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Patients With Erythrophobia (Fear of Blushing) Show Abnormal Autonomic Regulation in Mental Stress Conditions

From the Psychosomatics and Psychosocial Medicine (K.L-H., B.B., P.W.), Psychiatric Out-Patient Department, University of Berne, Switzerland, and the Center for Psychobiological and Psychosomatic Research (L.M., H.R.), University of Trier, Psychosomatic Hospital St-Franziska-Stift, Bad Kreuznach, Germany.

Address reprint requests to: K. Laederach-Hofmann, University of Berne, Psychiatric Out-Patient Department, CH-3010 Berne-Inselspital, Switzerland. Email: laederach{at}insel.ch

OBJECTIVE: The objective of this study was to analyze the autonomic functions of patients with erythrophobia.

METHODS: Forty patients with a diagnosis of erythrophobia (female/male ratio 18/22) without any other organic lesions and 20 healthy volunteers (female/male ratio 10/10) were assessed. Clinical evaluation was performed using a modified version of semistructured interviews. Autonomic testing was performed by means of spectral analysis of heart rate and continuous blood pressure by sparse discrete Fourier transformation at rest and under mental stress.

RESULTS: There were no significant difference between the two samples in age, sex distribution, BMI, resting systolic, or diastolic blood pressure, nor was there a difference in autonomic baseline functioning between the 40 patients with erythrophobia and the control subjects. On the other hand, patients with erythrophobia consistently showed higher pulse rates (88 ± 20 vs. 78 ± 9 bpm, p < .05), higher total heart rate power values (8.40 ± 0.63 vs. 8.07 ± 1.02 p < .05), higher midfrequency spectral values (7.38 ± 0.66 vs. 7.02 ± 1.18, p < .01), higher high-frequency spectral values (6.89 ± 0.86 vs. 6.48 ± 1.44, p < .05), and lower baroreceptor sensitivity (8.62 ± 8.16 vs. 11.65 ± 4.42, p < .005) than the healthy subjects. ANOVA showed a significant group interaction (p < .0001) between the samples.

CONCLUSIONS: This study provides evidence for abnormal autonomic functioning in patients with erythrophobia when under mental stress.

Key Words: Autonomic testing, • fear of blushing (erythrophobia), • baroreflex sensitivity, • spectral analysis, • blood pressure, • semistructured interviews.

Abbreviations: BMI = body mass index;; DSM-IV = Diagnostic and Statistical Manual of Mental Diseases, fourth edition;; ICD-10= International Classification of Diseases, tenth edition;; LF/HF ratio = low frequency/high frequency ratio;; R-R interval = beat-to-beat interval in the electrocardiogram.

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