Is there a place for fear of blushing in social anxiety spectrum?

Fear of blushing (FB) in front of other people is a frequent and potentially incapacitating problem, but is not yet described as a specific diagnosis in psychiatric classifications. This can be explained by a lack of comparative studies with other forms of social anxiety disorder (SAD). Our aim was thus to explore the specificity of FB in patients with SAD.

SAD patients with FB but without other social threat (n = 142), the majority of whom were referred by a department of surgery after an initial request of sympathetic block for facial blushing, were compared to SAD patients with FB and other associated social fears (n = 97), and to SAD patients without FB (n = 190). They were assessed and compared with a structured diagnostic interview for DSM-IV and various scales measuring social anxiety, other anxiety and depressive symptoms, impairment and personality traits.

The group with pure FB showed specific profiles when compared with the two other groups: later age of onset, less comorbidity, lower behavioral and temperamental inhibition, and higher self-esteem. However, their levels of social anxiety and impairment were high. No important differences appeared between the two other groups.

The specificity of FB should be considered in the social anxiety spectrum, and could be viewed either as a SAD subtype or as SAD form secondary to facial blushing. Further epidemiological and therapeutic studies on this disorder are necessary.