Fear of Blushing

On that account the costs of blushing on any particular occasion are outweighed by the long-term benefit of being read as a member of the group in good standing. The person with erythrophobia is trying to suppress the mechanism that is working on their behalf.

How often erythrophobia is the main complaint

A conservative estimate from Dijk and de Jong in 2013 puts the lifetime prevalence of a fear of blushing at around four per cent.

The more revealing number is clinical. Essau, Conradt and Petermann found in 1999 that fear of blushing was the main complaint of about a third of people seeking help for social fears. That places erythrophobia at the centre of the presenting problem for a large share of social anxiety, which is why it is often described as a marker or subtype of social anxiety disorder rather than a separate condition.

Why blushing is believed to signal weakness

The belief is specific: that blushing damages the person's standing in the eyes of others, who will read it as abnormality, weakness or insecurity. It follows that situations where blushing might occur are avoided, and where they cannot be avoided they are endured with considerable fear.

The concealment is practical and worth recording because it is visible to anyone who knows to look: scarves, and heavy make-up. The intensity varies with setting, so familiar and friendly company produces less than an unfamiliar room, which distinguishes it from fears with a fixed object.

The consequences described are cumulative rather than acute. Difficulty forming friendships. Promotions missed and therefore earnings reduced. Secondary problems including alcohol misuse, depression and suicidal thinking follow from the narrowing rather than from the blushing.

Why blushing surgery is often regretted

Endoscopic thoracic sympathectomy removes the blushing response surgically, and it works. The 2015 reference records what follows: most patients, about eighty per cent, develop compensatory sweating elsewhere on the body, and roughly a quarter regret having had the operation, following Drummond in 2013.

It is not the preferred treatment, and the reasoning behind the alternative is the interesting part. The psychological approaches do not target the blush at all, because blushing is not under voluntary control. They target the fear of it, on the expectation that a reduced fear produces less blushing as a consequence rather than as a goal.

Why blushing shows in the face

The anatomy is genuinely different, which is unusual for a fear in this catalogue. Facial skin carries more capillary loops per unit area and more vessels per unit volume than skin elsewhere. The vessels of the cheek are wider, closer to the surface, and less obscured by tissue fluid. Wilkin concluded that increased capacity and greater visibility account for why flushing is confined to where it is.

Mellander and colleagues found in 1982 that human facial veins behave unlike veins elsewhere: they contract actively when passively stretched, developing an intrinsic basal tone, and they carry beta-adrenoceptors in addition to the usual alpha-adrenoceptors. Those beta-adrenoceptors could dilate against that basal tone, which is the mechanism they proposed for emotional blushing.

Drummond tested it in 1997 by blocking each receptor type separately and measuring forehead blood flow with a dual channel laser Doppler flowmeter, in undergraduates of mean age 22.9 sorted into frequent and infrequent blushers. Three results came out of it:

1. alpha-adrenergic blockade with phentolamine changed nothing, which was expected since vasoconstrictor tone in the face is low anyway
2. beta-adrenergic blockade with propranolol reduced blushing in both groups
3. blood flow still rose substantially during the embarrassment procedure despite complete blockade, so further dilator mechanisms remain unaccounted for

What Darwin said about blushing

Charles Darwin gave chapter thirteen of The Expression of the Emotions in Man and Animals, published in 1872, to self-attention, shame, shyness, modesty and blushing. What he called it:

the most peculiar and most human of all expressions

Salzen proposed in 2010 a different reading from Crozier's: that blushing and flushing are what the fight or flight mechanism does when neither confrontation nor retreat is available. Blushing has been linked to activation in the cerebellum and the left paracentral lobe.

How blushing differs from flushing and craniofacial erythema

Idiopathic craniofacial erythema is a medical condition in which a person blushes strongly with little or no provocation, and people with social phobia are described as particularly prone to it. Blushing is also distinguished from flushing, which is more intense, covers more of the body, and rarely has a mental cause at all.