2 - Psychophysiology of the blush  pp. 15-38

Psychophysiology of the blush

By Peter D. Drummond

Image View Previous Chapter Next Chapter

In Darwin’s view, blushing was ‘the most peculiar and most human of all expressions’ (1872/1965, p. 309). However, over the past twenty-five years an accumulating body of programmatic research has begun to shed light on the psychophysiological mechanisms and emotional correlates of blushing. This research is reviewed below.

Physiological mechanisms that may contribute to blushing

Blushing refers to reddening of the face in emotionally charged situations, typically in association with feelings of embarrassment, guilt or shame. The reddening is due to an accumulation of red blood cells in the superficial venous plexus in the facial skin. This appears to involve an active dilatation of the arterial supply because vascular pulsations increase markedly during blushing (Figure 2.1). In addition, as facial veins are supplied with β-adrenoceptors (Mellander et al., 1982), a β-adrenergic mechanism that contributes to the dilatation of veins may increase their capacity to hold blood.

The neural regulation of blood flow is more complex for the face than for most other regions of the body, because facial blood vessels supply the sensitive membranes of the eyes, nose and mouth in addition to the skin. Thus, broadly distributed sympathetic vasoconstrictor and dilator reflexes, locally distributed parasympathetic reflexes and vasodilator reflexes mediated by sensory nerves all influence facial blood flow. In addition, substances that arrive in the bloodstream (e.g., hormones, vasoactive peptides, dietary products and drugs), or that are produced locally by the vascular endothelium, add an extra level of control over facial blood flow. Potentially, each of these influences could contribute to blushing, although some of these influences clearly are more important than others.

