A key feature of this disorder is that the fear or anxiety is circumscribed to the presence of a particular situation or object (Criterion A), which may be termed the phobic stimulus. The cat— egories of feared situations or objects are provided as specifiers. Many individuals fear objects or situations from more than one category, or phobic stimulus. For the diagnosis of specific phobia, the response must differ from normal, transient fears that commonly occur in the pop— ulation. To meet the criteria for a diagnosis, the fear or anxiety must be intense or severe (i.e., ”marked") (Criterion A). The amount of fear experienced may vary with proximity to the feared object or situation and may occur in anticipation of or in the actual presence of the object or situation. Also, the fear or anxiety may take the form of a full or limited symptom panic at- tack (i.e., expected panic attack). Another characteristic of specific phobias is that fear or anxi- ety is evoked nearly every time the individual comes into contact with the phobic stimulus (Criterion B). Thus, an individual who becomes anxious only occasionally upon being con- fronted with the situation or object (e.g., becomes anxious when ﬂying only on one out of every five airplane ﬂights) would not be diagnosed with specific phobia. However, the degree of fear or anxiety expressed may vary (from anticipatory anxiety to a full panic attack) across different occasions of encountering the phobic object or situation because of various contextual factors such as the presence of others, duration of exposure, and other threatening elements such as turbulence on a ﬂight for individuals who fear ﬂying. Fear and anxiety are often expressed dif- ferently between children and adults. Also, the fear or anxiety occurs as soon as the phobic ob- ject or situation is encountered (i.e., immediately rather than being delayed).
The individual actively avoids the situation, or if he or she either is unable or decides not to avoid it, the situation or object evokes intense fear or anxiety (Criterion C). Active avoidance means the individual intentionally behaves in ways that are designed to prevent or minimize contact with phobic objects or situations (e.g., takes tunnels instead of bridges on daily commute to work for fear of heights; avoids entering a dark room for fear of spi- ders; avoids accepting a job in a locale where a phobic stimulus is more common). Avoid- ance behaviors are often obvious (e.g., an individual who fears blood refusing to go to the doctor) but are sometimes less obvious (e.g., an individual who fears snakes refusing to look at pictures that resemble the form or shape of snakes). Many individuals with specific ways designed to avoid the phobic object or situation as much as possible (e.g., an indi- vidual diagnosed with specific phobia, animal, who moves to reside in an area devoid of the particular feared animal). Therefore, they no longer experience fear or anxiety in their daily life. In such instances, avoidance behaviors or ongoing refusal to engage in activities that would involve exposure to the phobic object or situation (e.g., repeated refusal to ac- cept offers for work—related travel because of fear of ﬂying) may be helpful in confirming the diagnosis in the absence of overt anxiety or panic.