Adolescents who engage in aggression, hyperactivity, and delinquency experience a host of negative outcomes, including poor academic performance, peer rejection, and substance use. Previous researchers have linked somatization, such as pain, to behavioral problems. The purpose of this study was to examine whether resilience moderates the influence of somatization on externalizing problems by gender. We surveyed the parents of 195 adolescents, ages 14 to 17, while the adolescents were being treated in the pediatric emergency department of a large urban hospital. Parents answered questions about their adolescent’s somatic symptoms, resilience, and externalizing problems. Moderation models were conducted to test whether the influence of somatization on aggression, hyperactivity, conduct problems, and an externalizing behavior composite was dependent upon level of resilience, and whether these relationships differed by gender. Resilience lessened the impact of somatization on aggression and conduct problems, but these relationships did not differ by gender. The influence of somatization on hyperactivity as well as the externalizing composite index was buffered by high levels of resilience only for girls. These results are compatible with the Diathesis-Stress Model, suggesting that girls with low or average levels of resilience may engage in hyperactivity when they experience a level of somatic symptoms that exceeds the threshold within which they can manage stress. Future research should examine these constructs within longitudinal study designs in order to determine directionality of the relationships reported and advance the science of risk factors and potential intervention targets in the prevention of externalizing behaviors.