Blushing and social anxiety

What is happening in your body

Blushing is a rush of blood to the skin of your face, neck or chest. It happens when you feel embarrassed, ashamed or looked at. Your body’s alarm system drives it, so you cannot stop it by trying. Everyone blushes. Some people blush more easily than others.

In social anxiety, the blush itself is often not the main problem. The main problem is the fear of it: “They’ll see I’m red and think I’m weird, weak or lying.” That fear makes you watch for the first sign of warmth in your face. Feeling it then makes you more anxious, which can bring on more blushing.

In some cultures, fear of blushing is linked to a worry about making others uncomfortable. Taijin kyofusho covers that pattern.

Do other people notice?

Less than you think, and they mind less than you think.

• You feel it more than others see it. In a Dutch study, women with a strong fear of blushing and women without it were put in awkward situations, such as watching a video of themselves singing while two strangers sat with them. Their face colour and temperature were measured. The two groups blushed the same amount. But the women who feared blushing felt that they blushed much more.
• People overestimate how much their feelings show. In a set of experiments, people believed their inner states were far more visible than they were.
• When people do see a blush, they often judge you more kindly. In two experiments, people read about someone who had made a mistake or broken a social rule, then saw a photo of them with or without a blush. In most cases, the person who blushed was rated more favourably, for example as more sympathetic and trustworthy. A blush signals “I care that this went wrong”, and people respond to that.

What makes it worse

• Fighting it. Trying hard not to blush keeps your attention on your face, which tends to make the feeling stronger.
• Hiding it. Wearing heavy make-up, scarves or high collars, keeping your hair over your face, or avoiding bright rooms. These safety behaviours make the blush feel more shameful and stop you learning that people do not react badly.
• Avoiding situations. Saying no to meetings, dates or presentations because you might blush.
• Watching for it. Checking your face in mirrors or your phone camera.

What keeps social anxiety going explains why these feel helpful but keep the fear alive.

What helps

Therapy that targets the fear. Psychological treatment works well for fear of blushing. In a Dutch trial of 31 people, two approaches both reduced fear of blushing, and people kept improving over a year:

• exposure: facing situations where you might blush, on purpose and without hiding;
• task concentration training: practising putting your attention on the task and the people around you, instead of on your face.

Interestingly, the amount people actually blushed did not change. The fear did. A review of treatments for fear of blushing also lists cognitive therapy, applied relaxation, and newer methods like self-compassion and video feedback. Cognitive therapy for social anxiety includes most of these.

Medicines. The same review found no medicine proven to treat fear of blushing itself. SSRIs and SNRIs treat social anxiety disorder and may help some people whose main fear is blushing. A doctor must prescribe them.

Propranolol. Some people try this heart medicine before stressful events. It mainly calms shaking and a racing heart. There is little trial evidence for it in social anxiety: a review found only one small trial, with 16 people. A doctor must prescribe it. See propranolol.

When to see a doctor

See a doctor if:

• fear of blushing makes you avoid work, study or seeing people;
• your face goes red often without any emotional reason, or the redness lasts a long time, burns or comes with spots. Skin conditions such as rosacea can look like blushing and are treated differently.

Some people look into surgery or other medical treatments to stop blushing. Talk these through carefully with a doctor, including the risks, and consider trying psychological treatment first.