A comparison of two sections of the Outer Banks, North Carolina, USA (Pea Island and Avon-Buxton areas), reveals the importance of the interplay between oceanic and estuarine shoreline dynamics to long-term changes in barrier island width. From 1852 to 1998, the northern portion of Pea Island experienced an average net increase in width of 431 m (3 m/y); this area experienced low to moderate rates of oceanic shoreline erosion and high rates of back-barrier land accretion via overwash and formation of flood tidal delta islands. In contrast, between 1852 and 1998, the width of the southern portion of Pea Island and the Avon-Buxton area decreased an average of 515 m (4 m/y) and 594 m (4 m/y), respectively, because of high rates of oceanic shoreline erosion and variable changes in estuarine shoreline accretion and erosion. Net gain or net loss of barrier island width is strongly dependent on the natural depositional processes of overwash and flood tide delta formation. Anthropogenic modifications to the barrier island, such as construction of barrier dune ridges, planting of stabilizing vegetation, and urban development, can curtail or even eliminate the natural, self-sustaining processes of overwash and inlet dynamics.