[Borderline structure and painful skin hemorrhages: a case of Gardner-Diamond syndrome].

The Gardner-Diamond Syndrome is an infrequently diagnosed impressive psychosomatosis. The patients (exclusively female) suffering from this disorder are described as "angry young women". They are considered hysterical, masochistic, depressive, hostile and timid. Physically the syndrome is characterized by atypical, painful, apparently spontaneous skin bleeding in young women and these patients look like they have been beaten, injured or are seriously ill. Besides hematoma, renal hemorrhage, uterine hemorrhage, headaches or unconsciousness as well as numerous symptoms of conversion in the narrower sense of the word have been observed, e.g. loss speech, gait deviation, or feelings of discomfort. To this day the pathophysiological peculiarity that enables the patients to transform subconscious psychic events into the specific temporary alteration in the permeability of the capillary walls being a constitutional variant characteristic of females suffering from Gardner-Diamond Syndrome and activated by psychic stimuli. In the case history presented, the problem is the psychic working out of narcissistic injuries in the context of a borderline structure. These injuries turn into physical symptoms analogous to the process of conversion. Since, in this case, there is no question of a defense against oedipal fantasies one would prefer to speak of a "narcissistic conversion". Quite peculiar is the universally described resemblance of the patients to one another. The syndrome, together with the character and psychodynamic features, is repeated in almost a stereotypical manner. An explanation for this phenomenon cannot be expected even from the discovery of a pathophysiological detail in the blood vessels. Rather, we are confronted with one of those extremely rare syndromes where, in a limited field, physical and psychic events are completely blended. The physical events such as affects and defense mechanisms for which they can be substituted at random and without mutual interference. It is as though these disorders had retained a phylogenetically lost unity and primeval capability of interchanging psychic and somatic structures and, so to speak, preserved them in the manner of a museum. These syndromes make us surmise that in processes of somatization a recourse to ancient, long-faded psychosomatic relationships may play a certain role.