Transcultural Psychiatry 2019, Vol. 56(4) 786–803 ! The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1363461519861795 journals.sagepub.com/home/tps Cultural concepts of distress and psychiatric disorders: Understanding symptom experience and expression in context Roberto Lewis-Ferna ´ndez Columbia University, New York State Psychiatric Institute Laurence J. Kirmayer McGill University Introduction The contributions to this issue of Transcultural Psychiatry on cultural concepts of distress show how much work on this topic has evolved and equally what remains to be done. In this Commentary, we take stock of the current state of the field and outline some future directions for research and clinical application. Cultural concepts of distress in DSM-5 The term ‘‘cultural concepts of distress’’ (CCD) was introduced in DSM-5 to better characterize the broad set of constructs identified in clinical and ethnographic research on cultural variations in distress. 1 Much work in medical anthropology on cultural variations in distress has been framed in terms of ‘‘idioms of distress’’ (Nichter, 1981, 2010) and this is the term used by most of the articles in this special issue to cover a range of symptoms, syndromes, and modes of expression. In the DSM-5, however, ‘‘idiom of distress’’ denotes only one type of CCD and is dis- tinguished from explanatory models, syndromes, and folk illness categories. The term ‘‘idiom’’ is meant to emphasize the communicative function of a CCD as a local linguistic or nonverbal mode of expression (Lewis-Ferna´ndez, Kirmayer, Guarnaccia, & Ruiz, 2017). The term ‘‘idiom’’ also does not presuppose pathology; the same idiom can be used to denote everyday concerns or subclinical levels of affliction as well as more severe forms of suffering that lead to help seeking. Of course, cultural idioms are used to talk about other facts of experience that may or Commentary Corresponding author: Roberto Lewis-Ferna ´ndez, 1051 Riverside Drive, Unit 69, New York, NY 10032 USA Email: roberto.lewis@nyspi.columbia.edu