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th edn. Washington, DC: American Psychiatric Association.
Amies, P. L. , Gelder, M. G. , & Shaw, P. M. (1983). Social phobia: a comparative clinical study. British Journal of Psychiatry, 142, 174–9.
Bögels, S. M. , Alberts, M. , & de Jong, P. J. (1996). Self-consciousness, self-focused attention, blushing propensity and fear of blushing. Personality and Individual Differences, 21(4), 573–81.
Baker, S. R. , & Edelmann, R. J. (2002). Is social phobia related to lack of social skills? Duration of skill-related behaviours and ratings of behavioural adequacy. British Journal of Clinical Psychology, 41(3), 243–57.
Blair, D. , Glover, W. , & Roddie, I. (1961). Cutaneous vasomotor nerves to the head and trunk. Journal of Applied Physiology, 16, 119–22.
Bouwer, C. , & Stein, D. J. (1998). Hyperresponsivity to nicotinic acid challenge in generalized social phobia: a pilot study. European Neuropsychopharmacology, 8(4), 311–13.
Carrive, P. , & Bandler, R. (1991). Control of extracranial and hindlimb blood flow by the midbrain periaqueductal grey of the cat. Experimental Brain Research, 84(3), 599–606.
Changizi, M. A. , Zhang, Q. , & Shimojo, S. (2006). Bare skin, blood and the evolution of primate colour vision. Biology Letters, 2(2), 217–21.
Chen, V. , & Drummond, P. D. (2008). Fear of negative evaluation augments negative affect and somatic symptoms in social-evaluative situations. Cognition and Emotion, 22(1), 21–43.
Chou, S. H. , Kao, E. L. , Lin, C. C. , Chang, Y. T. , & Huang, M. F. (2006). The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases. Surgical Endoscopy, 20(11), 1749–53.
Cuthbert, B. N. (2002). Social anxiety disorder: trends and translational research. Biological Psychiatry, 51(1), 4–10.
Darwin, C. (1872/1965). The expression of the emotions in man and animals. University of Chicago Press.
de Jong, P. J. (1999). Communicative and remedial effects of social blushing. Journal of Nonverbal Behavior, 23(3), 197–217.
Dijk, C. , de Jong, P. J. , & Peters, M. L. (2009). The remedial value of blushing in the context of transgressions and mishaps. Emotion, 9(2), 287–91.
Dijk, C. , Voncken, M. J. , & de Jong, P. J. (2009). I blush, therefore I will be judged negatively: influence of false blush feedback on anticipated others’ judgments and facial coloration in high and low blushing-fearfuls. Behaviour Research and Therapy, 47(7), 541–7.
Drummond, P. D. (1989). Mechanism of emotional blushing. In N. W. Bond & D. A. T. Siddle (Eds.), Psychobiology: issues and applications. Amsterdam: Elsevier, 363–70.
Drummond, P. D. (1992). The mechanism of facial sweating and cutaneous vascular responses to painful stimulation of the eye. Brain, 115(5), 1417–28.
Drummond, P. D. (1994a). Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome. Clinical Autonomic Research, 4(5), 273–85.
Drummond, P. D. (1994b). The effect of anger and pleasure on facial blood flow. Australian Journal of Psychology, 46(2), 95–9.
Drummond, P. D. (1995). Mechanisms of physiological gustatory sweating and flushing in the face. Journal of the Autonomic Nervous System, 52(2–3), 117–24.
Drummond, P. D. (1997a). The effect of adrenergic blockade on blushing and facial flushing. Psychophysiology, 34(2), 163–8.
Drummond, P. D. (1997b). Correlates of facial flushing and pallor in anger-provoking situations. Personality and Individual Differences, 23(4), 575–82.
Drummond, P. D. (1999a). Facial flushing during provocation in women. Psychophysiology, 36(3), 325–32.
Drummond, P. D. (1999b). Autonomic disorders affecting cutaneous blood flow. In C. J. Mathias & R. Bannister (Eds.), Autonomic failure, 4th edn. New York: Oxford University Press, 487–93.
Drummond, P. D. (2000). A caution about surgical treatment for facial blushing. British Journal of Dermatology, 142(1), 194–5.
Drummond, P. D. (2001). The effect of true and false feedback on blushing in women. Personality and Individual Differences, 30(8), 1329–43.
Drummond, P. D. (2004). The effect of cutaneous mast cell degranulation on sensitivity to heat. Inflammation Research, 53(7), 309–15.
Drummond, P. D. (2006). Immersion of the hand in ice water releases adrenergic vasoconstrictor tone in the ipsilateral temple. Autonomic Neuroscience, 128(1–2), 70–5.
Drummond, P. D. (2012). [Making a mistake evokes blushing]. Unpublished raw data.
Drummond, P. D. , & Finch, P. M. (1989). Reflex control of facial flushing during body heating in man. Brain, 112(5), 1351–8.
