Joseph R. Anticaglia MD
Medical Advisory Board
Charles Darwin considered blushing to be “the most peculiar and most human of all expressions.” Mark Twain said: “Man is he only animal that blushes. Or needs to.” Patricia, a high school student said: “Whenever a teacher asks me a question, I can’t stop myself from blushing.”
Blushing is unmistakably human. It’s the sudden, involuntary appearance of redness and the sensation of warmth most commonly on the face and neck. It can affect other areas of the body and you cannot suppress its appearance as one might a laugh.
Emotional blushing (E.B.) has been associated with feelings of embarrassment and shame. This type of self-consciousness differs from non-emotional blushing such as eating spicy foods, exercise or alcohol consumption.
E. B. also differs from a variety of medical conditions that cause blushing such as rosacea, reaction to niacin-vitamin B3, menopause, fever, the viral fifth disease in children and certain tumors (carcinoid syndrome).
The nervous system is divided into two parts: The central nervous system (CNS). consisting of the brain and spinal cord and the peripheral nervous system (PNS) which makes up the rest of the nervous system.
The autonomic nervous system (ANS) is part of the peripheral system. It keeps the heart pumping while you’re sleeping, allows you to breathe without you thinking about it, keeps you alive when you’re knocked unconscious and among many other things, makes the digestive juices flow or slow down without you knowing about it.
The autonomic nervous system is also divided into two parts, sympathethetic and parasympathetic systems. Blushing is thought to be associated with the sympathetic system and the ‘fight or flight’ phenomena.
When you’re put on the spot, for instance, at being asked a difficult question in school, you can’t escape. You may fear being judged by your classmates. The sympathetic system is activated, increasing the blood supply to muscles as well as to blood vessels in the face. The facial blood vessels dilate, become closer to the surface causing the blush, redness of the face.
Psychologist Mark Leary et al in a 1992 article wrote about four triggers of social blushing:
Psychologist Ray Crozier references Leary’s work by illustrating the above with his own work and examples of people’s recollections when they blushed: [Compare Leary’s a) to Crozier’s a) and so forth.]
We can see from the above, receiving a compliment, someone indicating that you’re blushing or having fear of being scrutinized by others in a classroom or outside of it can trigger blushing.
Besides embarrassment, fear and shame, other emotions can precipitate the blush. Anger, rage, pain or sexual attractiveness often send signals to the other person which can vary from “Help” to I’m fascinated by you.”
The occasional blushing that most of us have experienced at one time or another is a normal bodily reaction that doesn’t require treatment. At other times, the problem can become intolerable, ruining your life with tragic consequences.
Psychiatrist Enrique Jadresic uses the term Pathologic Blushing (PB) to describe chronic blushing due to an overactive sympathetic nervous system.
A hyperactive sympathetic nervous system causes a person to suffer episodes of blushing more frequently and more severely compared to occasional blushing experienced by others. It can start during the teenage years, worsen and become more chronic and intolerable as the person gets older. People who are tormented by this condition seek surgery (see below) as a last resort to get relief from their physical and psychological struggles.
Treatments of non-emotional blushing depend on the cause. It can vary from drinking alcohol in moderation, eliminating spicy foods to cancer surgery. Exercise and other dietary changes may be useful as well.
Emotional blushing has been linked to social anxiety disorder. This disorder elicits embarrassment and self-consciousness in everyday encounters. People are anxious about being judged or scrutinized when confronting other people or situations.
Hypnosis, medications, psychological counseling and breathing exercises have had some success in reducing the anxiety associated with blushing. As a last resort, individuals have opted for surgery, sympathectomy to treat intolerable blushing.
Endoscopic Thoracic Sympathectomy (ETS) is a procedure in which a surgeon cuts or clamps the nerve chain responsible for the “fight or flight” response. One can imagine the state of mind causing a person to opt for ETS surgery. As with any surgery, one needs to be aware of the risks and benefits of such a procedure.
Blushing is an overlooked and underestimated condition. It’s not well understood why some people do not seem to blush, others blush occasionally and some are shackled with an overactive sympathetic nervous system.
People sometimes trivialize blushing unaware that the psychological effects can be calamitous. If you find it bothersome, consult your family doctor to rule out a potential serious problem.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.
