Specific Phobia

A. Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (eg, flying, heights, animals, receiving an injection, seeing blood).

B. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack. NOTE: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging).

C. The person recognizes that the fear is excessive or unreasonable. NOTE: In children, this feature may be absent.

D. The phobic situation(s) is avoided or else is endured with intense anxiety or distress.

E. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F. In individuals under age 18, the duration is at least 6 months.

Animal Type: if the fear is cued by animals or insects. This subtype generally has a childhood onset.

Natural Environment Type: if the fear is cued by objects in the natural environment, such as storms, heights, or water. This subtype generally has a childhood onset.

Blood-Injection-Injury Type: if the fear is cued by seeing blood or an injury or by receiving an injection or other invasive medical procedure. This subtype is highly familial and is often characterized by a strong vasovagal response.

Situational Type: if the fear is cued by a specific situation such as public transportation, tunnels, bridges, elevators, flying, driving, or enclosed places. This subtype has a bimodal age-at-onset distribution, with one peak in childhood and another peak in the mid-20s. This subtype appears to be similar to Panic Disorder With Agoraphobia in its characteristic sex ratios, familial aggregation pattern, and age at onset.

Other type: if the fear is cued by other stimuli. These might include the fear or avoidance of situations that might lead to choking, vomiting, or contracting an illness; "space" phobia (ie, the individual is afraid of falling down if away from walls or other means of physical support); and children’s fears of loud sounds or costumed characters.