Mental disorders may be best represented by dimensional constructs that span traditional diagnostic boundaries. There is evidence that empirically derived dimensional phenotypes improve nosology and etiological research, but less is known about their clinical utility. We compared dimensional and categorical representations of anxiety and depression as predictors of response to psychological treatment in a large patient sample (N = 3,760). Confirmatory factor analysis demonstrated that an internalizing factor—hypothesized to be the substrate of anxiety and depression—explained correlations among interview-based diagnoses at treatment outset. The internalizing factor had consistent, albeit sometimes modest, prospective associations with all treatment outcome measures: global clinical improvement, anxiety and depression symptoms, and need for inpatient hospitalization (standardized effect range = .13–.43). Categorical diagnoses—except major depression—did not reliably predict treatment outcome after adjusting for the higher order internalizing dimension. We conclude that reorienting clinical assessment around transdiagnostic phenotypes might enhance prognosis and other aspects of clinical decision-making.

精神障碍最好用跨越传统诊断界限的维度结构来代表。有证据表明，凭经验得出的维度表型可以改善疾病学和病因学研究，但对其临床用途知之甚少。我们比较了焦虑和抑郁的维度和分类表征，作为在大量患者样本中对心理治疗反应的预测指标（N= 3,760）。验证性因素分析表明，内化因素（被认为是焦虑和抑郁的根源）解释了治疗开始时基于面试的诊断之间的相关性。内在化因素与所有治疗结局指标均具有一致的，尽管有时是适度的前瞻性关联：整体临床改善，焦虑和抑郁症状以及住院治疗的需要（标准化疗效范围= .13–.43）。在针对较高级别的内在化维度进行调整之后，分类诊断（除严重抑郁症以外）无法可靠地预测治疗结果。我们得出结论，围绕转诊表型重新定位临床评估可能会增强预后和临床决策的其他方面。