Updated May-19-2010

Specific Phobia 

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

B. The phobic object or situation consistently provokes fear or anxiety. Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.

C. The phobic object or situation is actively avoided or endured with intense fear.

D. The  fear or anxiety is out of proportion to the actual danger posed by the specific object or situation. NOTE: Out of proportion refers to the sociocultural context; see text.

E. The duration is at least xxx months *

F. The fear, anxiety or avoidance cause clinically significant distress or impairment in social, occupational, or other important areas of functioning **

G:  The fear, anxiety and avoidance associated with the specific object or situation are not restricted to the symptoms of another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a traumatic event), Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder, or Agoraphobia.

Specify Type:

Animal type  (e.g., spiders, insects, dogs)

Natural environment type (e.g., heights, storms, water)

Blood-injection-injury type  (e.g.  needles, invasive medical procedures)

Situational type  (e.g., flying, driving, bridges, tunnels, enclosed places)

Other type (e.g., situations that may lead to choking or vomiting;  in children, loud sounds or costumed characters)

* Need to examine duration in secondary data analyses

** An option that is still under discussion is the possibility of deleting criterion F.

Updated May-19-2010

1. Rewording and reordering of criteria A, B, C, D to increase consistency across anxiety disorders, and improve ease of use and clinical utility.

Reference: LeBeau RT et al: Specific Phobia: A Review of DSM-IV Specific Phobia and Preliminary Recommendations for DSM-V; Depression & Anxiety (2010; in press) (section D)

2. Criterion A/B: The term ‘marked’ will be operationalized in the text as intense. The phrase‘fear or anxiety’ is used consistently across the criteria within Specific Phobia and across anxiety disorders. The term “consistently provokes” is intended to simplify the criteria in place of “almost invariably provokes an immediate anxiety response” and is consistent with new phrasing for Social Anxiety Disorder and Agoraphobia

Reference: Craske MG et al: What is an Anxiety Disorder?; Depression & Anxiety (2009; 26: 1066-1085)

3. Criterion C: Added the descriptor “actively avoided” as a means for raising diagnostic threshold on the basis of symptom severity

Reference: LeBeau RT et al: Specific Phobia: A Review of DSM-IV Specific Phobia and Preliminary Recommendations for DSM-V; Depression & Anxiety (2010; in press) (section D)

4. Criterion D: Operationalization of what is meant by “excessive or unreasonable” by using the term “out of proportion to danger posed”; to increase ease of use and clinical utility. Also,’self recognition’ is removed since elderly are often underdiagnosed as a result of overattribution of fears to their aging constraints and since there is clinical consensus that a number of adults deny that their fears are out of proportion/excessive. The Note reminds the clinician to take into account the appropriate cultural norms. Further testing is required to assess the impact of this change.

Reference: LeBeau RT et al: Specific Phobia: A Review of DSM-IV Specific Phobia and Preliminary Recommendations for DSM-V; Depression & Anxiety (2010; in press) (section D)

5. Criterion E: By extending “duration” to adults, the phobic fear, anxiety and avoidance is defined as intense (Criterion A), active (Criterion C) and durable – these descriptors will raise the diagnostic threshold based on symptom severity, and may suffice in place of the impairment/distress criterion. 6 months duration is currently preferred but needs further data analysis

Below is an alternative scale that has been developed and is being tested. This scale assesses fear, anxiety and avoidance, as well as distress.

Anxiety Disorder Specific Severity Measure: Specific Phobia

Specific Phobia (formerly Simple Phobia)

A. Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation(e.g., 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 years, the duration is at least 6 months.

G. The anxiety, Panic Attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder.

Specify type:

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 stimuli might include the fear of choking, vomiting, or contracting an illness; “space” phobia (i.e., 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.