Erythrophobia

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Classification according to ICD-10
F40.1 or F40.2 Social phobia or
specific (isolated) phobias
ICD-10 online (WHO version 2019)

Under erythrophobia (from the Greek. Erythr- red / reddish and phobia fear) or Errötungsangst understands the fear of blushing that the extent of a phobia (, anxiety disorder reached). It is controversial among experts whether the fear of reddening is to be classified diagnostically as part of the social phobias , as a specific phobia or as yet another disorder.

At the end of the 19th and beginning of the 20th century, fear of reddening (probably in the western world) was common and widely discussed.

Description of the clinical picture

Those affected do not actually suffer from blushing, but rather from the fear of anticipation of the blushing and its supposed consequences - the blushing is massively perceived by others and they would usually rate the affected person negatively (fear of embarrassment). Social situations are experienced as uncomfortable or unbearable due to erythrophobia.

Those affected often try to avoid situations that trigger fear in a targeted manner (avoidance of attention or avoidance of the social situation in general) or possibly to prepare for them. In social situations they observe themselves more intensely (self-focused attention). They focus more on the blush, how strong it is, whether others can spot it, and how it can be covered up. Those affected usually have an exaggerated assessment of whether and how much they blush (distortion of perception ). In studies, people with mild and severe fear of reddening did not differ in how severely or how often they actually blushed.

Affected people are afraid of being viewed as unsafe by others because of the blushing and ultimately being assessed negatively, often it is about "embarrassment, disregard [sic!] Or rejection". Often those affected are well aware of the exaggerated nature of their fears, without this being able to reduce their fear.

Improvements to anxiety "by itself" are rare; anxiety tends to worsen. As a result of the avoidance reactions, fear of reddening can lead to social isolation, loneliness, loss of leisure activities and even unemployment , occupational disability or early retirement .

Explanatory model

As with other mental illnesses, the explanation of the illness is made up of general and individual factors. Different therapy schools explain diseases differently.

For example, behavioral therapy emphasizes that, as with other phobias, those affected usually behave in such a way that they do not experience the fear-inducing situation: Either they avoid the situation completely or they use certain behaviors ( safety behavior ) to make the situation seem more bearable (e.g. . Covering up reddening parts of the body with clothing, which can be more noticeable than reddening and can also increase natural reddening for temperature regulation). In both cases, those affected do not experience the situation actually feared (blushing, its possible perception by others, their possible reaction); In terms of behavior therapy, there is never a confrontation with the actual fear-inducing situation and thus never habituation or erasure of fear (maintenance).

Studies have shown that an excessive focus of attention on blushing as a (visible) body symptom of arousal also plays an important role in maintenance.

Therapeutic approaches

As part of behavioral therapy , cognitive and behavioral strategies for dealing aggressively with the reddened face can be taught, which change the way people deal with the fear of blushing. If the blush was previously increased in the sense of a self-fulfilling prophecy, the treatment can reduce it; as a rule, however, it is about a changed way of dealing with blushing and fear. For behavioral treatment includes the confrontation treatment so that sufferers learn to deal differently with their fear. One measure can also be a check of the actual blushing (getting feedback, video recordings, ...). Anxiety management measures can include relaxation procedures.

An (operative) sympathectomy can be performed as a last resort . This reduces actual flushing. Since the fear of reddening is caused less by physiological than by psychological factors, it must be examined critically in individual cases whether such an intervention can actually promise an improvement in the fear of reddening and how to deal with them.

Diagnostic classification

Diagnostically, the classification of erythrophobia is controversial.

Many experts regard it as part of the social phobias (F40.1) in the ICD-10 diagnostic system ( WHO diagnostic system ) . The fear of blushing is then considered to be comparable to other fears of body reactions - such as nausea, tremors, the urge to urinate - all of which are to be seen against the background of social fear. The ICD-10 says: “More extensive social phobias (...) can manifest themselves in complaints such as blushing, hand tremors, nausea or the urge to urinate. The person in question sometimes thinks that one of these secondary manifestations of fear is the primary problem. ”It remains to be seen whether the fear of reddening should be considered a generalized or a non-generalized subtype of social phobia in this context: It is usually assigned to the generalized subtype, because it is experienced in (almost) all social situations; some authors, however, see disorders in which (social) fears of visible body reactions take priority (here: blushing) as a non-generalized subtype.

