The term refers to a question, problem, solution, or controversial issue that is obvious, but which is ignored by a group of people, out of embarrassment or taboo. The idiom can imply a value judgment that the issue ought to be discussed openly, or it can simply be an acknowledgment that the issue is there and not going to go away by itself.
The term is often used to describe an issue that involves a social taboo, such as race or religion.
The idiom is commonly used in addiction recovery terminology to describe the reluctance of friends and family of an addicted person to discuss the person's problem, thus aiding the person's denial.
The idiom is also occasionally invoked as a "pink elephant", possibly in reference to alcohol abuse, or for no other reason than that a pink elephant would be more visible than a normal elephant.
Gus Van Sant's 2003 film Elephant, which is named after the Clarke film, places the idiom in the context of a Columbine-style high school shooting—although this was apparently inadvertent, as Van Sant apparently believed Clarke was referring to the fable of the blind men and an elephant, each perceiving a different object.
In the short animated film Elephants Dream, the two main characters appear to exist in a vast machine. The elephant in the room is that the machine appears to be perceived solely by one character and may not actually exist.
Political columnist Ryan Sager entitled his book about the conflict between the Christian right and Libertarians for control of the United States' Republican Party "The Elephant in the Room," a play on both the English idiom and the Republicans' elephant symbol.
Prof. Randy Pausch started his Last Lecture by saying, "My father always said, 'if there is an elephant in the room, introduce it!'"