The purpose of the present study was to compare the expression and frequency of somatic, affective and cognitive symptoms of distress across Turkish and U.S. university students. An open-ended free-list question was used to elicit distress responses from 827 Turkish and U.S. participants. The coding was done using classical content analysis. It was found that Turkish students reported equal amounts of affective, cognitive, behavioral, somatic, interpersonal and coping responses, whereas the U.S. students reported more affective and somatic symptoms than other response categories. U.S. students reported more affective and somatic symptoms than the Turkish students and the Turkish students listed more behavioral, interpersonal, and coping responses than the U.S. students. Turkish students’ tendency to report more behavioral, coping, and interpersonal responses is consistent with the collectivist nature of Turkish society. U.S. students’ tendency to report higher levels of somatic symptoms contradicts the findings from the WHO primary care study (Gureje et al. American Journal of Psychiatry 154:989–995, 1997). Limitations of the study and research and counseling implications of the findings are discussed.