The expectation that Chinese people present distress somatically is a central prediction of cultural psychopathology and has been the subject of considerable theoretical speculation. At the same time, empirical studies have been infrequent and have yielded mixed results. The authors examined symptom presentation in Chinese (n = 175) and Euro-Canadian (n = 107) outpatients, using spontaneous problem report, structured clinical interview, and symptom questionnaire methods. All 3 methods yielded cross-culturally equivalent somatic and psychological symptom subscales. Chinese outpatients reported more somatic symptoms on spontaneous problem report and structured clinical interview compared with Euro-Canadians, who in turn reported more psychological symptoms on all 3 methods. The relation between culture and somatic symptom presentation was mediated by a tendency toward externally oriented thinking. Difficulties with identifying emotions or describing them to others did not differ significantly across cultures, supporting a nonpathological interpretation of observed differences. Psychological symptom effects were larger and more consistent than somatic symptom effects; because other studies have confirmed the ubiquity of somatic presentations worldwide, these results suggest that Western psychologization may be more culturally specific than is Chinese somatization.

The tendency for Chinese individuals to emphasize somatic symptoms of depression is widely acknowledged and is now a key finding of cultural psychopathology (Ryder, Yang, & Heine, 2002). Chinese somatization has been described in China, Hong Kong, and Taiwan, as well as in Chinese immigrants to Western  ^[ 1 ]  countries, and these descriptions have been accompanied by an extensive theoretical literature. The much smaller empirical literature is mixed, however; comparison groups are infrequently used,...