Deconstructing the heterogeneity of adolescent social anxiety: A cognitive diagnostic approach from a sex perspective.

BACKGROUND: The cognitive vulnerability patterns of adolescent social anxiety are highly sex-specific. However, traditional data-driven subtyping approaches often overlook these sex-specific patterns due to a lack of direct theoretical mapping. This study introduces Cognitive Diagnosis Models (CDMs) to identify sex-specific cognitive subtypes, exploring how these cognitive patterns manifest within high-risk comorbid contexts. METHODS: A sample of 2005 Chinese adolescents (Mage = 12.9 years; 54.5% male) was assessed on four core cognitive attributes: post-event rumination, negative social interpretations, fear of negative evaluation, and public self-consciousness. Depressive (SMFQ) and anxiety (SCARED) symptoms were also measured. CDMs were fitted separately for males and females to derive cognitive profiles. Subtype distributions were then compared within high-depression (n = 611; SMFQ ≥ 8), high-anxiety (n = 408; SCARED ≥ 25), and high-comorbidity (n = 312) subgroups. RESULTS: While a "Pervasive Cognitive Deficits" subtype was common, a significant sex-specific pattern emerged. Females were more likely to present with profiles high in post-event rumination and negative interpretations (an "internalizing-ruminative" pattern). In contrast, males were more likely to display profiles high in fear of negative evaluation and public self-consciousness (a "performance-monitoring" pattern). These sex-differentiated cognitive profiles were consistently observed across high-depression, high-anxiety, and high-comorbidity contexts. CONCLUSIONS: As one of the first studies to apply CDM to adolescent social anxiety with sex-stratified analyses, our study extends the understanding of social anxiety heterogeneity beyond a uniform model. The identification of distinct, sex-specific cognitive subtypes suggests the potential value of developing targeted, sex-informed intervention frameworks, which represents an important direction for future clinical validation.