Abstract

Hwa-Byung has long been known as a form of psychogenic illness among lay people in Korea and recently listed as a culture-bound syndrome of Korea in DSM-IV. However, there has been neither diagnostic criteria nor diagnostic instrument, which rendered empirical studies liable to subjective biases. The purpose of this study was to establish diagnostic criteria of Hwa-Byung, develop a structured diagnostic interview schedule for Hwa-Byung, and examine its reliability and validity. Participants were 55 patients visiting the depression clinic and 26 patients visiting the Hwa-Byung clinic. The diagnostic criteria was first determined on the basis of previous research findings and clinical case studies. Then the initial items of Hwa-Byung Diagnostic Interview Schedule (HBDIS) were selected to obtain information necessary to diagnose Hwa-Byung. This initial interview schedule was administered to 31 patients, which results were discussed and reviewed by all the authors. After some additional modifications based upon interviewers' comments, the present form of the instrument was completed and conducted to 81 patients. Independent clinical diagnoses for each patient were made by psychiatrists, psychiatrists of oriental medicine and clinical psychologists, which rate of agreement was demonstrated to be .84. The test-retest reliability of the HBDIS was examined for 28 patients and calculated to be .82. The validity of the HBDIS was evaluated on the extent to which HBDIS diagnosis assigned to 81 patients agreed with diagnosis determined by clinicians. As a result, Overall agreement was .85, Sensitivity was .83, and Specificity was .88. The kappa coefficient and other validity indicators were in the acceptable range (.70 - .88), indicating that the HBDIS was valid. Limitations and applications of the HBDIS were discussed.