A blush is a sudden, temporary increase in blood flow through blood vessels close to the surface of the facial skin. It is under sympathetic nervous system control, although this process is not entirely understood, so we are in the area of anticipation of, or reaction to threat, in the case of the blush a potential threat to reputation or to social acceptance. A perception of threat leads to heightened sympathetic nervous system (SNS) activity; nevertheless, a blush is a distinctive SNS response, differing from fear or anger reactions. This might be because there is an ambivalence about the circumstances that elicit a blush; they are rewarding as well as threatening, or else the flight response for which SNS activity prepares us is not appropriate. We do not see our own reddening but we know when we are blushing because of the felt increase in facial temperature caused by the blood flow. Others can interpret our blush in various ways: they think we are embarrassed, uncomfortable, shy, guilty, secretive, or sexually interested. We can interpret our own blushing in negative or in positive ways: it can have different meanings. All of us blush at one time or another. It is interesting to understand the psychological processes involved in this and also to understand the causes of individual differences in the frequency or intensity of blushing, whether the causes are physiological, psychological or both. These issues are discussed in my short book, Understanding the Blush (https://www.amazon.com/Understanding-Blush-Raymond-Crozier/dp/1475106130, 2012; ISBN: 978-1475106138), which is modestly priced and available from Amazon as a paperback or eBook. A collection of original chapters edited by Peter J. de Jong and myself for Cambridge University Press (The Psychological Significance of the Blush, 2015; ISBN: 978-1-107-53166-6, https://www.amazon.com/Psychological-Significance-Blush-Ray-Crozier-ebook/dp/B00ADP7A9Q/ref=sr_1_1?crid=24VMM0FNJ8WNU&keywords=The+Psychological+Significance+of+the+Blush&qid=1658697195&s=books&sprefix=the+psychological+significance+of+the+blush%2Cstripbooks-intl-ship%2C242&sr=1-1) is also valuable.

Blushing is now widely considered to be a sign of embarrassment, but in the past, it was identified with shame. Psychologists postulate a class of ‘self-conscious emotions’ that includes shame, shyness, embarrassment, guilt and modesty. What these have in common is a psychological state of acute self-consciousness, which is not simply awareness of oneself or self-reflection, but involves taking an ‘other perspective’ on the self, seeing oneself as if from outside and an object of potential evaluation. For some psychologists, this is an inherently aversive state, but I don’t think it is necessarily so, nor is a blush inherently unpleasant, although it often is. Nevertheless, the psychological state of acute self-consciousness seems to be at the heart of the experience of blushing, which helps us understand, for example, how it is that we can blush while alone; an imagined audience can be sufficient.

Being the centre of attention – or at least thinking that you might be – can be sufficient to trigger a blush. Being conspicuous, publicly praised, congratulated or thanked can also make you blush. Actions of others can also do so if it creates a predicament for you, making you self-conscious and uncertain about how to act.

Effective ways of coping can include redirecting your attention away from your bodily symptoms to other aspects of the situation. Acknowledging your blushing, rather than worrying about its visibility or its possible consequences, can also help. (I notice it is now quite common for people to flap a hand in front of their face as if to cool down.) People can be sympathetic to someone who is in a predicament. Humour can also help. Nevertheless, uncomfortable, unwanted blushing can also be distressing and have a negative impact on our social life. I outline ways of coping with this in answers to subsequent questions.

Yes, they often are related to blushing, for the reasons I have described in previous answers. Insecurity and self-doubt can be transient feelings and depend on particular social circumstances. Blushing is a common symptom of shyness, which itself can be a transitory experience, but it can also be enduring, a personality trait. It can take various forms but is typically characterised by feelings of self-consciousness, inhibition, reticence and silence in social situations, particularly in the presence of authority figures and people you don’t know, and feelings of anxiousness. Shyness can impact our social life and our career, leading us to avoid social situations or to stay in the background and fail to show our strengths. Anxiety about blushing can also be distressing and lead to social difficulties.

There are at least two questions here! With regard to inheritance, all humans blush, although levels of skin pigmentation – which are also heritable - can make it more or less visible. Perhaps the question refers to individual differences in the likelihood of blushing or in anxiety about blushing. There is evidence of variation in both of these. A self-report questionnaire measure of likelihood is the Blushing Propensity Scale (Leary & Meadows, 1991; doi:10.1037/0022-3514/60/s/254, https://scales.arabpsychology.com/s/blushing-propensity-scale-bps/) that has been used in research. Studies have investigated whether high scorers on this measure do, in fact, blush more or whether they overestimate the frequency, visibility and consequences of their blushing. Individual differences might also be due to inherited physiological differences that make blushing more likely or visible. Fear of blushing is common, not least because blushing can be an unpleasant experience and bring about a challenging social situation. It can create anxiety about what others think of us, which can lead to a vicious circle where our blushing increases our anxiety, which in turn leads us to interpret situations in such a way as to make blushing more likely. A meta-analysis undertaken by Nikolić and colleagues (2015; doi: 10.1111/cpsp.121020, available for purchase at https://onlinelibrary.wiley.com/doi/full/10.1111/cpsp.12102) reported that the more embarrassed or socially anxious participants were, the greater their self-reported propensity to blush, even though there was no evidence that they do actually blush more.

