Pseudocyesis or Psychological Pregnancy: What Is It?

Psychological pregnancy or pseudocyesis is a very strange physical and psychological condition. However, certain reports allow us to describe it to you in the following space.

Written and verified by el biólogo Samuel Antonio Sánchez Amador.

Last update: 25 June, 2024

Pregnancy is one of the most beautiful and demanding moments that a human being can experience throughout their life. Although the miracle of life is incomparable to any other event, it causes hormonal, physiological, and psychological changes that are difficult for women to face. And all of this is much more complicated when this process isn’t real, but rather a case of pseudocyesis or psychological pregnancy.

Although it may seem like a typical concept in books and movies, psychological pregnancy is a serious clinical condition that must be taken into account when making medical diagnoses. Next, we’ll tell you everything you need to know about this disorder and differentiate it from other similar entities. Keep reading!

What is pseudocyesis or psychological pregnancy?

Every few years, the American Psychiatric Association (APA) updates its Diagnostic and Statistical Manual of Mental Disorders (DSM). In its fifth edition (edited in 2013), this document defines pseudocyesis as “a false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy, which may include abdominal enlargement, reduced menstrual flow, amenorrhea, subjective sensation of fetal movement, nausea, breast engorgement and secretions, and labor pains at the expected date of delivery.”

The very name of the pathology indicates its main features, as in Greek, the word pseudo indicates “false,” and the word Kyesis refers to ‘”pregnancy”. This disorder is also known as false pregnancy, phantom pregnancy, and in some cases, delusion of pregnancy. However, as we’ll see below, pseudocyesis and delusions are different things.

As studies indicate, the prevalence of pseudocyesis has declined drastically in recent years. In 1940, it was estimated that 1 in 250 pregnancies were false, while in 2007, this percentage had dropped to 1-6 cases per 22,000 live births. In 2016, only 550 cases were registered in the medical literature.

Pseudocyesis is more common in women between the ages of 20 and 44, but it’s still a very rare disorder. However, it has been found that false pregnancy is much more common in low-income countries. The lack of financial means and psychiatric help may explain part of this inequality.

Causes of pseudocyesis

The factors involved in pseudocyesis are both psychological and neuroendocrine. However, the exact mechanisms that promote its appearance are still largely unknown. Next, we’ll briefly present you some of the agents involved in its appearance.

Previous psychological disorders and hormonal imbalances

As a study in the journal Reproductive Biology and Endocrinology indicates, the majority of women with pseudocyesis suffer from chronic major depressive disorder, anxiety, or emotional stress. Curiously, they tend to present a very marked conflict of feelings: They want to have children but are afraid of pregnancy.

People with depressive disorders are deficient in dopamine and norepinephrine at the brain level. According to sources already cited, this event could be linked to the main explanation of pseudocyesis. Experts postulate that these patients may have a dysfunction of the catecholaminergic pathways of the central nervous system.

Dopamine has been associated in women with the inhibition of pulsatile secretion of luteinizing hormone (LH). In a normal situation, it acts on the ovaries to make the follicles release their eggs. It also encourages the production of hormones that prepare the uterus to be ready for the implantation of a fertilized egg.

Endocrine changes derived from emotional conditions could favor the appearance of some of the symptoms of false pregnancy. For this reason, conditions such as major depression or chronic anxiety are believed to promote it.

Psychological factors specific to the patient

Beyond the hormonal imbalance derived from the psychological disorders that the patient may suffer, there are certain traits that encourage the experimentation of pseudocyesis. Among them, studies highlight the following:

1. Ambivalence regarding the idea of pregnancy. It can be seen as something positive, but, at the same time, the individual may have a lot of qualms about it.
2. The person may have the desire to have a child but a fear of the process of pregnancy and childbirth.
3. A history of infertility.
4. Feelings of loss followed by a fallopian tube ligation or oophorectomy (surgical removal of the ovaries).
5. Childhood deprivation during the early stages of the patient’s life.
6. An inability to resolve emotional stress.
7. Cognitive misinterpretation of bodily sensations.
8. Sexual abuse during childhood.

