Heterogeneity of symptomatology in socially anxious adolescents: are case concepts based on perceived causal networks (PECAN) able to capture personalized symptoms and their relations?

Purpose: Social anxiety disorder (SAD) is a prevalent and challenging mental disorder in children and adolescents, with traditional cognitive models often failing to account for its heterogeneity. This study explores personalized symptom networks based on individuals’ perception as an alternative approach. Methods: Ninety socially anxious individuals (10–21 years, M  = 16.48, SD  = 5.14) created personalized symptom networks using the adapted Perceived Causal Network method for children and adolescents (PECAN-CA). Participants identified their symptoms, rated severity, and mapped causal relations. After four weeks, they evaluated their personalized symptom network against a randomized network (same symptoms, randomized relations) and a common disorder model (Clark & Wells, 1995) to assess representativeness. Results: Participants generated highly individualized networks, highlighting significant variability in symptoms and their relationships. The most reported symptoms were physiological arousal (90%), stuttering (71%), and fear of evaluation (69%). Fear of evaluation (6.53/10) and avoidance behavior (6.43) were rated most severe. Physiological arousal showed the highest perceived causal input, while fear of evaluation had the highest output. Participants rated their personalized symptom network (M = 7.23, SD = 2.15) as most representative, followed by randomized networks (M = 6.08, SD = 2.05) and the common model (M = 4.32, SD = 2.18; A > B > C, p < .001). Conclusions: Findings highlight substantial heterogeneity in SAD symptoms and causal relations, suggesting that common disorder models fail to capture individual differences. PECAN-based case concepts offer a promising approach to personalized treatment.