Pseudocyesis

Pseudocyesis (i.e., 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, the majority of cases of pseudocyesis occur in rural areas and in developing countries where individuals may not be examined by a physician 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.

Pseudocyesis has become particularly rare in countries where individuals have easy access to pregnancy tests. Over the past century, cases of pseudocyesis have decreased significantly in the United States but remain high in cultures where an individual’s worth in society is highly associated with their ability to conceive. Although pseudocyesis can occur throughout an individual’s lifetime, it is more common in individuals of childbearing age.

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, 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 may alter hormonal regulation in predisposed individuals, resulting in endocrine changes that could explain the signs and symptoms of false pregnancy. 

Other psychiatric conditions, including depressive disorders, personality disorders, and schizophrenia are fairly common among individuals with pseudocyesis and may 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.

In certain cases, pseudocyesis may resolve spontaneously when the psychological stressors and social factors contributing to the false pregnancy are addressed. As a result, the duration of the symptoms is highly variable and can range from a few weeks to nine months or even longer. Psychotherapy or informal counseling with a healthcare provider can help individuals come to terms with their false pregnancy as well as resolve any underlying issues that may contribute to their condition. In cases where pseudocyesis is worsened by a medication or other medical conditions, adjusting or changing that medication and treating the underlying disorder can help decrease the severity of pseudocyesis.

Pseudocyesis, or false pregnancy, refers to the false but non-delusional belief of being pregnant that is associated with objective signs and symptoms of pregnancy. The exact cause of pseudocyesis is not fully understood, although it may involve a complex interplay between psychological and neuroendocrine changes. In order to diagnose pseudocyesis, it is important to rule out a viable pregnancy or any other medical conditions that could resemble a false pregnancy. Treatment of pseudocyesis is mainly supportive, with some individuals requiring psychotherapy, or talk therapy. Prognosis is largely dependent on resolving the underlying psychological or social factors that have contributed to the false pregnancy.