Drummond, P. D. , & Granston, A. (2003). Facilitation of extracranial vasodilatation to limb pain in migraine sufferers. Neurology, 61(1), 60–3.
Drummond, P. D. , & Lance, J. W. (1992). Pathological sweating and flushing accompanying the & Lance, J. W. trigeminal lacrimal reflex in patients with cluster headache and in patients with a confirmed site of cervical sympathetic deficit: evidence for parasympathetic cross-innervation. Brain, 115(Pt 5), 1429–45.
Drummond, P. D. , & Lance, J. W. (1987). Facial flushing and sweating mediated by the sympathetic nervous system. Brain, 110(3), 793–803.
Drummond, P. D. , & Lazaroo, D. (2012). The effect of niacin on facial blood flow in people with an elevated fear of negative evaluation. European Neuropsychopharmacology, 22(3), 200–4.
Drummond, P. D. , & Lim, H. K. (2000). The significance of blushing for fair- and dark-skinned people. Personality and Individual Differences, 29(6), 1123–32.
Drummond, P. D. , & Mirco, N. (2004). Staring at one side of the face increases blood flow on that side of the face. Psychophysiology, 41(2), 281–7.
Drummond, P. D. , & Quah, S. H. (2001). The effect of expressing anger on cardiovascular reactivity and facial blood flow in Chinese and Caucasians. Psychophysiology, 38(2), 190–6.
Drummond, P. D. , & Su, D. (2012). The relationship between blushing propensity, social anxiety and facial blood flow during embarrassment. Cognition and Emotion, 26(3), 561–7.
Drummond, P. D. , Back, K. , Harrison, J. , Helgadottir, F. D. , Lange, B. , Lee, C. , Leavy, K. , Novatscou, C. , Orner, A. , Pham, H. , Prance, J. , Radford, D. , & Wheatley, L. (2007). Blushing during social interactions in people with a fear of blushing. Behaviour Research and Therapy, 45(7), 1601–8.
Drummond, P. D. , Camacho, L. , Formentin, N. , Heffernan, T. D. , Williams, F. , & Zekas, T. E. (2003). The impact of verbal feedback about blushing on social discomfort and facial blood flow during embarrassing tasks. Behaviour Research and Therapy, 41(4), 413–25.
Edelmann, R. J. , & Baker, S. R. (2002). Self-reported and actual physiological responses in social phobia. British Journal of Clinical Psychology, 41(1), 1–14.
Edelmann, R. J. , & Skov, V. (1993). Blushing propensity, social anxiety, anxiety sensitivity and awareness of bodily sensations. Personality and Individual Differences, 14(3), 495–8.
Fleming, I. (2010). Molecular mechanisms underlying the activation of eNOS. Pflugers Archiv: European Journal of Physiology, 459(6), 793–806.
Fox, R. H. , Goldsmith, R. , & Kidd, D. J. (1962). Cutaneous vasomotor control in the human head, neck and upper chest. Journal of Physiology (London), 161, 298–312.
Gerlach, A. L. , Wilhelm, F. H. , & Roth, W. T. (2003). Embarrassment and social phobia: the role of parasympathetic activation. Journal of Anxiety Disorders, 17(2), 197–210.
Gerlach, A. L. , Wilhelm, F. H. , Gruber, K. , & Roth, W. T. (2001). Blushing and physiological arousability in social phobia. Journal of Abnormal Psychology, 110(2), 247–58.
Hofmann, S. G. , Moscovitch, D. A. , & Kim, H. J. (2006). Autonomic correlates of social anxiety and embarrassment in shy and non-shy individuals. International Journal of Psychophysiology, 61(2), 134–42.
Horley, K. , Williams, L. M. , Gonsalvez, C. , & Gordon, E. (2003). Social phobics do not see eye to eye: a visual scanpath study of emotional expression processing. Journal of Anxiety Disorders, 17(1), 33–44.
Irmak, M. K. , Korkmaz, A. , & Erogul, O. (2004). Selective brain cooling seems to be a mechanism leading to human craniofacial diversity observed in different geographical regions. Medical Hypotheses, 63(6), 974–9.
Izumi, H. (1999). Nervous control of blood flow in the orofacial region. Pharmacology and Therapeutics, 81(2), 141–61.
Laederach-Hofmann, K. , Mussgay, L. , Buchel, B. , Widler, P. , & Ruddel, H. (2002). Patients with erythrophobia (fear of blushing) show abnormal autonomic regulation in mental stress conditions. Psychosomatic Medicine, 64(2), 358–65.
Leary, M. R. , & Meadows, S. (1991). Predictors, elicitors, and concomitants of social blushing. Journal of Personality and Social Psychology, 60(2), 254–62.
Leary, M. R. , Britt, T. W. , Cutlip, W. D. I I , & Templeton, J. L. (1992). Social blushing. Psychological Bulletin, 112(3), 446–60.
