Racial Discrimination and Hwa-byung, a Korean Medicine-Based Anger Syndrome, among Foreign Residents in South Korea: a cross-sectional study

Objectives: Researchers have traditionally viewed Hwa-byung (HB) as a culture-bound syndrome specific to Korea.However, no studies have examined how racial discrimination experienced by foreigners and naturalized citizens contributes to HB in Korea's increasingly multicultural society.The present study investigated how experiences of racial discrimination influence HB among foreigners and naturalized Korean citizens living in Korea and offers a new perspective on the concept of culture-bound syndromes.Methods: In June 2025, a web-based cross-sectional survey collected responses from 601 foreigners and naturalized citizens aged 19 years or older who had lived in Korea for at least one year.The analysis used multivariate binary logistic regression with HB presence as the dependent variable.Results: The overall prevalence of HB was 23.8%.Individuals who consistently experienced racial discrimination had 10.581-fold higher odds of HB (95% CI: 1.920-58.308),representing the strongest association in the analysis.Poor subjective health status (OR = 2.602), higher HB trait scores (OR = 1.134), higher depression scores (OR = 1.147), and higher stress scores (OR = 1.130) also significantly increased the likelihood of HB.Conclusion: HB among foreigners and naturalized citizens residing in Korea shows preliminary associations with experiences of racial discrimination, raising the theoretical question of whether HB's etiological mechanism may extend beyond its original cultural context.The finding that those who consistently experience racial discrimination showed more than a 10-fold higher odds of HB presence represents a preliminary finding that warrants replication in larger samples.