Dissociative Identity Disorder Presenting With Psychogenic Purpura

Received August 11, 1999; revised November 29, 1999; accepted December 9, 1999. From the Department of Psychiatry and Department of Internal Medicine, Division of Hematology, Istanbul Medical School, Istanbul Turkey. Address reprint requests to Dr. Yucel, Istanbul Medical School, Department of Psychiatry, Capa 34390 Istanbul, Turkey. Copyright 2000 The Academy of Psychosomatic Medicine. Pychogenic purpura was first described in four women by Gardner and Diamond in 1955 as the occurrence and spontaneous recurrence of painful ecchymoses after minor trauma. This phenomenon was initially thought to result from sensitization of patients against their own extravasated erythrocytes and thus was called “autoerythrocyte sensitization purpura” (Gardner-Diamond syndrome). This syndrome was renamed “psychogenic purpura” by Ratnoff and Agle, who postulated a psychogenic basis for the etiopathogenesis of the disorder; however, the exact mechanism of this syndrome is still unknown. The primary clinical feature reported in the literature is recurring ecchymoses. Apart from skin lesions, different systemic symptoms have been mentioned, including episodic abdominal pain, nausea, vomiting, arthralgia, headache, and other hemorrhages such as epistaxis, gastrointestinal bleeding, and bleeding from ear canals. Although bleeding from the eyes is very rare, especially in Western literature, seven cases have been reported in Turkey. Some of the patients with psychogenic purpura also had dissociative reactions, conversion symptoms, and hysterical traits along with their hemorrhagic symptoms. In this case report we describe a patient diagnosed with dissociative identity disorder (DSM-IV) who presented with psychogenic purpura in the form of bleeding from the eyes and various body surfaces.