Body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD), collectively referred to as compulsive disorders, have typically not been included in structural research on the internalizing spectrum due to low prevalence in community samples. The current study examined the higher-order structure of anxiety, depressive and compulsive disorders among patients in a psychiatric partial hospital program (N = 2,178). We applied confirmatory factor analysis to diagnostic data obtained at admission and compared several competing models of the comorbidity structure. A one-factor model accounted well for the co-occurrence of all the disorders. A two-factor model comprised of fear and distress factors, wherein compulsive disorders loaded on fear, also fit the data well. However, a very large factor correlation (r = 0.86) suggested limited discriminant validity of fear and distress in the sample. Alternate models that featured a distinct compulsivity factor were not viable owing to large correlations between fear and compulsive disorders. Overall, our findings indicate that a broad internalizing dimensions underlies not only anxiety and depression, but also compulsive disorders, in an acute psychiatric population. Future studies using symptom-level data are needed to replicate these results and determine the structure of internalizing disorders from the bottom up, starting with narrowly defined symptom components.

身体畸形障碍（BDD）和强迫症（OCD），统称为强迫性障碍，由于社区样本中的患病率较低，因此通常不包括在内部化频谱的结构研究中。当前的研究在精神病学部分医院计划中检查了患者焦虑，抑郁和强迫性疾病的较高阶结构（N = 2,178）。我们将确认性因子分析应用于入院时获得的诊断数据，并比较了合并症结构的几种竞争模型。一因素模型很好地解释了所有疾病的共同发生。由恐惧和困扰因素组成的两因素模型，其中因恐惧而引起的强迫性疾病也很好地拟合了数据。但是，因子相关性非常大（r = 0。86）建议在样本中对恐惧和困扰的判别有效性有限。由于恐惧和强迫性疾病之间存在较大的相关性，因此替代模型具有独特的强制性因素，因此不可行。总体而言，我们的发现表明，在急性精神病人群中，广泛的内在化因素不仅是焦虑和抑郁的基础，也是强迫症的基础。需要使用症状水平数据进行进一步的研究来复制这些结果，并从狭窄的症状成分开始，从下至上确定内在化疾病的结构。我们的发现表明，急性精神病患者的广泛内在化因素不仅是焦虑和抑郁的基础，也是强迫症的基础。需要从症状水平数据开始的未来研究来复制这些结果并从下至上确定自下而上的内在化疾病的结构。我们的研究结果表明，广泛的内在化因素不仅是急性精神病患者焦虑和抑郁的基础，也是强迫症的基础。需要使用症状水平数据进行进一步的研究来复制这些结果，并从狭窄的症状成分开始，从下至上确定内在化疾病的结构。