Is that a rash on your neck or are you just anxious to see me?

I go red when I’m nervous. And when I’m embarrassed. And frustrated. And amused. In fact, any time I experience the slightest increase in emotion or temperature, you will see it on my skin, clawing its way out of my collar and onto my face.  I discovered this delightful fact about myself in high school, when someone kindly pointed out that they would have presumed I was sunburnt, had I not been so deathly pale everywhere else.  They weren’t the only person to notice, either.  Every time it happened, someone would comment on it. Once the focus was firmly on me and my neck, I would get even more uncomfortable, more red, more comments, more anxious, more red, and the cycle would continue.

Fortunately most adults don’t feel the need to comment on every perceived flaw or defect in other people.  By the time I was training to become a psychologist, I worried less about whether people would notice me going red and focused my attention on more grown up fears, like whether they would discover I am a massive fraud who didn’t belong here and had probably been let onto the doctorate programme by mistake.

The Red CycleWhen I starting learning about CBT for social anxiety, it was like an emotional portal back to high school.  People with social anxiety tend to direct their attention inwards in social situations, focusing less on the other person and more on how they themselves appear to the other person, how they are coming across, and what they should be doing next.  As a result, people with social anxiety often miss the cues from other people that tell them things are fine, or they miss part of the conversation and struggle to keep up, thus making the interaction more awkward and reinforcing their belief that they can’t cope well in social situations.  This puts them on high alert again next time, and the cycle continues.

One of the most common concerns is that they will show visible signs of anxiety, like, say, going red from chest to cheeks.  When, say, presenting your doctoral research proposal to a room full of professors.  Because their focus is so closely on themselves, they often take their feelings as facts: if I feel this hot, then I must be bright red.  I feel this scrutinised, then people must be judging me.  If I feel this nervous, then I must not know what I’m talking about.

In CBT, there are some key experiments that we suggest for social anxiety.

1. Find out if your symptoms are as noticeable as you think they are.

2. Challenge your beliefs that people are judging you so harshly.

3. Check if your usual attempts to make things better are actually working.

4. As always, remember that anxiety is a perfectly normal human emotion and not a sign of weakness or gross incompetence. No matter what those dicks at high school said.

It has taken me roughly eight years to complete this set of experiments.  Turns out potential humiliation is a powerful predictor of avoidance.

Experiment 1 – Do you see what I see?

As a newly qualified psychologist, I ran a training day teaching the basics of CBT to a room full of social care and allied health professionals.  I decided to draw on a little personal experience to demonstrate how to use a quick poll (of a room full of people) to test out an alternative belief (that there was no way I could actually be as bright red as I felt like I was). I thought they would all reassure me, then spend their tea break discussing how impressively I could intertwine personal stories into a neat theoretical framework in a way that was both informative and touching, the mark of a non-fraudulent professional who definitely belonged here at the front of the room telling people what to do.

#NoFilter
#NoFilter

While telling this story I was, of course, extremely nervous.  When I managed to shift my attention back out towards the group, I saw only confusion and expectation.  It was later obvious that they were waiting for the second part of the story, the bit that explained why I had just drawn their attention to how extremely bright red I was whilst asking them to convince me otherwise.  When that part never came, a psychiatric nurse gently informed me of my flushed state, and then she very neatly tied it into a theoretical framework that was both informative and touching. A little something for the others to admire over a cup of tea.

Result: As the old saying goes, just because you’re paranoid, doesn’t mean that you’re not covered in red splotches.

Experiment 2 – Do you think what I feel?

I never intended to complete this part of the experiment.  I don’t mind asking if you can see that I’ve gone red, I don’t mind finding out if you could tell I was nervous, but I will fight to the death for my right to assume that you think I am competent.  I didn’t choose this experiment, it was handed to me along with a glass of sparkling shiraz after finishing my MC duties at my brother’s wedding.

“You looked so nervous up there!  Don’t worry – I don’t think people minded.  You did good considering how nervous you were. They’ve had heaps of champagne and people only care about the proper speeches anyway.”

Result: I guess I did good considering how nervous I was?

Experiment 3 – Is a roll neck the solution to all my problems?

Result: “It looks like that jumper might be giving you a rash.”

Experiment 4 – This is just my thing.

I spent a long time fighting the idea that my anxiety was directly related to my competence.  It took me a long time to realise that the correlation might actually be a positive one: I get nervous because I care about what I am doing, and because I believe the outcome matters.  I can feel calm, or I can be good.

Nowadays, when I choose talk about any of this during training or with my patients, I ask people to comment on how noticeable the redness is, and on what their thoughts were when they saw it.  Did they make any assumptions about me or my emotional state? Did it bring up anything for them?  Did their thoughts shift at all when I drew their attention to it and discussed it openly?

And then I tie it all up into a nice theoretical framework that I like to think teaches them a little something about CBT, anxiety, training skills, and maybe just a little bit about themselves. Because, after all, I’m a non-fraudulent professional, who knows she goes red in the face and almost certainly believes she definitely sort of belongs here.

12 Comments

  1. You’ve just printed out my life story except I’m not nervous in front of people–only that my “excited” state makes me blotch up. I have yet to find my solution other than try to “tan” it away.

  2. yes, surprised to see that i am not the only one with this problem. I called it rosacea, but it is not. only happens in situation of sudden change of temperature, glass of wine, high emotions… very hard to control… and the fear of people noticing and saying: “oh! my God what happened to you, you look so red!!!”. How to react? it only makes it worst of course, it is a vicious circle… but is there any laser treatment to eradicate this horrible problem???

