Overview

The physical symptoms of Frey Syndrome have been observed since the 1920s, along with the characterisation of its hallmarks and causes.¹ Frey Syndrome causes sweating and flushing in the cheek, temple and around the ear when eating or thinking about food. This is caused by nerve damage in the area and when these nerves attempt to grow back, the nerves which were previously responsible for stimulating saliva now stimulate sweat. Frey Syndrome is not life-threatening, however, despite the seemingly harmless nature of this disorder, its uncomfortable psychological and social impacts on sufferers are usually left out of the discussion. 

The psychosocial effects of living with Frey syndrome vary from case to case and depend heavily on the individual. Those suffering from this disorder may experience mental health issues such as anxiety, low self-esteem and depression as well as social stigma, which can lead to social isolation and further impacts on health. Due to the visible nature of the symptoms, sufferers may find themselves experiencing difficulty in both their professional and personal lives. 

What is Frey Syndrome and how is it caused?

Frey Syndrome is a rare neurological disorder characterised by excessive sweating and redness on the cheek near the front of the ear when eating or thinking about food.¹ In other words, things that usually would cause you to produce saliva now cause you to sweat in this region instead. Although the exact cause of this disorder is not completely understood, Frey Syndrome is associated with damage to the nerves surrounding the parotid gland, and most commonly presents itself months and even years after undergoing parotid surgery, but can also be caused by damage in other ways. It is thought that in the case of Frey Syndrome, after the nerves are damaged, they are regenerated abnormally, leading to new innervation of sweat glands as opposed to salivary glands, leading to the following symptoms when eating or thinking about food in the affected areas of the forehead, cheek and ear:²

• Sweating 
• Flushing
• Burning
• Itching 
• Pain/Neuralgia

However, although these physical symptoms are benign, they may cause the sufferers of this disorder mental and social discomfort, possibly hindering their lives as a consequence. 

Psychological Effects of Frey Syndrome

Emotional impact

It comes as no surprise that hyperhidrosis (excessive sweating) of any kind can cause emotional distress and lead to issues with mental health and wellbeing. Most patients suffering from similar disorders to Frey Syndrome report anxiety, general nervousness and depressive symptoms.^3,4 Due to the presentation of Frey Syndrome in the face, those with the disorder may suffer from body image concerns and issues with self-esteem. It has also been observed that these emotional effects may worsen with time, due to the chronic nature of the disease, despite the physical symptoms being stable from the onset of the disorder.⁵

Impact on quality of life

The emotional impacts of Frey Syndrome can affect the quality of life experienced by patients. Whilst Frey Syndrome itself does not impact the quality of life,⁶ the mental toll of living with it may cause difficulties in the day-to-day lives of those with it. For example, the anxiety experienced by patients as a consequence of the symptoms of this disorder can develop into a plethora of anxiety disorders such as social anxiety disorder or even agoraphobia, both of which are known to have a negative effect on the quality of life.^7,8 Typically, the effect on quality of life is correlated with the severity of symptoms and seems to improve following treatment.⁹ 

Coping mechanisms and psychological resilience

Patients with Frey Syndrome who are also presenting symptoms of anxiety, depression and low self-esteem could benefit from talking therapies, such as counselling or cognitive behavioural therapy. Sufferers may also find it helpful to join a support group focussed on aiding those with hyperhidrosis, such as The International Hyperhidrosis Society, to connect with those who understand and have related experiences. 

Social Effects of Frey Syndrome

Social stigma and isolation

Frey Syndrome can make it challenging to engage socially with colleagues or peers, due to the shame and stigma that comes with the visible symptoms of this disorder. Whether it is a date, a shared family meal or a quick snack on the road, food is often a pillar of human connection. It is therefore understandable that Frey Syndrome can make these usually enjoyable social situations uncomfortable. This discomfort can lead to social isolation, which can exacerbate the psychological impacts (anxiety, depression, low self-esteem) of this disorder. Social isolation is also linked to decreased immunity, inflammation and sleep quality and an increased level of stress.¹⁰

Impact on professional life

The effects of living with Frey Syndrome do not end with difficulties in social life. Individuals with Frey Syndrome may feel uneasy in the workplace and their career options may be limited due to the triggers of this disorder. Meetings held over lunch or team-building activities involving food can be daunting and lead to feelings of shame and embarrassment. Lower self-esteem or anxiety as in one's personal life can quickly trickle into work life and impact motivation to work, productivity and effectiveness.¹¹

Effects on personal relationships

Shared meals play an important role in connecting with family and friends. Individuals with Frey Syndrome may miss out on crucial time with their loved ones due to the stigma surrounding the condition. This could cause strain on personal relationships. 

FAQs

What is the supportive therapy for Frey Syndrome?

Frey syndrome can typically be treated with the administration of botulinum A toxin (BOTOX) in the area of the cheek and ear where the symptoms are present. Other treatments include topical ointments, antiperspirants and in some cases surgical intervention. 

Is gustatory sweating serious?

Gustatory sweating is a natural reaction to eating specific foods that cause us to sweat (spicy, sour or salty foods). In Frey Syndrome, this occurs when eating or thinking about food and is not a life-threatening disorder but may have some negative psychosocial effects. 

Can you get Frey Syndrome without surgery?

Although surgery is the most common cause of nerve damage leading to Frey Syndrome, it is not the only one. Nerve damage can be a result of many things including trauma, infection or nervous system dysfunction. The cause of the nerve damage may play a hand in exacerbating the psychosocial impacts of living with this disorder. 

How do I manage the embarrassment of sweating?

Sweating is a natural response. In the case of Frey Syndrome, it may help to stay away from foods which cause you to sweat to minimise symptoms. Excessive sweating is a medical condition and shouldn’t be the cause of mental suffering. It is worth seeing a mental health professional for support or guidance.

Summary

Frey Syndrome is a rare neurological disorder that arises from damage to facial nerves which, under normal circumstances, innervate the parotid salivary gland. In this disorder, when the damaged nerves heal, they innervate the sweat glands instead of the salivary glands. As a result of this, when the signal is sent down from the brain by these nerves that are meant to stimulate saliva production, sweat production is stimulated instead. This causes the individual to excessively sweat and become flushed in the area of the cheek ear and temple when eating or thinking about food. Because as humans, we place a lot of importance on experiencing food socially, the symptoms of this disorder can cause social unease and distress for those experiencing them. In severe cases, these benign symptoms can lead to mental health disorders such as anxiety, depression and low self-esteem. Although there is limited research on Frey Syndrome due to it being a rare disease, its psychosocial impacts are akin to those faced by individuals suffering from hyperhidrosis (excessive sweating). Negative psychosocial effects can be mitigated by talking therapies (such as cognitive behavioural therapy or counselling) and finding a community that relates to the uncomfortable symptoms of Frey Syndrome. Furthermore, these effects can also be relieved with treatment of the disorder.