In patients attributing their health complaints to environmental factors (EnvPat) evidence based medical diagnostics usually do not confirm environmental and somatic causes of symptoms. Many symptoms remain unexplained. Aim of the study was the systematic assessment of medically unexplained physical symptoms (MUPS) in EnvPat and comparison to symptom rates reported by subjects of an environmental study exposed to environmental odors (EnvExp). This specific exposure was chosen, as odors are associated by an unclear mechanism with physical symptoms. By this we aimed to enlighten the open question as to likeliness that MUPS of EnvPat are caused by hitherto unrevealed environmental exposures or result from somatization. MUPS were measured with SOMS-2 in EnvPat n=92, patients presenting in a university environmental outpatients clinic, and different study groups exposed to environmental odors (EnvExp). These were: (1) subjects exposed to annoying odors and medically relevant concentrations of bioaerosols, such as airborne microorganisms (EnvExp-1, n=74), and (2) subjects exposed to odors alone (EnvExp-2, n=282) as well as unexposed controls (Controls, n=235). Logistic regression and analysis of variance were applied to analyze rates of single complaints and the sum index of complaints (SOMS-CoIx). In EnvPat rates of MUPS were highest - significant (p<0.05) adjusted OR in 23 of 25 MUPS compared to controls - and highest SOMS-CoIx (mean 15.3 (S.D. +/-9.3). Rates of MUPS were lower in environmentally exposed subjects with difference in the two strata: while EnvExp-1 differed in several complaints, i.e., nausea and SOMS-CoIx (mean 7.2, S.D. +/-6.9) from controls (p<0.05), EnvExp-2 (SOMS-CoIx mean 4.8, S.D. +/-5.2) showed relevant differences only in two single complaints and not in the SOMS-CoIx from controls, SOMS-CoIx mean 3.9, S.D. +/-5.0. This remained when adjusting for age, gender, and school education. Rates of MUPS in environmental patients were clearly higher than in subjects with actual environmental exposure, making it unlikely that their symptoms are due to undetected environmental factors. MUPS of EnvPat show similarities to psychosomatic patients. In the environmental survey symptom assessment by SOMS-2 was sensitive to different environmental scenarios, i.e., higher rates of physical complaints were only found in subjects with hazardous residential bioaerosols pollution as well as an annoying odor exposure and interestingly not in subjects exposed to annoying odors alone. This underlines that questionnaire data of somatic complaints need to be interpreted on the basis of exposure assessment in order to unjustly attribute health complaints to annoyance.