Dear Doctor Column, October 1, 2001

Question:

I have a problem with uncontrollable blushing, particularly when I'm around other people. It makes me angry and depressed, because the blushing often keeps me from socializing. I find this very hard to live with. Please give me some advice.

Answer:

Blushing is a normal involuntary reaction that results from dilation of the superficial blood vessels in the face, bringing more oxygen-rich, red blood to the face and to the ears and upper neck. It occurs when emotions increase autonomic nervous system activity and affect beta receptors, which can cause blood vessel dilation.

Some people experience excessive problems with blushing and become exquisitely sensitive to people's reactions to the blushing or misinterpret their reactions. Both responses can lead to "social phobias."

Other symptoms related to social phobias include frequent and excessive sweating, trembling, and unexplained dizziness, all of which can impair social interactions. Some people become so distressed by these reactions that they withdraw from all situations known to stimulate these symptoms and even quit work, living a life of isolation.

Everyone blushes, and the intensity and frequency usually peaks in the teenage years and declines after that. However, anyone at any age, from birth to old age, can blush.

Fair-skinned people are more likely to be aware of blushing, but researchers have been unable to discover a clear physical reason why some people experience frequent blushing and others do not. Some studies suggest abnormalities in the actions of a chemical called serotonin, which transmits messages between nerves and regulates mood, play a role.

Research shows that counseling by a mental health professional using a technique called cognitive-behavioral therapy often helps people with blushing and social phobias. The therapist helps you confront emotional situations that trigger blushing and develop a realistic appraisal of the effects of your blushing on others. Once you overcome some of the anxiety that triggers the blushing, its frequency and intensity will decrease, allowing you to function more comfortably in previously threatening situations.

Some people with social phobias respond to drugs called beta-blockers and others are helped by drugs that affect serotonin levels. An option for the few people who do not respond to behavioral or drug therapy and who cannot function professionally or socially because of facial blushing is a procedure that involves cutting the nerves responsible for blood vessel dilation in the face. However, other effects of this procedure limit its usefulness, and it is reserved for only the most disabling conditions.