Pseudocyesis Diagnosis And Treatment

One to six cases of pseudocyesis, an uncommon somatic condition, are reported for every 22,000 live births. Most have affected people between the ages of 16 and 39. and were more common when there were no reliable pregnancy tests.¹

This disorder predominantly affects women who have lower socioeconomic status, lack access to adequate health care, and are under immense pressure to conceive.²

What is pseudocyesis?

Pseudocyesis is a Greek word. ‘Pseudo’ means false, and ‘cyesis’ means pregnancy. So, the term pseudocyesis means false pregnancy.³

Pseudocyesis, also called “phantom pregnancy,” is a rare condition in which the person assigned female at birth (AFAB) believes themselves to be pregnant, but in reality, they are not.

With pseudocyesis, the person has all the classic symptoms of pregnancy and feels pregnant, but no baby is growing in their uterus. 

Despite this, the duration of these symptoms can be long enough to give the impression of a person being pregnant, leading not only them but also those around them to believe so.

Difference between pregnancy and pseudocyesis

There are three significant differences between a natural pregnancy and pseudocyesis.

• No foetal heartbeat
• No foetus in the ultrasound
• No labour pains for delivery

Difference between pseudocyesis and couvade syndrome

Pseudocyesis is a condition in which a person AFAB develops objective pregnancy signs in the absence of pregnancy and firmly believes themself to be pregnant.

However, couvade syndrome, also known as “sympathetic pregnancy,” is the nonpregnant partner equivalent of pseudocyesis, in which they exhibit typical pregnancy-like symptoms while their partner is expecting a child.⁴

Symptoms of pseudocyesis

The symptoms of pseudocyesis are the same as actual pregnancy, such as:

• Tender and enlarged breasts (or chest area)
• Swollen belly
• Missed menstrual periods
• Morning sickness
• Weight gain
• Food cravings
• Mood swings

These symptoms may persist for a few weeks, nine months, or even a few years. Physically, the most common symptom is an enlarged belly, just like a baby bump. However, this is not due to the presence of a baby; might be caused by a buildup of gas, fat, faeces, or urine.

These symptoms are so similar to actual pregnancy that it is hard to believe it to be a false event.

Mechanism of pseudocyesis

Although the precise processes of pseudocyesis remain unclear, psychological and hormonal factors may contribute significantly.

Abnormal hormonal regulation changes combined with strong emotions can elevate prolactin levels substantially. Pregnancy-like emotions in women include tension, anxiety, excitement, and general emotional fluctuation. 

Many of the signs and symptoms of an actual pregnancy, including lack of menstrual periods, galactorrhea, and sore breasts, can be caused by elevated prolactin levels. Increased activity of the central nervous system might be a factor in the distension of the abdomen, foetal movement feelings, and pains felt during contractions that many people experience with pseudocyesis.⁵

Pseudocyesis is associated with hormonal abnormalities such as increased nervous system activity, decreased dopamine levels, or central nervous system malfunction. Amenorrhoea, galactorrhea, and hyperprolactinemia observed in people AFAB who are not pregnant may be caused by these alterations. Elevated sympathetic activity has been linked to increased abdominal size and the apparent feel of foetal movement and contractions.⁵

Causes of pseudocyesis

The exact causes of pseudocyesis are still unknown, but it may be due to the following reasons.

• Strong desire to be pregnant
• Infertility
• Previous loss of a child
• Depression
• Emotional trauma
• Sexual abuse 

Diagnosis of pseudocyesis

An ultrasound scan, a blood or urine pregnancy test, and a pelvic exam can confirm pseudocyesis. 

A pelvic exam can show if conception has occurred, and blood and urine can be tested for hormones released in pregnancy.

If the ultrasound scan shows the absence of a foetus, pseudocyesis can be reliably distinguished from actual pregnancy. 

For people AFAB who have experienced a false pregnancy, there is no standard laboratory profile; the detected levels of prolactin, progesterone, oestrogen, follicle-stimulating hormone, and luteinizing hormone might differ significantly. 

Sometimes, the signs of a false pregnancy might be mistaken for underlying medical disorders such as gallstones, ovarian cysts, central nervous system tumours, or abdominal tumours. Imaging and medical testing are advised to rule out potentially fatal diseases.

