The term idiom of distress is used to describe culturally specific experiences of suffering. Most of these studies have been conducted with small groups, making comparison of symptom profiles difficult. Female undergraduate and graduate students in Japan (n = 50) and Korea (n = 61) completed the Beck Depression Inventory (BDI) and 7-day daily reports of their experiences of 46 somatic symptoms. Between-culture comparisons revealed that BDI scores did not differ; however, the Korean women had significantly higher somatic distress means than the Japanese women. Despite the higher Korean distress mean, regression analysis showed that somatic distress explained 30% of the variance of BDI score for the Japanese but only 22% of the variance for the Koreans. Within-culture comparisons showed that both high-BDI Japanese and Koreans had 19 somatic distress symptoms with significantly higher means than their low-BDI counterparts; 11 somatic symptoms were shared by the two groups. Multidimensional scaling matrices were used to compare symptom proximities and revealed cultural differences. The problems with using broad racial categories in clinical research, the clinical significance of these findings, and the implications for psychiatric nursing assessment and practice are discussed.