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Micropaleontological, geophysical, and chronologic data indicate that normal salinity conditions occurred over currently estuarine back-barrier areas of the Outer Banks of eastern North Carolina during the peak of the Medieval Climate Anomaly. Sedimentary units several meters thick, containing foraminiferal assemblages usually found on the continental shelf of North Carolina, are present in 16 vibracores acquired from the shallow shoals of Pamlico Sound behind Cape Hatteras. Optically stimulated luminescence age estimates from these normal salinity units range from approximately 1360 to 980 calibrated years (cal yr) BP, corresponding with a previously documented collapse of a segment of the southern Outer Banks. It is vital to understand past scenarios of barrier island formation and segmentation to provide insight on how these islands may react to future change in climate and sea level. [ABSTRACT FROM AUTHOR]