Hwa-Byung: a Korean culture-bound syndrome?

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.