Lindsey, K. Q. , Caughman, S. W. , Olerud, J. E. , Bunnett, N. W. , Armstrong, C. A. , & Ansel, J. C. (2000). Neural regulation of endothelial cell-mediated inflammation. Journal of Investigative Dermatology Symposium Proceedings, 5(1), 74–8.
Magerl, W. , & Treede, R. D. (1996). Heat-evoked vasodilatation in human hairy skin: axon reflexes due to low-level activity of nociceptive afferents. Journal of Physiology (London), 497(3), 837–48.
Malmivaara, A. , Kuukasjarvi, P. , Autti-Ramo, I. , Kovanen, N. , & Makela, M. (2007). Effectiveness and safety of endoscopic thoracic sympathectomy for excessive sweating and facial blushing: a systematic review. International Journal of Technology Assessment in Health Care, 23(1), 54–62.
Mellander, S. , Andersson, P. O. , Afzelius, L. E. , & Hellstrand, P. (1982). Neural beta-adrenergic dilatation of the facial vein in man: possible mechanism in emotional blushing. Acta Physiologica Scandinavica, 114(3), 393–9.
Modigliani, A. (1968). Embarrassment and embarrassability. Sociometry, 31(3), 313–26.
Mulkens, S. , de Jong, P. J. , & Bögels, S. M. (1997). High blushing propensity: fearful preoccupation or facial coloration? Personality and Individual Differences, 22(6), 817–24.
Mulkens, S. , de Jong, P. J. , Dobbelaar, A. , & Bögels, S. M. (1999). Fear of blushing: fearful preoccupation irrespective of facial coloration. Behaviour Research and Therapy, 37(11), 1119–28.
Nagasaka, T. , Brinnel, H. , Hales, J. R. , & Ogawa, T. (1998). Selective brain cooling in hyperthermia: the mechanisms and medical implications. Medical Hypotheses, 50(3), 203–11.
Neto, F. (1996). Correlates of social blushing. Personality and Individual Differences, 20(3), 365–73.
Nielsen, B. (1988). Natural cooling of the brain during outdoor bicycling? Pflugers Archiv: European Journal of Physiology, 411(4), 456–61.
Nordin, M. (1990). Sympathetic discharges in the human supraorbital nerve and their relation to sudo- and vasomotor responses. Journal of Physiology (London), 423, 241–55.
Pohjavaara, P. , Telaranta, T. , & Vaisanen, E. (2003). The role of the sympathetic nervous system in anxiety: is it possible to relieve anxiety with endoscopic sympathetic block? Nordic Journal of Psychiatry, 57(1), 55–60.
Rapee, R. M. , & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–56.
Roberts, A. H. , Schuler, J. , Bacon, J. G. , Zimmermann, R. L. , & Patterson, R. (1975). Individual differences and autonomic control: absorption, hypnotic susceptibility, and the unilateral control of skin temperature. Journal of Abnormal Psychology, 84(3), 272–9.
Shearn, D. , Bergman, E. , Hill, K. , Abel, A. , & Hinds, L. (1990). Facial coloration and temperature responses in blushing. Psychophysiology, 27(6), 687–93.
Shearn, D. , Bergman, E. , Hill, K. , Abel, A. , & Hinds, L. (1992). Blushing as a function of audience size. Psychophysiology, 29(4), 431–6.
Shearn, D. , Spellman, L. , Straley, B. , Meirick, J. , & Stryker, K. (1999). Empathic blushing in friends and strangers. Motivation and Emotion, 23(4), 307–16.
Smidfelt, K. , & Drott, C. (2011). Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing. British Journal of Surgery, 98(12), 1719–24.
Spielberger, C. D. (1991). State-trait anger expression inventory professional manual, rev. research edn. Odessa, FL: Psychological Assessment Resources.
Sugimura, H. , Spratt, E. H. , Compeau, C. G. , Kattail, D. , & Shargall, Y. (2009). Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. Journal of Thoracic and Cardiovascular Surgery, 137(6), 1370–6; discussion 1376–7.
Vassend, O. , & Knardahl, S. (2005). Personality, affective response, and facial blood flow during brief cognitive tasks. International Journal of Psychophysiology, 55(3), 265–78.
Voncken, M. J. , & Bögels, S. M. (2009). Physiological blushing in social anxiety disorder patients with and without blushing complaints: two subtypes? Biological Psychology, 81(2), 86–94.
Watson, D. , & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33(4), 448–57.
Wilkin, J. K. (1988). Why is flushing limited to a mostly facial cutaneous distribution? Journal of the American Academy of Dermatology, 19(2) (Pt 1), 309–13.
Zachariae, R. , Oster, H. , & Bjerring, P. (1994). Effects of hypnotic suggestions on ultraviolet B radiation-induced erythema and skin blood flow. Photodermatology, Photoimmunology and Photomedicine, 10(4), 154–60.
Zajonc, R. B. , Murphy, S. T. , & Inglehart, M. (1989). Feeling and facial efference: implications of the vascular theory of emotion. Psychological Review, 96(3), 395–416.