190 Anxiety Disorders
diately induced by the phobic situation, to a de gree that is persistent and out of proportion
to the actual risk posed. There are various ty pes of specific phobias: animal; natural envi-
ronment; blood-injectio n-injury; situational; and other situations. 
In social anxiety disorder (social phobia), the individual is fearful or anxious about or
avoidant of social interactions and situations  that involve the possi bility of being scruti-
nized. These include social interactions such as meeting unfamiliar people, situations in
which the individual may be observed eating or drinking, and situations in which the in-
dividual performs in front of others. The cogn itive ideation is of being negatively evalu-
ated by others, by being em barrassed, humiliated, or re jected, or offending others.
In panic disorder, the individual experiences recurrent unexpected panic attacks and is
persistently concerned or worr ied about having more panic attacks or changes his or her
behavior in maladaptive ways because of the pa nic attacks (e.g., avoidance of exercise or of
unfamiliar locations). Panic attacks are abrupt surges of intense fear or intense discomfort
that reach a peak within minutes, accompan ied by physical and/or cognitive symptoms.
Limited-symptom panic attacks include fewer than four symptoms. Panic attacks may be
expected,  such as in response to a typically  feared object or situation, or unexpected,  meaning
that the panic attack occurs for no apparent reason. Panic attacks function as a marker and
prognostic factor for severity of diagnosis, co urse, and comorbidity ac ross an array of dis-
orders, including, but not limit ed to, the anxiety disorders (e.g., substance use, depressive
and psychotic disorders). Panic attack may therefore be used as a descriptive specifier for