[Malingering in vascular disease]

Pathomimicry occurs in all fields of medicine. Although difficult to recognize, 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 be distinguished from Munchhausen's syndrome which involves simulation of severe disease and extravagant lies with false history reporting leading to successive hospitalizations in different hospitals. Pathomimesis is also distinguished by the goal of the simulation which is to obtain a precise material benefit. In vascular pathology, pathomimesis can take on several aspects:hemorrhagic syndrome by self-prescribed anticoagulants, self-induced limb edema (tourniquet), or self-inflicted skin wounds. Diagnosis is suggested by the absence of a cause, identification of the stricture groove in case of edema, imprivement with occlusive dressings for skin ulcers and by the general presentation. Pathomimesis 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 the past. The patient attempts to overcome an earlier tragic situation. Pathomimicry is thus expressed during acute episodes of fear and/or anxiety. For the practitioner, it is important to avoid accusing the patient 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 unstated interchange allows the patient to establish a confident relationship with the physician, a relationship which should lead to an accepted psychotherapy.