anger at post-treatment (p = 0.022 for between group). No adverse events were reported during the study.

Attitudes toward Women’s Roles, Marital Satisfaction, and Hwa-Byung among Korean Married Couples

This study surveyed 150 middle-aged Korean wives and husbands and examined the hypothesized path model that gender-role attitudes – in this case, those of women – would be associated with marital satisfaction, which, in turn, would be related to Hwa-Byung. Hwa-Byung is a Korean culture-bound syndrome and means “anger illness.” The results of structural equation modeling using an actor-partner interdependence strategy indicated that husbands’ egalitarian attitudes toward women’s roles predicted their own and their wives’ marital satisfaction, and marital satisfaction was then associated with decreased Hwa-Byung symptoms. However, wives’ attitudes toward women’s roles was not related to their own or their husbands’ marital satisfaction. These results imply that what is crucial in understanding marital satisfaction and Hwa-Byung among Koreans is not wives’ attitudes toward women’s roles, but rather husbands’ egalitarian attitudes toward women’s roles. The implications of the present study for Hwa-Byung treatment and couple counseling were discussed.

The Role of Economic Stress and Coping Resources in Predicting Hwabyung Symptoms.

This article reports the findings from a study that examined the role of economic stress and coping resources in predicting hwabyung symptoms among Koreans in the United States. The literal meaning of hwabyung is "fire illness" or "anger illness." Koreans believe that chronic stress can cause the onset of hwabyung, manifested mainly through somatic symptoms. Data collected from an anonymous survey of 242 voluntary participants were analyzed using hierarchical multiple regression (R2). The findings demonstrated the important role that social support and sense of self-esteem play in explaining hwabyung symptoms. Also, the graduate education attained in the United States appears to play positive role in reducing the hwabyung symptoms, while being a woman can increase their vulnerability to this indigenous psychiatric illness to Korean people. Based on the findings, the implications for practice and suggestions for future study are discussed.

Heritability of Hwabyung Symptoms in South Korean Adolescent and Young Adult Twins.

The present study aimed to estimate heritability of Hwabyung (HB) symptoms in adolescent and young adult twins in South Korea. The sample included 1,601 twins consisting of 143 pairs of monozygotic male (MZM), 67 pairs of dizygotic male (DZM), 295 pairs of monozygotic female (MZF), 114 pairs of dizygotic female (DZF), and 117 pairs of opposite-sex dizygotic (OSDZ) twins and 129 twins with non-participating co-twins (mean age = 19.1 ± 3.1 years; range: 12-29 years). An HB symptom questionnaire was given to twins via a telephone interview. Consistent with the literature of HB, the mean level of HB was significantly higher in females than in males. Maximum likelihood twin correlations for HB were 0.31 (95% CI [0.16, 0.45]) for MZM, 0.19 (95% CI [-0.05, 0.41]) for DZM, 0.50 (95% CI [0.41, 0.58]) for MZF, 0.28 (95% CI [0.11, 0.44]) for DZF, and 0.23 (95% CI [0.05, 0.40]) for OSDZ twins. These patterns of twin correlations suggested the presence of additive genetic influences on HB. Model-fitting analysis showed that additive genetic and individual-specific environmental influences on HB were 44% (95% CI [37, 51]) and 56% (95% CI [49, 63]), respectively. Shared environmental influences were not significant. These parameter estimates were not significantly different between two sexes, and did not change significantly with age in the present sample, suggesting that genetic and environmental influences on HB in both sexes are stable across adolescence and young adulthood.

The efficacy and safety of a Huanglian-jie-du decoction on Hwa-byung patients: A study protocol for a randomized controlled trial.

ObjectiveHwa-byung is one of the cultural concept of distress in Korea resulted from chronic accumulated anger. It is characterized by various symptoms like stuffy in the chest, hot or heat sensation, something pushing up in the chest, feeling of mortification, and a flush of anger. This protocol aims to explore the efficacy and safety of Huanglian-jie-du decoction on various somatic symptoms and insomnia in patients with Hwa-byung.MethodsThis is study protocol for a randomized, double-blind, placebo-controlled trial. A total of 44 patients will be randomly assigned to the experimental group or the placebo group in a 1:1 ratio. All medications will be taken orally 3 times per day for 7 consecutive days. The primary outcomes are the mean changes in Patient Health Questionnaire of physical symptoms (PHQ-15) and Insomnia Severity Index (ISI) after the 7 days of administration. The secondary outcomes include the scales to assess stress response, symptoms of Hwa-byung, and state anger.ConclusionThe results of this study will provide high quality and explorative evidence to investigate the effect of Huanglian-jie-du decoction on Hwa-byung.

The effects of Interpersonal Relationship Problems, Occupational Stress, and Anger Rumination on Hwa-Byung Symptoms among White-collar Male Workers

The effects of Interpersonal Relationship Problems, Occupational Stress, and Anger Rumination on Hwa-Byung Symptoms among White-collar Male Workers

The Relationship between Belief in a Just World and Hwa-Byung Symptoms: Distributive and Procedural Justice Beliefs

The Relationship between Belief in a Just World and Hwa-Byung Symptoms: Distributive and Procedural Justice Beliefs

