A successfully analyzed case of pathological blushing is presented, followed by a formulation as to the cause of blushing that would reconcile current conflicting views. All influences leading to increased shame tension between the ego ideal and the ego, and thereby to a relatively unmodulated affect discharge of shame, tend to produce blushing in a physiologically reactive individual. The influences include special ways in which instinctual derivatives, ego defenses, and superego immaturities contribute, and the influences also include social and cultural factors that modify the ego ideal through their effect on the parents, as well as through later identifications of the individual with nonparental figures.