Blushing and Social Anxiety Disorder

Blushing is often part of social anxiety disorder.
Learn why you blush and what to do about it. Bernine / Getty Images

Blushing is a normal physiological response that results in the face, neck and/or chest becoming red. However, it can also be a source of misunderstanding.

Below are five myths about blushing that have persisted.

1. Blushing Always Signals Embarrassment

Blushing may result from strong emotions such as embarrassment, anger or excitement. However, it may also be linked to medical problems like carcinoid syndrome, fever, menopause, rosacea, medications used to treat diabetes and high cholesterol, and other triggers such as alcohol, hot or spicy foods and quick changes in temperature.

2. If You Try Hard Enough, You Can Stop Blushing

When you blush, the blood vessels in your face widen, allowing more blood to pass through to the skin. The tiny muscles in your blood vessels usually keep the vessels slightly squeezed; however, during a blushing episode, nerves in your body send signals to relax these muscles.

Because this action is automatic, it is nearly impossible to stop once it has begun. In fact, the harder you try to stop blushing, the redder you will usually get.

3. All People with Social Anxiety Disorder Blush

Blushing is a symptom of social anxiety disorder (SAD); however, not all people who have SAD have problems with blushing. In addition, not all people who blush have social anxiety disorder.

However, for those with SAD who have problems with blushing, reddening of the face usually happens frequently.

When a person with social anxiety disorder blushes, it usually goes along with a host of negative automatic thoughts, such as "Everyone is noticing how red I am" or "Everyone thinks that I'm weird." Some people with SAD blush when they are put on the spot, made the center of attention, or caught off guard in a social situation.

4. Blushing Cannot Be Controlled

In fact, a number of treatments are available for problems with blushing.

If your blushing goes along with other physical symptoms or appears along with a medical problem, a medical cause is likely and a medical doctor can offer the best course of treatment.

When blushing is a symptom of social anxiety disorder, cognitive-behavioral therapy (CBT) directed at the underlying anxiety that maintains blushing is a good treatment option.

Through CBT, you will learn how to think, act and feel differently, which in turn will have a positive impact on your problems with blushing. Another treatment option that can help at the same time is medication to treat SAD.

5. Blushing is Always a Bad Thing

In a 2016 study of 102 children aged 4.5 years who were asked to sing in front of an audience and then watch their performance in front of the audience, contrary to what might be expected, blushing was related to lower social anxiety (rated by the parents) for some children.

The results of this study showed that for children who showed "positive" shy behaviors (e.g., smiling while averting their gaze), more blushing did not mean more social anxiety. In contrast, for children without these positive shy behaviors, more blushing meant more social anxiety.

However, children with "negative" shy behaviors (e.g., negative facial expressions) were very socially anxious whether they blushed or not.

The authors of the study conclude the following may be true (for children):

1) blushing + negative facial expressions OR blushing + no facial expressions = early indicator of problems with social anxiety

2) blushing + positive facial expressions = adaptive social mechanism

Clearly, more research needs to be conducted on this topic to figure out just what it means when a child blushes! Certainly, it is not something to be overly concerned about unless your child also appears distressed by the blushing or about social anxiety in general.

Coping with Blushing

Above all else, remember that blushing can become a vicious cycle. If you choose not to make a big deal about your red face, you will probably blush much less than when you actively try to prevent it from happening.

Sources:

Nikolić M, Colonnesi C, de Vente W, Bögels SM. Blushing in Early Childhood: Feeling Coy or Socially Anxious? Emotion. 2016;16(4):475-487. doi:10.1037/emo0000131.

Pelissolo A, Moukheiber A. Open-label Treatment with Escitalopram in Patients with Social Anxiety Disorder and Fear of Blushing. J Clin Psychopharmacol 2013;33:695-8. doi: 10.1097/JCP.0b013e31829a878b. 

Social Anxiety Institute. Blushing: A symptom of social anxiety

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