Background: The purpose of this study was to analyse the connection between two types of social relations in school (to peers and to teachers) and psychosomatic health complaints among adolescents in school Year 9 in the Swedish compulsory school. In particular, the focus is on the importance of students’ academic orientation as a possible modifier of the association between social relations and psychosomatic health complaints. Methods: The data were collected during the 1995–2005 time period from approximately 10 000 Swedish adolescents in the age of 15–16 years by using a questionnaire that was handed out in the class room. Results: There are strong associations between adolescents’ social relations in school (both to peers and to teachers) and psychosomatic health complaints. Worse relationships are connected to worse psychosomatic health. The health effects of teacher contacts were significantly modified by academic orientation; they were stronger for theoretically (i.e. those with better health) than for non-theoretically oriented students. Conclusion: Interpreted from a social class perspective, the results may reflect that the theoretically oriented students to a higher degree strive to conform to the culture present in school making this group of students more sensitive for teacher relations manifested as recognitions, rewards or penalties. In order to promote social equity in health, efforts to improve social relations in school should not solely focus on the teacher–student relationships but also on the relationships between peers.