Pseudocyesis Photo by: Gladskikh Tatiana

Definition Pseudocyesis is the medical term for a false pregnancy. Pseudocyesis can cause many of the signs and symptoms of pregnancy, and often resembles the condition in every way except for the presence of a fetus.

Description Pseudocyesis has been observed and written about since antiquity. Hippocrates set down the first written account around 300 B.C., and recorded 12 different cases of women with the disorder. One of the most famous historical examples is Mary Tudor (1516-1558), Queen of England, who believed on more than one occasion that she was pregnant when she was not. Some even attribute the violence that gave her the nickname "Bloody Mary" as a reaction to the disappointment of finding out that she was not carrying a child. Other historians believe that the queen's physicians mistook fibroid tumors in her uterus for a pregnancy, as fibroids can enlarge a nonpregnant uterus. Pseudocyesis has become increasingly rare in many parts of the world in which accurate pregnancy tests have become widely available. Cultures that place high value on pregnancy, or that make close associations between fertility and a person's worth, still have high rates of the disorder.

Signs and symptoms The symptoms of pseudocyesis are similar to the symptoms of true pregnancy and are often hard to distinguish from such natural signs of pregnancy as morning sickness, tender breasts, and weight gain. Many health care professionals can be deceived by the symptoms associated with pseudocyesis. Eighteen percent of women with pseudocyesis were at one time diagnosed as pregnant by a medical professional. In some cases, the only difference between pregnancy and pseudocyesis is the presence of a fetus. The sign of pseudocyesis that is common to all cases is that the affected patient is convinced that she is pregnant. Abdominal distension is the most common physical symptom of pseudocyesis (63– 97% of women are found to experience this). The abdomen expands in the same manner as it does during pregnancy, so that the affected woman looks pregnant. This phenomenon is thought to be caused by buildup of gas, fat, feces, or urine. These symptoms often resolve under general anesthesia and the woman's abdomen returns to its normal size. The second most common physical sign of pseudocyesis is menstrual irregularity (56–98% of women experience this). Between 48% and 75% of women are also reported to experience the sensation of fetal movements known as quickening, even though there is no fetus present. Some of the other common signs and symptoms include: gastrointestinal symptoms, breast changes or secretions, labor pains, uterine enlargement, and softening of the cervix. One percent of women eventually experience false labor.

Causes No single theory about the causes of pseudocyesis is universally accepted by mental health professionals. The first theory attributes the false pregnancy to emotional conflict. It is thought that an intense desire to become pregnant, or an intense fear of becoming pregnant, can create internal conflicts and changes in the endocrine system, which may explain some of the symptoms of pseudocyesis. The second theory concerns wish-fulfillment. It holds that if a women desires pregnancy badly enough she may interpret minor changes in her body as signs of pregnancy. The third leading theory is the depression theory, which maintains that chemical changes in the nervous system associated with some depressive disorders could trigger the symptoms of pseudocyesis.

Demographics The rate of pseudocyesis in the United States has declined significantly in the past century. In the 1940s there was one occurrence for approximately every 250 pregnancies. This rate has since dropped to between one and six occurrences for every 22,000 births. The average age of the affected woman is 33, though cases have been reported for women as young as 6-1/2 and as old as 79. More than two-thirds of women who experience pseudocyesis are married, and about one-third have been pregnant at least once. Women who have been victims of incest may be at greater risk for developing pseudocyesis. Pseudocyesis is found in some mammals other than humans—most often cats, dogs, and rabbits.

Treatment Because pseudocyesis is not known to have a direct underlying physical cause, there are no general recommendations regarding treatment with medications. In some cases, however, the patient may be given medications for such symptoms as the cessation of menstruation. Because most patients with pseudocyesis have underlying psychological problems, they should be referred to a psychotherapist for the treatment of these problems. It is important at the same time, however, for the treating professional not to minimize the reality of the patient's physical symptoms. The treatment that has had the most success is demonstrating to the patient that she is not really pregnant by the use of ultrasound or other imaging techniques.

Alternative therapies There have been reports of patients being cured of pseudocyesis by hypnosis, purgatives, massage, opioids, or after nine months of symptoms, by experiencing "hysterical childbirth," but there are few data available on the effectiveness of these or similar procedures.

Prognosis Symptoms of pseudocyesis generally last from a few months to a few years. In most cases, symptoms last for a full nine months. There is a high success rate for treatments involving psychotherapy , as it treats the underlying psychological causes of the disorder.

Resources

BOOKS Knobil, Ernst, and Jimmy D. Neill, eds. Encyclopedia of Reproduction . New York: Academic Press, 1998. Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry. 7th ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins, 2000.

PERIODICALS Hendricks-Matthews, Marybeth K., Douglas M. Hoy. "Pseudocyesis in an Adolescent Incest Survivor." Journal of Family Practice 36 no. 1 (January 1993): 97-104. Paulman, Paul M., and Abdul Sadat. "Pseudocyesis." Journal of Family Practice 30 no. 5 (May 1990): 575-582.

OTHER Aldrich, Knight, M.D. "Sixteenth-Century Psychosomatics." Psychiatric News. April 16 1999 (cited 15 March 2002). <www.psych.org/pnews/99-04-16/history.html> .

Tish Davidson, A.M.