Safe Integration of Physician Assistants in German Ambulatory Care: A Narrative Review and Practical Supervision Framework.

Hwabyung is a culture-related syndrome primarily reported in East Asian cultural contexts, particularly in Korea. The Korean Standard Classification of Diseases (KCD) formally classifies it under code U22.2 and is also described as a culture-bound syndrome in the ICD-10 of the World Health Organization. Hwabyung is characterized by emotional symptoms such as feelings of unfairness and resentment, emotional suppression, and han (恨), a culturally specific form of accumulated sorrow or unresolved resentment. Patients also experience various somatic symptoms, including chest tightness, sensations of heat, the feeling of something rising in the chest, and a lump-like sensation in the throat or epigastrium. These symptoms typically occur during stressful life events (). When standardized diagnostic criteria are applied, the prevalence of Hwabyung in Koreans ranges between 4.2-13.3% (–). Treatment for Hwabyung is generally provided by Korean medicine doctors (). Existing psychiatric classification systems have been refined primarily focusing on depression and anxiety; however, diagnostic frameworks that conceptualize anger as a core pathological emotion remain relatively underdeveloped. Anger has generally been described as a symptom that may occur in several psychiatric conditions, including personality disorders, trauma-related disorders, attention-deficit/hyperactivity disorder, and intermittent explosive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (, ). However, these descriptions have not led to the development of an independent diagnostic construct centered on anger.