The Psychotic Symptom Rating Scales (PSYRATS) is an instrument designed to quantify the severity of delusions and hallucinations, and is typically used in research studies and clinical settings involving psychosis and schizophrenia. It is comprised of the auditory hallucinations (AHS) and delusions subscales (DS), but these subscales do not necessarily reflect the psychological constructs causing intercorrelation between clusters of scale items. Identification of these constructs is important in clinical and research contexts, because item clustering may be caused by underlying etiological processes of interest. Previous attempts to identity these constructs have produced conflicting results. In the current study we compiled PSYRATS data from 12 sites in seven countries, comprising 711 participants for AHS and 520 for DS. We compared previously proposed and novel models of underlying constructs using structural equation modeling (SEM). For the AHS, a novel four-dimensional model provided the best fit, with latent variables labeled Distress (negative content, distress and control), Frequency (frequency, duration and disruption), Personification (location and origin of voices), and Loudness (loudness item only). For the DS, a two-dimensional solution was confirmed, labeled Distress (amount/intensity) and Frequency (preoccupation, conviction and disruption). The within-AHS and within-DS dimension intercorrelations were higher than those between subscales, with the exception of the AHS and DS Distress dimensions, which produced a correlation that approached the range of the within-scale correlations. Suggestions are provided for integrating these underlying constructs into research and clinical applications of the PSYRATS.