Endoscopic thoracic sympathectomy (ETS) is a surgical operation dividing (or sometimes clipping) the sympathetic chain to prevent the blush from taking place. This is a difficult question for me to address. No surgical operation, particularly one that may have unwanted and enduring side effects, should be entered without taking specialist advice and discussion of the possible outcomes with friends or family. My own position is to consider that the operation is based on the assumptions that (a) the blush is in itself a bad thing – the procedure stops it from taking place – and (b) that the physical blush is the cause of the person’s anxieties, which will be minimised or reduced once it is no longer to be feared. Are these assumptions warranted? What if they are not? Anxiety about blushing can be severe and impair an individual’s social life, but there are psychological and pharmacological forms of treatment that might prove effective. See my answer to the question about blushing and anxiety disorder. A thoughtful analysis of ETS and comparison with other forms of treatment is provided by Jadresic, 2016; doi: 10.5867/medwave.2016.06.6490, https://pubmed.ncbi.nlm.nih.gov/27420477/).

I can think of two ways in which it might do so. First, it can create sympathy for us in circumstances where failure to do so would make us appear uncaring, shameless, indifferent to the feelings of others, and so on. Second, there is a long tradition of women’s faces with rosy cheeks being thought beautiful – this has been evident in painted portraits for centuries, including religious pictures of the Madonna. It is not clear why this is so, and it has attracted little research; perhaps it is a sign of good health. A blusher is a common cosmetic. Blushing is often associated with flirtation, which might be linked to awareness of being the object of another’s attention. Red cheeks in themselves are not the same as a blush, but they seem to be connected in this case.

Only humans blush (as the humourist Mark Twain wrote, only humans need to). The blush’s association with self-conscious emotions suggests to some philosophers and psychologists that its equivalent on other group-living mammal species might be a sign of appeasement or subordinate rank. Many species have dominance hierarchies; displaying subordination to a superior can avoid aggression and exclusion from their group. This is not shown by the redness of the skin but by other forms of signals. We can see the parallel with the blush as a nonverbal form of apology. Biologists would regard this as an ‘honest’ signal because the blush is involuntary and cannot be controlled as, for example, a verbal apology or a smile can be feigned.

There are published reviews of intervention strategies for fear of blushing using psychological methods. Drummond and colleagues (2020; doi:10.1007/s11920-020-01152-5, available for purchase at https://psycnet.apa.org/record/2020-43234-001) provide an overview that includes three approaches that have been evaluated in research: task concentration training (redirection of attention); gradual exposure to feared situations; cognitive therapy (identifying and challenging beliefs about the frequency, visibility and consequences of blushing; social skills training. All involve systematic practice, but each has a different rationale. One key concept is that of ‘safety behaviours’, idiosyncratic strategies that the individual has developed to avoid or escape situations believed to be likely to cause a blush, but which can be counterproductive in denying the opportunity to acquire coping strategies and maintaining fears. More research is needed into the effectiveness of interventions to reduce fear of blushing.

The Diagnostic and Statistical Manual of Mental Disorders, DSM-V) includes fear of blushing as a diagnostic feature of social anxiety disorder (SAD). This condition is characterised as a persistent and disabling fear of social situations that has a significant impact on a person’s life. It is one of the most common anxiety disorders, with estimates of lifetime prevalence varying across studies but as high as 12%. One psychological approach to SAD is to hypothesis that anxiety is maintained by biased and entrenched beliefs about the likelihood and negative consequences of social failure that are attributed to the person’s own shortcomings. These beliefs distort the meanings of social experiences: any successes are not attributed to the self. Common forms of treatment are: self-help, with the aid of guidebooks; various forms of cognitive behaviour therapy; relaxation techniques; pharmacological treatments, including the SSRIs (selective serotonin re-uptake inhibitors). These pharmacological treatments were developed for depression but have increasingly been applied to anxiety conditions. They have not been applied specifically to fear of blushing but nevertheless might help by reducing social anxiety. Research into their effectiveness typically takes the form of randomised control trials where a target treatment is pitched against an alternative treatment or a placebo group, and the researchers do not know before the analyses are completed which participant has been assigned to which condition. Jadresic (2016; doi: 10.5867/medwave.2016.06.6490, available for purchase at https://psycnet.apa.org/record/2020-43234-001) and Drummond and colleagues (2020; doi:10.1007/s11920-020-01152-5) offer useful overviews of treatments applied to anxiety about blushing.