The complaint of fatigue is a common presentation all over the world. However, the concept of fatigue and its meaning for the patient may vary from culture to culture. A fatigue questionnaire, developed in London, was translated into Arabic and revalidated on a Arabian Gulf State population. The prevalence of fatigue was found to be much higher than other studies using the same questionnaire in Western populations. Did the symptoms of fatigue convey a different concept to the Arabic patients? Somatic symptoms are a frequent accompaniment to fatigue. On the other hand, fatigue itself may be a way to somatise emotional distress into a common complaint. In this way, distress can be relieved by rituals aimed at abating the somatic symptom. This article suggests that the complaint of fatigue in certain populations may be a culture-bound idiom of distress that should be viewed as a separate condition where mind and body can be linked in symptom presentation, disease concept and management plan.