Specific Phobia 199
ance behaviors are often obvious (e.g., an indi vidual 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
phobias have suffered over many years and have changed their living circumstances in
ways designed to avoid the phobic object or si tuation 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 behavi ors 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. 
The fear or anxiety is out of proportion to th e actual danger that the object or situation
poses, or more intense than is deemed necess ary (Criterion D). Although individuals with
specific phobia often recognize their reactions as disproportionate, th ey tend to overesti-
mate the danger in their feared situations, an d thus the judgment of being out of propor-
tion is made by the cl inician. The individual ’s sociocultural contex t should also be taken
into account. For example, fears of the dark may be reasonable in a context of ongoing
violence, and fear of insects may be more di sproportionate in settings where insects are
consumed in the diet. The fear, anxiety, or avoidance is persistent, typically lasting for
6 months or more (Criterion E), which helps distinguish the disorder from transient fears