» Blushing and phobic states

Blushing and phobic states

Types of blushing

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Shyness blushing

You may have been very shy in early childhood, blushing easily already then. Adolescence may have added only slightly to the proneness to blush.

People who suffer from childhood blushing have often had quite a happy childhood, but the they may have lived in somewhat isolated surroundings such as in a rural area with no other people nearby, or in a small village. Their upbringing has typically been pretty formal, and in many cases there have been high parental expectations of decent and obedient behavior, even physical punishment. Often other members of the family, for example one of the parents or another child, also have suffered from a similar type of blushing. This is explained by the heredity of  family characteristics.

This blushing type responds very well to endoscopic sympathetic block (ESB) 2.

Conflicted-type blushing

You may not have been a blusher in early childhood; blushing may not have begun until later on in childhood. It may have begun when, for example, you have felt it difficult to meet teachers’ expectations. Your social communication skills have suffered from early setback in a group setting at school. There may even have been bullying by schoolmates. Many of conflicted-type blushers have difficulties in forming intimate relationships or even normal relations with the opposite sex. The affected person tries to make contacts, but has to withdraw once and again due to the embarrassing blushing reaction. If you belong to this group of blushers, you will probably be very much helped by ESB procedure.

If you suffer from  both sweating and blushing

You may have been a blusher in the adolescence, but since then, sweating has little by little overcome the blushing. Sweating associated with this form of blushing is usually limited to the face or to the head, but sometimes the pattern is more general. Many suffer from stage frights, and there may a habit of easing the stage fright with a drink or two. Facial sweating sometimes may be a sign of the feeling of existential anxiety – was I actually a wished for child at all? This type of situation is best helped with ESB 3 or 4 sympathetic block procedure.

Panic disorder

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Panic disorder is often difficult to separate from social phobia (fear of social situations).  However, some differentiating factors between the two conditions do exist:

  • Panic disorder needs no preliminary triggers, it may strike like a lightning from a clear sky.
  • In social phobia there normally always is a preceeding situation which triggers the fear episode.
  • In panic disorder, one often asks for help from any person in sight.
  • In social phobia, the person would rather vanish from the scene as quickly as possible.

When it comes to ESB, it is not of high importance to define whether a patient suffers from social phobia or panic disorder, since in many cases the treatment is the same. Both conditions respond readily to sympathetic block.

Social phobia

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Social phobia is often described as fear of public situations and scrutiny which leads to embarrassment or humiliation. When you have social phobia you may have extreme feelings of self-consciousness built into powerful fear. Physical reactions such as blushing, sweating or trembling can make public situations worse. See below for information on how we can treat social phobia by endoscopic sympathetic block (EBS), and on different types of social phobia.

ESB is an effective treatment for social phobia

In the last 10 years, Sympatix surgeons have treated over 2,500 patients using ESB with an excellent success rate. Results of social phobia treatment with ESB are shown in Figure 1 below. The basics of the treatment of the various forms of social phobia by ESB can be read in our fundamental study . A study of 160 patients also showed clear overall satisfaction of ESB patients operated by Sympatix (Privatix) (Pohjavaara P, 2004.). These results were confirmed by a long-term study (Rantanen and Telaranta, 2013) which showed a high level of patient satisfaction which persisted long-term.

Figure 1. Results of the treatment of Social Phobia with the sympathetic block (ESB)

The results of this study of 187 patients demonstrated a significant relief in both the physical symptoms – mainly blushing, sweating, heart racing, and trembling – and the psychological feeling of anxiety. As might be expected, treatment of social phobia by ESB can improve the quality of life.

Social phobia types

1.The conflicted type

Can be thought to have developed following strict discipline, high expectations at home or at school, and possibly parental undervaluation of the child, these being only examples not by any means accusations. Such an adolescent and future adult wants eagerly join the social company of the others, but finds it embarrassing due to lack of self-esteem. He/she often blushes, but does not sweat markedly. An ESB procedure results in effective relief from conflicted type social phobia.

2. The withdrawal type

Can be thought to have developed following isolated home environment and lack of social contacts. He/she does not necessarily blush, but avoids company and eye contact, likes to isolate and hide. An ESB procedure may may result in effective relief from withdrawal type social phobia. This can be confirmed with a temporary stellate ganglion block performed before the surgery.

Parkinson’s and trembling

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ESB has been used successfully to treat Parkinson’s. A case is presented below.

Relief of extrapyramidal symptoms by sympathetic block

Published 2003-07-15, updated 2010-12-17,Timo Telaranta1 and Markku Partinen2,3

We present a 44 years old male patient, whose extrapyramidal symptoms were relieved by an endoscopic sympathetic block at high thoracic level. Following surgery his symptoms related to anxiety and social phobia were also relieved, and his capacity in daily living improved markedly. This finding opens new questions about pathophysiology of Parkinsonian symptoms and may give new possibilities to treat patients with Parkinson’s disease who are anxious or who suffer from social phobia.

