OBJECTIVE: Somatization has often been viewed as a defense against awareness of emotional distress or as a masked version of depression. This report examines whether community residents with high levels of functional somatic symptoms also report overt psychological distress and whether somatization is associated with any specific psychiatric disorder. METHOD: Analyses used data from the community sample of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study, a population-based survey of psychiatric morbidity among more than 18,000 residents of five U.S. communities. RESULTS: Increasing number of somatization symptoms was strongly associated with overt expression of psychological distress and psychiatric symptoms. Among ECA respondents with five or more current functional somatic symptoms, 63% reported current psychological symptoms and 50% met criteria for a current psychiatric diagnosis (compared to 7% and 6%, respectively, among those with no current somatization symptoms). Somatization symptoms showed strongest associations with anxiety and depressive symptoms, intermediate association with symptoms of psychotic disorders, and weakest associations with symptoms of substance abuse and antisocial personality. CONCLUSIONS: ECA study respondents with high levels of somatization symptoms typically reported overt psychological distress, especially anxiety and depression. Patterns of response do not support a dissociation between physical and emotional symptoms. Functional somatic symptoms appear to be common expressions of distress instead of defenses against awareness.Abstract Teaser