Psychogenic purpura (Gardner-Diamond syndrome, autoerythrocyte sensitization, painful bruising syndrome) is a rare and poorly understood clinical presentation of unexplained painful ecchymotic lesions, mostly on the extremities and/or the face. This disorder mainly occurs in Caucasian women with emotional stress or one or more concomitant mental illnesses. It has been speculated that this might be the disease entity responsible for reported episodes of "hysterical" bleeding or religious stigmata.
The clinical, pathophysiologic, and diagnostic aspects of psychogenic purpura will be discussed here. The general approach to the patient with a bleeding diathesis is discussed separately. (See "Approach to the adult patient with a bleeding diathesis" and "Approach to the adult patient with thrombocytopenia" and "Congenital and acquired disorders of platelet function".)
The first publication concerning psychogenic purpura was by Gardner and Diamond in 1955 . Since that time, a number of reviews [2-6] and case reports have been published, the vast majority in adult Caucasian women [7-29], although this disorder has also been described in children, adolescents, and adult men [30-39].
Disease episodes are associated with painful bruises on the extremities and/or face; all systemic tests of the coagulation system are normal. Since psychogenic purpura occurs in the psychiatric patient population, factitious bleeding and deliberate self-induced mutilation or other trauma need to be ruled out.
Bleeding episodes — According to the patient, bruises occur either spontaneously or after trauma or surgery at other sites of the body. One patient, for example, had a wrist fracture and a subsequent carpal tunnel syndrome requiring intervention . This was accompanied by severe emotional disturbance; spontaneous bruises began three weeks later on the same arm and hand.