Underlying causes may include:

- Han (a Korean culture-related depressive sentiment related to hard life and social unfairness resulting not only from a tragic collective national history, but also from personal traumas)

- prior instances of major depressive disorder

- prior instances of anxiety disorder

- prior instances of adjustment disorder

- prior instances of other somatoform disorders

- repression of feelings of anger/resentment arising from past events

Triggering causes are typically external events, including:

- familial stressors, e.g. spousal infidelity or conflict with in-laws

- witnessing acts/actions/phenomena that conflict with one's own moral and/or ethical principles

The syndrome itself is believed to be the result of the continued repression of feelings of anger without addressing their source. In holistic medicine the containment of anger in hwabyung disturbs the balance of the five bodily elements, resulting in the development of psychosomatic symptoms such as panic, insomnia, and depression after a long period of repressed feelings.

It is possible that hormonal imbalances such as those around the time of menopause may also be an underlying cause of hwabyung in middle-aged women, the most often-diagnosed demographic.

Hwabyeong or Hwabyung is a Korean somatization disorder, a mental illness which arises when people are unable to confront their anger as a result of conditions which they perceive to be unfair.

Hwabyung is a colloquial and somewhat inaccurate name, as it refers to the etiology of the disorder rather than its symptoms or apparent characteristics. Hwabyung is known as a culture-bound syndrome. The word hwabyung is composed of "hwa" (the Sino-Korean word for "fire" which can also contextually mean "anger") and "byung" (the Sino-Korean word for "syndrome" or "illness"). In South Korea, it may also be called "ulhwabyeong" (), literally "depression anger illness". In one survey, 4.1% of the general population in a rural area in Korea were reported as having hwabyung. Another survey shows that about 35% of Korean workers are affected by this condition at some time.