I’m not sure I understand what you mean by “are the causes purely superficial”. I bump against something and I end up with a bruise. My skin also tears easily. I have found that Arnica gel helps heal faster but nothing otc that I’ve tried helps prevent bruising. I fall into the same category as many people that have this issue with bruising. Especially after starting this topic, I know I’m not alone! I spent a lot of time in the sun when I was younger and my skin is thin. My mom had this problem and her mom had it too. They were older when it started but they didn’t have the sun exposure I did over the years. I do trust my primary completely. She has no qualms about referring me if she thinks it’s necessary. Thanks for your concern!