Culture shapes the expression and recognition of mental symptoms. Western culture makes a distinction between mind and body, but many Asian cultures do not. With the concept of unity of mind, body and soul, Asians may express their psychological distress mostly through physical symptoms. Therefore it is not surprising that there is a lack of descriptive psychological vocabulary in Asian languages. Further, because of the sense of stigma, it is more acceptable for Asians to express their psychological distress through the body rather than the mind.
For example, traditional Asians may show their depression by complaining of severe, constant headaches, muscle aches, joint pains, fatigue, low energy, dizziness, or blurred vision; anxiety can be expressed as an increased frequency of urination, constipation, or diarrhea; frustration, anger, or feelings of disgust can lead to repeated vomiting, shortness of breath, or chest pain. Physical symptoms tend to be exacerbated at night, when the person may have difficulty sleeping and has more time to think about the troubling issues. Studies have shown that Chinese Americans with mood disorders exhibit more somatic symptoms than do White Americans. The tendency of Chinese patients to focus on physical discomfort while ignoring or suppressing the reporting of emotional symptoms has been a challenge for clinicians who work with this population. However, for the majority of Chinese patients, psychological and behavioral symptoms will emerge if the clinician inquires specifically about these symptoms.