This review addresses the influence of ethnicity on the expression of psychotic symptoms and the implications for evaluating and treating patients of diverse backgrounds. Growing clinical and population research from Europe and the United States supports a dimensional interpretation of psychosis, yet the evidence suggests that psychotic symptoms place individuals at higher risk for a range of severe psychiatric conditions and adverse outcomes, such as suicidality. Ethnocultural diversity challenges clinicians to accurately interpret the clinical significance of patients' symptom presentations. Disproportionate psychotic symptoms and higher rates of psychotic disorders have been found in some ethnic groups, particularly among immigrants and their offspring, but profound inconsistencies in these patterns remain. More cultural research on the clinical implications of ethnic variation in psychosis is needed. Developing awareness and requisite skills is a priority for clinicians who evaluate and recommend treatments to ethnically diverse patients.