You asked: Can you literally be scared to death?

Halloween is around the corner, and with that comes haunted houses and corn mazes, mummies, ghosts and creatures of the night jumping out at you—all sure to give a harmless fright, or so we thought. Can that scary monster sneaking up behind you actually scare you to death? The answer may be as spooky as it gets.

“It is possible for someone to have health complications or die from fright,” said John P. Erwin III, MD, a cardiologist and professor at the Texas A&M College of Medicine. “It is more probable for people who have pre-existing conditions, but it is possible to suffer a cardiac-related death as a result of being scared.”

How can fear turn fatal?

Your body has an automatic nervous system, called the sympathetic nervous system, that governs the fight-or flight-response—the body’s natural protective mechanism. When faced with a life-threatening situation, the nervous system triggers the release of the hormone adrenaline into the blood, sending impulses to organs to create a specific response (typically increased heart rate, increased blood flow to muscles and dilated pupils). While the adrenaline rush can make people faster and stronger (hence the advantage to primitive humans), there is a down side in revving up your nervous system. In rare instances, if the adrenaline kick is too high or lasts too long, your heart may overwork and cause tissue damage or constriction of blood vessels, in turn, raising blood pressure.

“This exaggerated response can actually damage the cardiovascular system in several ways,” Erwin added. In addition to raising the blood pressure and risking heart attack or stroke, it can cause more long-lasting damage to organs if these neuro-hormones are elevated over time or if there is an imbalance in the chemicals.

While it may be rare for a completely healthy individual to drop dead from fear, those with a predisposition to heart disease are at an increased risk of sudden death. “Some people with genetic heart abnormalities who get a sudden rush of adrenaline can have a cardiac arrhythmia,” Erwin said. “They can have an episode where their heart goes out of rhythm, and that can be fatal.” For example, if a woman with damaged heart tissue were to be held at gunpoint, she could experience fatal rhythm abnormalities or increased oxygen demands of her heart that may not be adequately supplied due to blockages or abnormal responsive mechanisms of her blood vessels.

People who experience a great fear can also develop a condition called takotsubo syndrome, or broken-heart syndrome. Scientifically known as stress-induced cardiomyopathy, ‘broken heart syndrome’ can present in healthy individuals with no prior cardiac problems. In rare cases of takotsubo syndrome, a suddenly weakened heart can’t pump enough blood to meet the body’s needs and the rapid rise of stress hormones in the body essentially ‘stuns’ the heart.

“We frequently run across this with psychological stress,” Erwin said. “People can develop a blood flow abnormality that can temporarily stun the heart or possibly leave the person with some degree of long-term damage to the heart.”

What are some long-term effects of being scared?

It’s often said, “What doesn’t kill you, will only make you stronger,” but that’s definitely not the case when it comes to repeat exposure to fear.

“Constant exposure to fear can be like a steady drip of water until it overflows,” Erwin said. “People who are chronically scared or anxious have a higher risk of developing high blood pressure or depression as well as many other physical ailments.”

Depression and fear can live along the same emotional spectrum, as many people can express fear instead of a sadness as a sign of depression. And, unfortunately, depression and anxiety can also increase the odds of being scared to death.

“One symptom of depression, for example, is learned helplessness, or fear of things you can’t control,” Erwin said. “This fear and depression can exacerbate pre-existing medical problems or possibly make them more susceptible to other conditions by weakening their immune system.”

And while constant exposure to fear may lead to common heart problems or anxiety, there is a possibility that it can lead to even greater problems down the line.

“Research has shown that there is a higher risk of immunological problems such as cancer or other inflammatory problems,” Erwin said. “But either way, there are deleterious effects on the heart and other organs in a person with constant fear.”

While working your heart muscle can be good for your health, constant exposure to fear does not have the same beneficial effects as a jog in the park.

“The chemical buildup that happens when you’re scared and when you’re exercising is different,” Erwin said. “The chemicals, such as adrenaline, are necessary, but when you exercise, you’re actually helping to maintain the healthy balance with other important chemicals. In a sense, you can ‘burn off’ some of the excess adrenaline as well.”

“There is no doubt that there is a small possibility of death or lasting complications from fear.” Erwin said. “Fear has its purpose in life, such as alerting you to danger, but in rare instances the scare is enough to be a danger in itself.”

While the odds of this happening are rare, it certainly puts a different spin on the famous line from Franklin D. Roosevelt: “The only thing we have to fear is fear itself.”