Pregnancy tests for pseudocyesis

Pregnancy tests for pseudocyesis are always negative because the hormone HCG (Human Chorionic Gonadotropin) is secreted from the cells of the placenta in an actual pregnancy, as there is no foetus and no placenta. Therefore, the test for detecting pregnancy is always negative.

Management and treatment of pseudocyesis

Working with gynaecologists, psychiatrists, and psychologists on several levels is needed for treatment to be holistic and effective.

The first line of treatment is breaking the news of being falsely pregnant to the person. It is better to show an ultrasound and other negative pregnancy tests to the person as evidence that no foetus is growing inside their body.

Healthcare professionals must also offer treatment for medical causes of pregnancy symptoms, for example, prescribing hormones that can restore the menstrual cycle. Further treatment options include psychotherapy.

When someone finds it difficult to accept their pseudocyesis diagnosis, or to stop feeling symptoms even after learning that there was no pregnancy, psychotherapy may help.6 It gives the person the opportunity to address additional psychological pressures and trauma that could be connected to false pregnancy symptoms, as well as to explore and process what has happened, and how to move forward.

Emotional support, behavioural therapy, and guidance from a therapist or counsellor are all essential for effective pseudocyesis treatment. Healing requires identifying the causes of the false pregnancy and learning how to manage them.

Emotional management of pseudocyesis

Someone who has experienced pseudocyesis requires strong emotional support. Being able to talk about their feelings to someone who is supportive and non-judgemental will be important for them to heal. 

A range of emotions, including trauma, grief, sadness, and anger, may surface as they mourn the loss of a potential pregnancy. Being there for them, and offering care and support, can make a huge difference whilst navigating a painful and challenging time.

Pseudocyesis versus delusion of pregnancy 

Delusional pregnancy is different from pseudocyesis, although there are some close similarities.

People experiencing pseudocyesis patients exhibit signs of an actual pregnancy. In contrast, people with delusional pregnancies have no signs of pregnancy but believe themselves to be pregnant.

Delusional pregnancy is a psychosomatic disorder, and more than a third of people who develop it have a diagnosis of schizophrenia.⁷

FAQ’s

What is the treatment for pseudocyesis?

Usually, treatment for pseudocyesis is offered via mental health care providers. However, sometimes medical interventions may also be appropriate (such as prescribing hormone therapy to re-start menstrual periods if these have stopped). 

Behavioural therapy, emotional support, and guidance from a therapist or counsellor can help to identify, explore, and address the underlying causes of the false pregnancy.

What are the complications of pseudocyesis?

Endocrine (hormonal) changes in pseudocyesis include decreased dopamine levels, increased nervous system activity, or dysfunction in the central nervous system. Amenorrhoea, galactorrhea, and hyperprolactinemia observed in people AFAB who are not pregnant may be caused by these changes and can cause problems with fertility. Long-term hyperprolactinemia may also be associated with osteoporosis, due to its effect on bone mass.⁵

What are the criteria for diagnosing pseudocyesis?

The DSM-5 defines pseudocyesis as the false perception of pregnancy that is linked to both objective and reported pregnancy symptoms. These symptoms can include breast engorgement and secretions, amenorrhoea, abdominal enlargement, subjective feelings of foetal movement, and signs of labour.⁵

Is false pregnancy harmful?

Psychological conditions such as anxiety or mood disorders, personality disorders, and schizophrenia are prevalent in people AFAB who have false pregnancies and may have a connection to the development of these conditions. Due to, some women a variety of factors, people who suffer from depression may notice changes in their weight. 

Summary

Pseudocyesis, or false pregnancy, is a rare somatic disorder predominantly affecting women, characterised by the belief of being pregnant despite no actual conception. Symptoms mimic those of an accurate pregnancy, including tender breasts, swollen belly, and missed periods. 

Diagnosis involves pelvic exams, ultrasounds, and hormone tests, all of which confirm the absence of a foetus. Treatment encompasses a multidisciplinary approach involving gynaecologists, psychiatrists, and psychologists. 

Breaking the news gently and addressing any underlying medical conditions are primary steps. Psychotherapy aids in managing emotional distress and accepting the diagnosis. Emotional support from loved ones is crucial throughout the healing process. 

It’s essential to differentiate pseudocyesis from delusional pregnancy, where individuals believe they’re pregnant without exhibiting physical symptoms. Despite the challenges, understanding and compassionate care can significantly aid recovery.