Yamile Garcia was helping a friend pack up her Essex apartment last week when she spotted something that made her skin go cold: the blood-red eyes of a 17-year cicada.
She can't really account for what happened next. She only knows that she yanked her shirt up over her face, burst into tears and had what felt like a panic attack.
"I couldn't catch my breath," recalls Garcia, 24, a Spanish language translator at Johns Hopkins Hospital. "My friend had to calm me and say, 'Yami, breathe.'
"I think she was like, 'What is wrong with this girl?'"
For Garcia and others who profess a mortal fear of insects - entomophobia - the emergence of billions of periodical cicadas across Maryland this month has turned life into one uncomfortably long episode of Fear Factor.
It is also drawing attention to a relatively common, yet little-understood anxiety disorder whose mysteries scientists are just starting to explore: the specific phobia.
The psychiatrist's bible, the Diagnostic and Statistical Manual of Mental Disorders, defines the condition as an excessive, persistent and irrational fear of a particular object or situation. Common examples include fear of insects, snakes, heights, blood, flying, injections, thunder, dogs and bridges.
An estimated 4 percent of Americans ages 18 to 54 demonstrate at least one specific phobia, according to the National Institutes of Mental Health in Bethesda.
Sally Winston, co-director of the Anxiety and Stress Disorders Institute of Maryland, says that since the cicadas arrived this month, four people have called her clinic in Towson seeking help for their insect fears - including one woman whose anxiety drove her to the hospital.
So far, though, Winston says, none of the callers has appeared in person - a pattern that doesn't surprise her. Experts say that most people with specific phobias don't seek medical treatment but instead find ways to avoid whatever scares them. Some episodes of evasive action aren't pretty.
Ronda Kardash, a promotions director at the Comedy Factory in downtown Baltimore, once plunged "screaming and flailing" (not to mention fully clothed) into her mother's pool to dodge a curious bee. Another time she jetted to the Bahamas on vacation but found herself shunning its famous beaches after spotting insects swarming the sand.
These days Kardash, 23, makes her roommate fetch the mail at their Rosedale apartment and refuses to crack the windows of her 1998 Plymouth Neon, which has a broken air conditioner. She'd rather sweat than face down a cicada.
Kardash still gets around more than Hadassah Beck, a 32-year-old Park Heights resident who says that in the past two weeks, she has left her house only for her job at Vann's Spices. Even then, she asks her husband to inspect the sidewalk for cicadas first - and chaperone her to the car.
"Everyone tells me, 'Oh, the cicadas don't bother you,'" she says. "In my head I know they don't bother you. ... "
Why some people have such extreme reactions remains a mystery.
One theory holds that phobias are learned, consciously or not, early in life. Yamile Garcia, the translator, traces hers to watching her mother crush a large insect - she suspects a cicada - in her bedroom when she was 12.
A dozen years later, Garcia says she still can't forget the wailing noise the bug made as it died. "It sounded like you were killing a human being," she says.
But there's also evidence that specific phobias might, at least in part, be genetic. Kenneth Kendler at Virginia Commonwealth University has found that identical twins, who share most of the same genes, are slightly more likely than fraternal twins to share specific phobias.
Another hint that phobias are at least partially hard-wired: the same ones typically show up over and over again. Psychiatrists group them into categories, such as fear of animals, fear of blood or injury, and fear of dangerous situations such as height or tight spaces. All of these could have spelled trouble for our ancient ancestors.
"It's kind of nature's way of helping us," notes University of Michigan psychiatrist Brian Martis.
Martis is one of a small number of scientists who use cutting-edge imaging equipment to peek inside the brains of people with specific phobias and see how their brains differ from those who don't harbor such fears.
In a study published this month in the journal Biological Psychiatry, Martis and a team at Massachusetts General Hospital in Boston found that compared with healthy volunteers, animal phobics displayed slight differences in some areas of the brain, such as the paralimbic cortex, that are linked to anxiety.
As researchers compile more clues about the underlying biology of specific phobias, Martis says, they could eventually develop new treatments. Meanwhile, others scientists are turning to rodents in search of drugs that can snuff out fearful associations more quickly than conventional methods.
Most phobics are treated using exposure therapy. Someone with a fear of spiders, for example, might be asked to look at a picture of a spider, then hold a plastic one, and then sit in a room with a caged spider, until the arachnophobe is finally comfortable holding the object of his angst.
But recently, scientists have become excited about a drug called D-cycloserine. Used for many years to treat tuberculosis, the drug also seems to extinguish fear in rats.
To see whether the same holds true in humans, Michael Davis and Barbara Rothbaum at Emory University gave D-cycloserine to people with a profound fear of heights and then treated them with conventional computer-based exposure therapy.
They found that people who received the drug required far fewer therapy sessions and were much more likely to ride elevators and brave bridges afterward than a control group who hadn't taken the drug.
Rothbaum said the drug might make it easier for people with specific phobias to avoid time-consuming and costly exposure sessions that often deter patients.
Meanwhile, insect phobics such as Garcia say they are counting the days until the cicadas are dead.
"I honestly wonder how other people don't have this kind of reaction," she says.
Medicine & Science