  3. I’ve always had pink/bushed cheeks, I never used to get red blotchy spots on my neck and chest. When I was 13, it first started to happen, during a presentation. I felt so hot, so nervous, and embarrassed. Everyone was like, “OMG whats that on your neck and chest!?” I just said it was a rash at the time, but I knew it wasn’t because my mum gets blotchy too. I will never forget that day. Always makes me wonder why, why does this happen to me. It’s been a year since then and i’m 14 now. I thought that I was the only one who had this “blotchy skin” or “problem”, I thought that no one understood the embarrassment that I felt, the nervousness that I felt/thought that it was going to happen everyday every second. Every dermatologist I went to in the States, just called it rosacea too (I knew that wasn’t the answer). Also what they said was “It’s just something that you have to live with”. But they don’t understand how hard it is for me because they don’t have the skin like I do (my skin is really bad, gets really red). It honestly makes me sad (makes me cry) whenever I think or talk about my skin. It makes me restrict myself from doing the things I love, what make me happy and get excited. I tried blocking my emotions at one point, still didn’t work for me (still got red and blotchy) I guess I will always be red, it sucks, it really does. (I hate it/my skin so much, but I hope one day I will learn how to except my skin, guess i’m to young to realize that my skin is actually sort of beautiful in a way, probably not though).

    1. Christina, this sounds so much like my experience as a teenager! I still get it worst when I do presentations. I wouldn’t say I’ve come to “love it” but I have accepted it is the way it is. Now I tend to make a joke about it if I think it’s really obvious, otherwise I just ignore it and people either don’t notice or are too polite to say anything. I hope you find a way for it not to stop you doing what you want to do. It already sucks once that it happens at all, hopefully you will get to the stage where it doesn’t suck a second time by missing out on the good stuff (and the challenging stuff).

  4. This is the first time I have found a similar story to mine. My redness has restricted me from truly expressing how I feel and pursuing the things that I would like to. I’m at the point in my life where I really need to not let it bug me so much. I’m 32 with 2 kids and hope to God they don’t have the same redness issue I have.

    Yes most adults are too polite to mention it but I’m sure they discuss my redness behind my back. Or do they? Is it just my anxiety getting the best of me again?

    Thank you for writing this. I hope all of us can move past this and realize it’s just redness. In the end…who cares what other people think. If they enjoy your company and the person you are they won’t mind.

    1. Your last sentence captures it perfectly. If a person forms their opinion of the whole you based on you going red, then that is one very strange person indeed.

      It’s hard to shake the old feelings about it though, it can feel like you’re sending yourself into mortal social danger. I found that it wasn’t until I started acting as if I didn’t care, that I actually stopped caring. But it’s quite a leap.

  5. This post nails exactly what happens to me spot on! People say “ are you allergic to something? your neck is all blotchy and your so red” which in turn makes me embarrassed than i turn more red , all from cooking pasta on the stove and the steam warming me face . I recognize it can be caused from anxiety , temperature changes and alcohol,but is there a natural remedy to help the blood vessels in my face and neck from from doing this??

  6. Thanks for sharing this!

    I think I must’ve always blotched up, but it’s only now that I’m in my doctorate program and teaching that people have started to point it out to me. I had a student ask me during group work what was wrong with my neck, and I was like, “When I’m in social situations, I blotch.” (She responded, “That’s so cute!” So. The struggle to be perceived as a professional is real.) Sometimes I can feel myself flushing, but other times I don’t even know that my skin’s broken out into a little map unless I look in a mirror.

    I do worry, especially now that people have started to comment on it, that I give the impression of being nervous all the time. I’m 29, and I’ve never covered it up before, but this semester I’ve started to wear high collar shirts. I think so far this has been helpful for me – I can more easily convince myself that even though I feel myself going red, no one can see it.

  7. This mirrors my experience almost exactly. I was always very confident until I went for my first job interview and then pow! It took me by surprise as much as anyone else. Since then I have shrunk into myself in work situations where I have to speak or present, which is actually quite tricky as a lawyer! The weird thing is I always seem to put myself up for jobs where I will be in those situations – can’t seem to stop myself. I have taken to wearing high necked tops whatever the weather, which prompts comments in itself. It is getting worse as I get older strangely. I have had CBT and hypnotherapy but noting seems to work. I’m looking in to laser treatment to make it less noticeable. Glad to see there are others like me (although sorry you are suffering too).

  8. It’s such a relief to read this. You’ve described me completely. Any/every emotion this happens to me. It really impacts on my life and I’m still in the stage of trying to embrace/accept it as just part of me. Hard isn’t it when you hate people focus being on you, and it instantly makes you centre of attention!

  9. I am so happy to find this as it really mirrors my experience too. It all started at a uni interview. I am an allied health professional now and it has been ongoing for 6 years. I have appointments with patients all day every day and it seems to just happen out of the blue pretty much every day at some point. I tried to cover it up by having my hair in a plait, with makeup, with the angle I am sitting, but no matter what my neck becomes a huge mass of red blotches and I feel really hot. I do think that it is related to my confidence, and that I feel it will make people judge that I do not know what I am saying. I was wondering if anyone has any cognitive solutions, thinking strategies that may help? Thanks!

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