VASCULAR PATHOMIMESIS

Pathomimicry occurs in all fields of medicine. Although difficult to r ecognize, all physicians should be aware of the underlying mechanisms in order to avoid excessive ordering of complementary examinations and therapeutic propositions which may be dangerous. Pathomimesis is to b e distinguished from Munchhausen's syndrome which involves simulation of severe disease and extravagant lies with false history reporting le ading to successive hospitalizations in different hospitals. Pathomime sis is also distinguished by the goal of the simulation which is to ob tain a precise material benefit. In vascular pathology, pathomimesis c an take on several aspects : hemorrhagic syndrome by self-prescribed a nticoagulants, self-induced limb edema (tourniquet), or self-inflicted skin wounds. Diagnosis is suggested by the absence of a cause, identi fication of the stricture groove in case of edema, imprivement with oc clusive dressings for skin ulcers and by the general presentation. Pat homimesis is usually encountered in young intelligent women with some medical knowledge. This behavior has a psychopathological significance , the provoked symptoms demonstrating difficult emotional events in th e past. The patient attempts to overcome an earlier tragic situation. Pathomimicry is thus expressed during acute episodes of fear and/or an xiety. For the practitioner, it is important to avoid accusing the pat ient or attempting to get the patient to avow as there is an important risk of exaggerated or self-destructive response. The patient should be led to realize that the physician knows what is happening. This uns tated interchange allows the patient to establish a confident relation ship with the physician, a relationship which should lead to an accept ed psychotherapy.