WASHINGTON -- The night started with one tiny click near the bedroom window.
Then came another, and another, until a great oak beside Lori Milani's South Arlington, Va. apartment was alive with an almost deafening roar of cicadas.
"It sounded like a human being murdered," Milani said, recalling her anxious reaction to the emergence of cicadas in 2004, when she shut herself inside for five weeks to avoid them. "I was really afraid they would come into the apartment."
For people like Milani, a graphic artist who struggles with her fear of bugs, the coming swarm of cicadas -- which were spotted as nearby as Fredericksburg, Va. last week -- elicits a single response: Dread.
During the swarm of Brood X nine years ago, the largest of more than a dozen cicada populations that emerge in different years, Milani stocked up on rice and noodles, filled her freezer and became a recluse.
Her summer communications design classes at Northern Virginia Community College that year? Dropped.
Millions of Americans struggle with phobias. People's fears can include flying in airplanes or becoming a landing pad for a flying cockroach, things they "go to ridiculous lengths to avoid," said Michael Reeder, a mental health counselor at Hygeia Counseling Services in Baltimore.
"I think I've always had ... a huge fear of bugs, any kind of bugs," said Milani, who would get no more specific than to say she is in her 20s and who started a blog, Cicadaphobia, to connect with others who share her feelings. "They just creep me out. I find them disgusting, anything with many legs. I don't eat crab; I don't eat shrimp. The cicadas are so huge, and there are so many of them."
Yet others adore cicadas for those same reasons. The teeming horde, the giant orange eyes, the jumbo size, the wicked buzz and the large wings, colorful like stained-glass windows.
Cicada-watchers have waited eagerly for this year's re-emergence of the group called Brood II. Enthusiasts plan to follow the insects, spy on them with binoculars, soak in their one-of-a-kind noise. It's one of nature's miracles, entomologists say, bugs creeping out of the earth when the ground temperature hits 64 degrees to mate, make babies and die.
But Yamile Garcia, 33, of Baltimore County, Md., doesn't see it that way. As cicadas whizzed about in the 2004 swarm, Garcia described being 30 minutes late for a doctor's appointment for her baby because she sat frozen in her car outside MedStar Franklin Square Medical Center in Baltimore.
Paralyzed, her imagination ran wild. She could see cicadas flying in her hair, feel their legs skittering on her skin. "They were all over the parking lot. I had to get myself together to run into the building," Garcia said.
Like a running back hoping to avoid tacklers, she visualized a path to the goal, the hospital's front door. Get the baby out of his car seat. Hustle a few steps down the walk. Don't touch or step on one because of the crunching sound.
"I know they don't hurt you," Garcia said. "I know they don't bite. My fear is they will fly into me, into my hair, down my shirt. I'm afraid of things that fly. I even hate butterflies."
Don't be quick to judge, psychiatrists say.
"When the cicadas show up, people will identify with these folks," said Reid Wilson, author of the self-help book "Don't Panic." "To some degree, it's the fear of the unknown showing up all of a sudden. It's them appearing everywhere, all over the grass and the picnic tables out back. You step on them and hear the crunch. They're disgusted."
Most people with phobias don't seek treatment, said Wilson, an associate professor of psychiatry at the University of North Carolina School of Medicine. They self-medicate, so to speak.
"They stop flying, stop going over bridges, don't get on an elevator, don't go above the 13th floor, avoid insects. That's the way to keep a phobia alive, avoid what scares you. They perceive that as acceptable," Wilson said.
Flying bugs such as cicadas are especially fearsome to people with entomophobia because they can be anywhere and come from any direction.
Scientific evidence has linked the disorder to genes, said Sally Winston, co-director of the Anxiety and Stress Disorders Institute of Maryland.
Sufferers know intellectually they're in no danger, but the creepiness causes an overwhelming adrenaline rush they can't control.
There's really only one way to treat it, Wilson and Winston said. Put the bug right in the patient's face, make them confront their fear.
Wilson's approach is direct. He wants a patient to look at videos of bugs, then touch one and hold it, owning the feeling of six legs crawling on their skin.
"I start by asking them: 'What do you want back in your life? What do you want to do, get back to going to work every day?' " he said. "I want them to put their game-face on. Look at video and not have any grimace or fidgeting. Say: 'I want my life back. I'm not going to continue to have this victim-oriented expression.' "
Winston's approach is more gradual. She starts with black-and-white photos of bugs, followed by a blown-up color photo. Maybe later, she will give the patient a life-size toy insect with stunning detail and have them grow accustomed to it.
After that, the patient gets a look at the real thing in a box or other container. Later the box is placed where the patient can't see it, to address the fear of the unknown. That step intensifies when the bug is set free, whereabouts uncertain.
Milani said she knows that approach, having started treatment in April. "It's a standard procedure called progressive exposure," she said. "You control how much you want to treat this. You see a picture, touch a picture, touch a toy of a bug."
Yamile said she's already gotten close enough to a cicada, and the experience wasn't pleasant. When she was about 12, one flew into her bedroom in Queens early one morning.
"It woke me up out of my sleep. I ran to my mom and said there was a big bug in my room," said Garcia, a Spanish interpreter. Her mother rushed in with a broom.
"It sounded like she was killing a human being," Garcia said. "It just kept going. She was whacking it with a broom and it wouldn't die. It was making this horrible, horrible sound."
Cicadas make Garcia frantic. "I freak out," she said. "I hyperventilate."
Despite her treatment, Milani said she will cower at home again if this year's expected Brood II swarm shows up in Arlington County.
"I'm waiting to see the first one," she said. "I made arrangements with my office so I can telecommute."