Extrapyramidal symptoms are found in patients with Parkinson’s disease and also as a consequence of neuroleptic (antidopaminergic) treatment. The golden standard of treatment is based on dopaminergic drugs (dopamin agonists and L-dopa-preparations). The effect of surgical procedures is considered limited (1). Disabling dysfunction of sympathetic nervous system may be present, and sympathetic ganglion transplantation from upper thoracal sympathetic ganglia into the caudate and putamen unilaterally has been proposed (2). Also depression and most recently anxiety has been the focus of Parkinson’s comorbidity representing up to 40 % of Parkinson’s patients (3). On the other hand, endoscopic sympathetic block has been proposed as a possible treatment for patients with social anxiety relieving also trembling (4). A Finnish 44 years old male had his first extrapyramidal symptoms at the age of 36. Earlier he had been operated on for hyperthyreosis at the age of 25, and had as a complication hypoparathyreosis, which is balanced with medication The neurological disease progressed quite rapidly causing significant incapacity in daily activities and forced him into early retirement. The main motor symptoms were rigidity, bradykinesia, hypomimia and resting parkinsonian-type tremor of both upper extremities. Estimated UPDRS-motor examination gave 38-42/56 points. The diagnosis of Parkinson’s disease was confirmed with b-CIT mapping of the brain. He was subsequently treated with L-dopa and carbidopa combibed with entacapone. During the last few years the effectiveness of the drugs gradually decreased, both in terms of the efficacy and duration of relief. As a young man under the age of 30, the patient had suffered considerably from stage fright. With time he learned to withstand it due to his work as a director of financing in a major bank. After the onset of the Parkinsonian symptoms, however, the signs of social phobia recurred together with anxiety. The patient has had a long-lasting therapy contact with ambulatory mental care unit and with a private psychiatrist. He had been treated with several SSRI drugs and mirtazapine without significant effect. The sympathetic function of the patient was investigated, and a slight dysfunction without any increase in sympathetic tone was found. A stellate ganglion block was performed in April. The patient experienced some, but not significant, relief. He notwithstanding wanted to continue to an experimental endoscopic sympathetic block (ESB), which was performed later on the same day according to Lin-Telaranta (5). Immediately after the surgery he felt that his tremor had decreased and his walking and coordination had improved. During the following 10 months post-surgery, the situation has further improved. We decreased his medication. The patient himself estimated at that point that the muscular rigidity and tremor were still present during some hours a day (20 %), compared to 50-70 % one year ago. After the surgery the UPDRS-motor examination gave 17-21/46 points. A year ago he was able to only occasionally drive a car, whereas now he was able to drive distances of over hundred miles. The patient intended to return to work from the already approved pension. Three years after the surgery he tells having been steadily getting better and he sends a home made video to us. He had turned to lead a family business instead of getting back to his former work. ESB has been demonstrated to be effective in the treatment of social phobia (6). In an extended Medline search we have not been able to find a single mention of its use in the treatment of extrapyramidal symptoms or in the treatment of Parkinson’s disease. The Parkinsonian type symptoms in our case were aggravated by anxiety, and the patient had also been diagnosed with social phobia. We can only speculate about possible pathophysiologic mechanisms. The results of motor improvement may be due to changes in the noradrenergic-dopaminergic feed-back systems. It is also possible that the autonomic nervous system plays a role in the Parkinson’s disease which is still poorly understood. Anyhow, so it seems to be in several cases of our Parkinson patients, here you see one of them. Further studies are needed on this topic.


1 Dysautonomia Research Institute, Tampere, 2 Haaga Neurological Research Centre, and 3 Department of Clinical Neurosciences, University of Helsinki, Finland (1) Schapira AH. Science, medicine, and the future: Parkinson’s disease. BMJ 1999;318:311-4 (2) Nakao N, Kakishita K, Uematsu Y, Yoshimasu T, Bessho T, Nakai K, Naito Y, Itakura T. Enhancement of the response to levodopa therapy after intrastriatal transplantation of autologous sympathetic neurons in patients with Parkinson disease. Neurosurg 2001;95:275-84 (3) Walsh K, Bennett G. Parkinson’s disease and anxiety. Postgrad Med J 2001;77:89-93 (4) Telaranta T. Past, present and future of the surgery of the sympathetics. Ann Chir Gyn 2001;90:153-6 (5) Lin CC, Telaranta T. Lin-Telaranta classification: The importance of different procedures for different indications in sympathetic surgery. Ann Chir Gyn 2001;90:161-6 (6) Pohjavaara P, Telaranta T, Väisänen E. The role of sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block. Nord J Psychiatry 2003;57:55-60

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