BACKGROUND.Reflex syncope occurs in 21% of the general population, and it varies from 35% to 73% in medical contexts.Among patients with suspected vasovagal syncope (VVS), from 5% to 20% have a negative response to the Head-Up Tilt Test (HUTT), indicating medically unexplained syncope (US).Psychological correlates of both kinds of syncope are quite evident but a well-defined relationship between them has not yet been established.AIMS.The objectives of the present study were to evaluate psychological and psychosomatic distress in patients with recurrent VVS or US who underwent HUTT, and to compare it among the two groups.METHODS.A consecutive series of 58 patients (27 males and 31 females; mean age=48±17.98 years) with suspected vasovagal syncope underwent to HUTT; 40 subjects (the VVS group) experienced syncope and 18 patients (the US group) did not lose consciousness during the procedure.The sample was then evaluated by 2 interviews (the Structured Clinical Interview for eliciting psychiatric Diagnoses-SCID, based on DSM nosography, and the Diagnostic Criteria for Psychosomatic ResearchDCPR, for eliciting psychosomatic syndromes) and 4 questionnaires (Symptom Questionnaire-SQ, Psychosocial IndexPSI, Illness Attitude Scale-IAS and Fear Questionnaire-FQ).RESULTS.Of the total sample, 94.8% had at least one DSM or DCPR diagnosis, such as DSM specific (48.3%) and social (22.4%) phobias, DCPR illness denial (22.4%)and demoralization (20.7%).Statistical differences on diagnoses distribution between VVS and US patients were not found.However, US group had significantly higher scores on SQ anxiety, depression and hostility (p<.001) and worse outcomes on PSI stress (p<.01), well-being (p<.001) and psychological distress (p=.001).CONCLUSIONS.Despite similar psychopathology, US report higher psychological distress than VVS patients.Specific indications concerning VVS and US patients management are needed.