화병군과 비화병군의 의사소통 유형 및 스트레스 대처 방식 비교 연구

Objectives: Interpersonal stress is a major cause and aggravating factor of Hwabyung. The purpose of this study was to compare communication type and stress coping style between the Hwabyung pa-tients group and non-Hwabyung patients group.Methods: The total number of study participants was 101. Based on the Hwabyung symptom scale, the study participants were divided into Hwabyung patients group (30 patients) and non-Hwabyung pa-tients group (43 patients; control group), and the others were excluded from the study . All included patients were administered the Virginia Satir's communication type questionnaire and stress coping scale based on Folkman & Lazarus's theory. The independent t-test was used to determine the stat-istical significance between the features of communication types and stress coping styles in each group. In addition, Spearman correlation analysis was used to identify the relationship between com-munication types and stress coping styles.Results and Conclusions: 1. Communication types differed significantly between the Hwabyung pa-tients group and non-Hwabyung patients group. 2. Hwabyung patients scored significantly higher in each dysfunctional communication type than functional communication type. Scores of placating stance and super-reasonable stance, which were subtypes of dysfunctional communication type, were high in the Hwabyung patients group. The non-Hwabyung patients group scored the highest in Congruent stance, classified as functional communication type. 3. Stress coping style was not sig-nificantly different between the two groups.Key Words: Hwabyung, Satir, Communication type, Stress coping.

Hwabyung Experiences Among Korean Immigrant Women in the United States

Hwabyung is an indigenous psychiatric illness commonly found among Korean women. Using hwabyung, this article describes the psychological ramifications of immigration experiences among Korean immigrant women in the United States. Data collected from an anonymous survey of adult Korean immigrant women (n = 143) were used for a statistical analysis. The findings highlight the significant effects of self-esteem, social support, financial hardship, and family cohesion on the changes in the hwabyung symptoms among Korean immigrant women. Based on the findings, the implications for practice and future study are discussed. Also discussed are the global significance of migrant women and their mental health issues.

The Effects of MAUM Meditation on Hwa-Byung Symptoms, Stress and Coping Styles

The Effects of MAUM Meditation on Hwa-Byung Symptoms, Stress and Coping Styles

중년여성의 화병 인식에 관한 내용분석

The purpose of this study was to make an extensive analysis of middle-aged women's awareness of Hwa-byung in an effort to shed light on their understanding of it. Method: A descriptive study was performed to make content analysis of middle-aged women's awareness of Hwa-byung. Results: The interview data with the selected middle-aged women who were in their 40s and 50s were classified to determine their knowledge on the concept, cause and symptoms of Hwa-byung and their coping methods. As a result, there were 261 significant statements and 33 categories. Conclusion: This study is expected to provide useful information on middle-aged women's awareness of Hwa-byung, on the development of easily accessible educational programs geared toward helping them to overcome it, and on how to prevent it and offer effective intervention.

Anger, anger expression, cardiovascular risk factors, and gastrointestinal symptoms by hwa-byung symptoms in Korean adult women

PurposeThis study explored relationships of anger and anger expression to cardiovascular (CV) risk factors and gastrointestinal (GI) symptoms in Korean women based on hwa-byung (HB) symptoms. MethodsA descriptive, comparative design was used. One-hundred four women who are from 20 to 65years old were recruited. Based on the HB score, 22 women indicated for HB and the rest were classified as normal. Data collection was done with several questionnaires including HB symptom scale, state-trait anger expression inventory, and GI symptom questionnaire and clinical information. ResultsWomen with HB demonstrated significantly higher levels of trait anger and dysfunctional anger expression such as anger suppression and anger expression than normal group. Although blood pressure was higher in women with HB, the differences were not significant. Self-report of GI symptoms were significantly more in women with HB, however no significant difference was found in gastroscopy results. ConclusionsWomen with HB were younger and might lack of sufficient social support. This study suggests relationship of anger and anger expression to functional GI symptoms. Characteristics of women with HB should be considered in developing intervention programs for healthy coping. Future studies need more women with HB for better comparison.

Hwabyung and Depressive Symptoms among Korean Immigrants

This article describes the findings from a study that examined the psychological ramifications of immigration experiences among Koreans in the United States using hwabyung and depressive symptoms. Data collected from an anonymous survey of 242 voluntary participants were analyzed using Pearson’s correlation coefficient (r), and hierarchical multiple regression (R2). The findings demonstrated the statistically significant correlation between hwabyung and depressive symptoms. Also found was the important role of coping resources in explaining both hwabyung and depressive symptoms among Korean immigrants. Additionally, the findings suggest that having a graduate school education in the United Sates, receiving money from Korea, and being a woman were found to be significantly related to hwabyung symptoms. However, no factors related to individual characteristics appeared to have a significant impact on depressive symptoms. Based on the findings, the implications for practice are discussed.

Anxiety and Anger Symptoms in Hwabyung Patients Improved More following 4 Weeks of the Emotional Freedom Technique Program Compared to the Progressive Muscle Relaxation Program: A Randomized Controlled Trial

Background. The Emotional Freedom Technique (EFT) is a meridian-based psychological therapy. The present clinical trial investigates the effectiveness of EFT as a new treatment option for Hwabyung (HB) patients experiencing anger and compares the efficacy to the Progressive Muscle Relaxation (PMR), the conventional meditation technique. Methods. The EFT and progressive muscle relaxation (PMR) methods were performed on 27 HB patients, and their capacities to alleviate anxiety, anger, and emotional status were compared. After a 4-week program, a survey was conducted; patients then completed a self-training program for 4 weeks, followed by a second survey. Results. During the initial 4 weeks, the EFT group experienced a significant decrease in the HB symptom scale, anger state, and paranoia ideation (p < 0.05). Over the entire 9-week interval, there were significant decreases in the HB symptom scale, anxiety state, anger state, anger trait, somatization, anxiety, hostility, and so on in EFT group (p < 0.05). Conclusion. The EFT group showed improved psychological symptoms and physical symptoms greater than those observed in the PMR group. EFT more effectively alleviated HB symptoms compared to PMR. EFT group showed better maintenance during self-training, suggesting good model of self-control treatment in HB patients.