Pseudocyesis

Pseudocyesis, also known as false pregnancy, is a rare psychosomatic disorder characterized by the false but non-delusional belief of being pregnant. Though based on a false belief, pseudocyesis is associated with objective signs and symptoms of pregnancy, including distended abdomen, weight gain, sensation of fetal movement, breast changes (e.g., breast tenderness, areola pigmentation, breast discharge), menstrual irregularities, and labor pains at the expected date of delivery.  

Nowadays, most cases of pseudocyesis occur in rural areas and in developing countries where individuals may not be examined by a clinician or midwife until they are in labor or they seek medical help. In other areas, individuals are generally examined by a healthcare professional in the first trimester of pregnancy to either confirm or rule out a viable pregnancy. Oftentimes, the diagnostic procedures that are performed (e.g., urine pregnancy test, blood tests, ultrasound, etc.) can help individuals come to terms with their non-pregnant condition. In cases of pseudocyesis, though, individuals may continue to believe that they are pregnant even after pregnancy has been clinically ruled out.  

The exact cause of pseudocyesis is not fully understood; however, both psychological and neuroendocrine changes seem to play a role in its development. According to research, many individuals with pseudocyesis often experience an overwhelming desire or fear of becoming pregnant. In such cases, pseudocyesis may be triggered by additional factors, such as loss of fertility or reproductive capacity, loss of a pregnancy or child, mental or physical trauma (e.g., sexual abuse), or social factors (e.g., loneliness, family pressure, cultural expectations, etc.). These strong emotions can affect brain regions like the hypothalamus, which plays a key role in regulating hormone secretion. Hormonal changes like increased levels of prolactin may lead to enlarged breasts and even lactation, while altered levels of sex hormones may result in missed periods. These physical changes reinforce the belief of pregnancy, creating a powerful feedback loop where the more real it feels, the more the body responds.  

Other psychiatric conditions, including depressive disorders, personality disorders, and schizophrenia are fairly common among individuals with pseudocyesis and may also be linked to its development. Additionally, some antipsychotic medications may cause hormonal changes that could further contribute to the signs and symptoms of false pregnancy. 

Diagnosis of pseudocyesis requires ruling out a viable pregnancy by performing a pelvic exam, collecting a blood or urine pregnancy test, or conducting an ultrasound. In certain cases, signs and symptoms of pseudocyesis may mimic those of other medical conditions, including hyperprolactinemia, hormone-secreting tumors, gallstones, or constipation, so additional testing may be necessary to rule out potentially life-threatening conditions.  

In addition, pseudocyesis should be distinguished from other related disorders, such as delusions of pregnancy, which refers to a false belief of being pregnant that is not accompanied by any physical symptoms of pregnancy. Unlike pseudocyesis, delusions of pregnancy generally occur in the setting of a psychotic state.