Despite the frequent association between anxiety and somatization, the role of somatic anxiety—a tendency to experience somatic sensations, when anxious—in relationship to persistent somatic complaints has not been addressed previously. This study assessed the predictive role of internalizing psychopathology (anxiety, posttraumatic stress, depression) and somatic anxiety for somatic complaints over a 1-year period in a community sample of urban youth. The Social and Health Assessment, a self-report survey, was administered to 2,524 (mean age = 12.8, 54 % female) American urban adolescents in two consecutive years. There was significant continuity of somatic complaints over 1 year. Girls reported higher levels of somatic complaints and somatic anxiety than boys. All types of internalizing psychopathology significantly predicted somatic complaints over time. Somatic anxiety was associated with somatic complaints over and above the role of internalizing symptoms. Internalizing psychopathology and somatic anxiety should both be considered in the assessment and treatment of youth with persistent somatic complaints.