Psychogenic "purpura" consists in the spontaneous appearance of recurrent bruising, it is a reality which is still unexplained. Most often woman with an underlying emotional disorder are affected. In addition to cutaneous
ecchymoses and
hematomas they may have menometrorrhagia,
hematuria,
epistaxis and gastrointestinal
bleeding in addition to many other complaints encompassing multiple organ systems. Cutaneous bruising is heralded by a burning or stinging sensation followed after a few hours by local warmth, puffiness and
erythema, most often with some
itching. The
pain subsides when the
ecchymoses appear a day later or earlier. Blood coagulation and
hemostatic tests remain normal in all patients. A rare but poorly studied variety of psychogenic
bleeding are religious or other stigmata with periodic
bleeding at hands and feet, under the left breast and at the forehead, occasionally with bloody tears. It would be risky to substitute one poorly understood diagnosis (stigmata) with another (hysterical conversion). It is very difficult to distinguish spontaneous psychogenic from selfinflicted iatrogenic
bleeding (
purpura factitia) because patients may have the same obsessive-compulsive behavior or hysterical trait. Moreover, patients with self-induced
bleeding act in a most clever manner and their continuous observation is difficult. The differential diagnosis with the "
battered child" syndrome is rather easy. Other
bleeding disorders with normal coagulation tests are an inherited failure of the
collagen biosynthesis (f.i.
Ehlers-Danlos syndrome) or congenital or acquired vascular disorders (
purpura senilis of Bateman,
vitamin C deficiency, morbus
Schamberg, purpura annularis of Majocchi, orthostatic
purpura). There is virtually no scientific information on the interaction between the nervous system and hemostasis or blood coagulation. The only therapeutic approach in patients with psychogenic
bleeding is psychiatric with particular attention to the sociocultural background of the patient and his family.