Blushing, shame and social anxiety
The blush is regarded as a facial expression of the ‘self-conscious’ emotions – an outward manifestation of shame, embarrassment, shyness and/or modesty. In addition, the blush itself can be a source of self-consciousness and shame. Fear of blushing (erythophobia) can be the major presenting problem in social phobia and social anxiety. It creates a problem in several ways. First, unlike body shame associated with disﬁgurements, skin diseases or body shape, it is experienced as an involuntary reaction. Second, awareness that one is blushing can intensify it; indeed, simply being told (correctly or not) that one is blushing can induce a blush. Third, people can regard their blushing in a negative light. Not only may they be anxious of how others evaluate them because they blush (external shame), they may interpret their dispositions to blush as a sign of personal weakness or evidence of social ineptness (internal shame). Both forms of shame can lead those who are susceptible to blush to engage in a variety of defensive or safety behaviours and avoid social situations in which blushing may occur. Such anxieties and defensive behaviours can be heightened by the perceptions that blushing is beyond their conscious control. Furthermore, as a blush begins attention can become more selffocused interfering with eﬀorts at social presentation and producing cognitive overload, which adds to anxiety, especially as other behaviours (e.g., speech ﬂow) are interrupted (Rapee & Heimberg, 1997). As discussed below, these concerns can lead people to seek professional help and there are a range of psychological and medical approaches to intervention.