American-diagnostic system DSM-5 , the term "erythrophobia" is only in the glossary of cultural concepts of suffering ( Glossary of Cultural Concepts of Distress ) as a variant of the Japanese taijin kyofusho mentioned. "Blushing" is also mentioned as one of the symptoms that socially phobics are afraid of. The section on additional features supporting the diagnosis (of a social phobia) ends with the sentence: “Blushing is a typical body reaction of social phobia.” ( Blushing is a hallmark physical response of social anxiety disorder. ) In the previous system, the DSM-IV- TR , the explanations of the diagnostic features contained at least the vague formulation that «blushing ... may be more typical of social phobia». (Saß et al., 2003, p. 474, quoted from Chaker & Hoyer, 2007)

According to another opinion, erythrophobia, on the other hand, is to be assigned to the specific (isolated) phobias (ICD-10: F40.2) and is thus seen parallel to, for example, fear of heights or spiders . The fear of reddening was also classified as a specific phobia in the alphabetical index of an extended version of the ICD-10 for the German area of ​​application ( German Modification ). In a (not yet final, even without the consent of WHO located) "Beta Design" ( Beta Draft ) for the re-edition of the diagnostic system, the ICD-11, the Errötungsangst is also allocated to the specific phobias.

Reddening anxiety is also rarely classified as an "anxiety disorder due to a medical disease factor ", " agoraphobia without a history of panic disorder ", an "unspecified anxiety disorder" or an " obsessive-compulsive disorder " (Laederach-Hofmann et al., 2002) or the similarity discussed on body dysmorphic disorder (Bögels, 2006).

Questionnaires

Questionnaires that were developed to assess fear of reddening are:

  • Blushing Propensity Scale (BPS) by Leary & Meadows (1991): depicts fear of reddening rather than actual tendency to redden
  • Blushing, Trembling and Sweating Questionnaire (BTS-Q) by Bögels & Reith (1999): 6 sub-scales for different body symptoms, which can also be used individually; 115 items , including 6 items for the subscale fear of reddening

supporting documents

  1. ↑ a b c d e f g h with details of other literature: Samia Chaker & Jürgen Hoyer (July 20, 2007): Erythrophobia: Disorder Knowledge and Behavioral Therapy. Behavioral Therapy, 17, 183-190. (Review article)
  2. ↑ a b c d Erythrophobia: Panic before blushing. Bernhard Croissant in an interview with Anne Backhaus; Spiegel Online from March 19, 2013, accessed on November 18, 2015
  3. ↑ Studt, 2000, p. 95: Hans H. Studt (2000): 2.3.5 Phobias (p.94-96). In: Hans H. Studt & Ernst R. Petzold (eds.): Psychotherapeutic medicine: Psychoanalysis - Psychosomatics - Psychotherapy. A guide for clinic and practice. Berlin & New York: Walter de Gruyter.
  4. ↑ a b c d Samia Chaker & Jürgen Hoyer (July 20, 2007): Erythrophobia: Disorder Knowledge and Behavioral Therapy. Behavioral Therapy, 17, 183-190.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (Review article)@1@ 2Template: Toter Link / www.psychologie.tu-dresden.de  
  5. ↑ * Samia Chaker & Jürgen Hoyer (July 20, 2007): Erythrophobia: Disorder Knowledge and Behavioral Therapy. Behavioral Therapy, 17, 183-190.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (Review article) @1@ 2Template: Toter Link / www.psychologie.tu-dresden.de  
  6. ↑ F40.1 of the ICD-10-WHO version 2013. ( Memento of the original from December 1, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. on dimdi.de @1@ 2Template: Webachiv / IABot / www.dimdi.de
  7. ↑ a b American Psychiatric Association (2013): Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5®). Arlington, VA: American Psychiatric Association.
  8. ↑ * Hans Reinecker (2003, 4th edition): Textbook of clinical psychology and psychotherapy. Models of mental disorders (p. 111). Göttingen: Hogrefe, publishing house for psychology.
  9. ↑ German Institute for Medical Documentation and Information (DIMDI) on behalf of the Federal Ministry of Health (BMG) in cooperation with the National Association of Statutory Health Insurance Physicians. Edited by Bernd Graubner (2014). ICD-10-GM 2014. Alphabetical index. International statistical classification of diseases and related health problems. 10. Revision - German Modification (p. 324). Cologne: German doctors publishing house.
  10. ↑ ICD-11 Beta Draft: Specific phobia. Frozen version as of May 31, 2015. ( Memento of the original from December 30, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (accessed November 18, 2015) @1@ 2Template: Webachiv / IABot / apps.who.int

literature

Scientific literature:

Self-help literature:

  • Carsten Dieme: Afraid of blushing? Erythrophobia: Background, ways out and success stories of those affected. Stillwasser , 2004, ISBN 3-9808696-1-X .
  • Doris Wolf : Don't be afraid of blushing. Psychological strategies for self-help. 3. Edition. PAL Verlag, 2005, ISBN 3-923614-59-4 .