Why Do We Blush?

Why we turn red when we’re embarrassed or feel shy—and what can be done about it

Is there anything worse than being told that you’re blushing by a person who’s watching you blush? While flushing cheeks may have their appeal to some—many equate blushing with innocence,  youth, and modesty, though research has shown that blushing can be associated with fertility and mimic the flushing that often comes with sexual arousal—the experience of blushing can be anything but pleasant. In fact, many would say that blushing is only slightly less mortifying than being naked in public.

“Blushing is an involuntary physiological response” to embarrassment and other emotions, says psychiatrist Alexandra Canetti, MD, of ColumbiaDoctors Tarrytown, noting that it is seen more frequently in people who suffer from social anxiety. “Autonomic hyperactivity [arousal of the autonomic nervous system] may also play a role in excessive blushing,” she says. 

 At its core, says Canetti, “Blushing is related to the fight-or-flight response, which is an evolutionary adaptation for us to be able to react to life-threatening situations. Hormones, including adrenaline and cortisone, are released by our bodies in response to situations perceived as dangerous. The sympathetic nervous system and the adrenal-cortical system take over causing changes that include increased heart rate and blood pressure, dilated pupils, increased blood flow to major muscles, and blushing.”

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While most of us can deal with an occasional blush, some people do it so often and so excessively that it can be debilitating. Depending on the cause and severity, “various options are available for people who blush excessively,” says Canetti. These include simple fixes such as green color-corrective makeup, cognitive-behavioral therapy (for anxiety disorders), or medications such as beta blockers (used off-label as treatment for performance anxiety) and Selective Serotonin Reuptake Inhibitors, or SSRIs, which can also be used to treat social anxiety. 

In very extreme cases, endoscopic thoracic sympathectomy, a surgical procedure sometimes recommended for facial blushing and/or excessive sweating, may be warranted. “Through a small incision, the surgeon cuts selected sympathetic nerves or sympathetic ganglia, causing a reduction in facial blushing and excessive facial sweating,” Canetti explains. “It has a success rate of 90 percent, but some studies cite that up to 15 percent of patients regret having the surgery, due to the compensatory hyperhidrosis (excessive sweating in the back, abdomen, thighs, and legs).” 

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