This case-control study compared 219 adolescent girls (ages 12–18) across three SAD subtypes — performance-only (n=52), social interaction-only (n=50), and combined (n=67) — plus healthy controls (n=50), assessing obsessive beliefs (OBQ-44), alexithymia (TAS-20), and cognitive flexibility (CFI) using K-SADS-PL-guided diagnosis.
Clinician-rated severity (CGI-S) did not differ across the three clinical groups, yet all three showed distinct cognitive-emotional profiles (large effect sizes, ε²=0.16–0.25): performance-only SAD had lower obsessive beliefs and relatively preserved cognitive flexibility; interaction-only SAD showed reduced flexibility in generating alternative interpretations; combined SAD had the highest alexithymia, longest illness duration, and most prior psychiatric referrals. A gradient boosting classifier distinguished the three groups with 96% cross-validated accuracy (macro-F1=0.96), dropping only to 93% when severity indicators were removed.
- All-female, clinic-referred sample from Turkey limits generalizability to boys and community populations. - Cross-sectional design prevents causal inference about cognitive-emotional mechanisms. - Full-text methodology details (e.g., exact comorbidity exclusions, medication status) are not available from the abstract alone.
Clinicians should not rely on overall symptom severity alone to characterize SAD subtypes in adolescent girls — cognitive flexibility deficits and alexithymia vary meaningfully across performance-only, interaction-only, and combined presentations, and may warrant tailored assessment and treatment approaches.
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