In cases where the psychological burden is very high, women often avoid confrontation with reality or reject the diagnosis (that the pregnancy isn’t real). These conditions are generally associated with losses: The loss of reproductive capacity, of a child, or of self-esteem due to previous events.

As you can see, some of these traits are natural, while others border on psychological disorders (mentioned and not mentioned) in terms of symptoms. Explaining pseudocyesis from a psychiatric point of view alone is a real challenge, as there are few literary sources regarding it, and each patient is different.

Nervous system hyperactivity

The excessive activity of the central nervous system could explain some of the symptoms that we’ll see below, such as abdominal distention, somatization of fetal movement (although there’s no fetus), and the “contractions” experienced by the patient. This, in turn, is linked to the neuroendocrine events cited above.

Symptoms of pseudocyesis or psychological pregnancy

It seems unbelievable at first, but women with pseudocyesis don’t just have psychological symptoms of pregnancy. Physical signs that are visible to the naked eye also develop in this picture. Among them, the following stand out:

1. Interruption of menstrual period in adulthood (secondary amenorrhea): Hormonal imbalance caused by lack of dopamine causes more LH hormone to be produced and less follicle-stimulating hormone. This causes the menstrual cycle to break down and the woman to stop bleeding.
2. Abdominal bloating: This clinical sign could be explained by the accumulation of fat in the abdomen, bloating due to constipation, and lordosis. Interestingly, the distention usually disappears after the differential diagnosis.
3. Breast growth and milk production: The excess of the prolactin hormone can prepare the woman for breastfeeding despite not having a fetus implanted in her uterus.
4. Fetal movements and contractions: Again, this can be explained by the activity of the nervous system.
5. Vomiting, nausea, and weight gain.

Pseudocyesis is always accompanied by physical symptoms like the above. This distinction is essential, as another disorder (known as delusion of pregnancy) shares several signs with this entity but doesn’t involve the physical events visible to the naked eye. False pregnancy is psychosomatic, while delirium has a clear psychotic component.

Diseases that can confuse the patient

It may also happen that the patient confuses the aforementioned symptoms with a pregnancy when, in fact, she suffers from a diagnosable physical condition. Some of the diseases that cause pregnancy-like signs (in isolation) are the following:

• Liver cirrhosis due to alcoholism: Alcoholics are prone to irreversible liver damage. Chronic liver failure causes the accumulation of abdominal fluid (ascites), which can be confused with the appearance of a pregnant woman. As a differential sign, it should be noted that cirrhosis presents with jaundice (yellowing of the skin and mucous membranes).
• Chronic constipation: This condition is characterized by infrequent bowel movements or difficulty in having a bowel movement for several weeks or more. The bloating caused by constipation can be mistaken for one of the typical symptoms of pregnancy.
• Tumors that promote hormonal secretion: Some benign or malignant tumors can cause the affected glands to become overly excited, which causes the woman to show signs of pregnancy when, in reality, no fetal implantation has taken place.

All these diseases show how necessary it is to go to the doctor at the slightest symptom of pregnancy. The person in question may be pregnant, or they may have pseudocyesis or an underlying disease that’s confused with a normal pregnancy. It’s necessary to go to a specialist to rule out the worst scenario.

Diagnosis

The symptoms of pseudocyesis perfectly mimic those that are typical of normal pregnancy (including abdominal distention and contractions). In addition, this condition overlaps with others of a purely psychiatric nature (such as psychotic delusions). Therefore, making the diagnosis with the naked eye is an impossible task.

To ensure that the picture isn’t an actual pregnancy, a gynecologist will need to order a series of tests, including a simple pregnancy test, a blood test, and an ultrasound. This last method provides a definitive diagnosis, as it clearly shows whether or not a fetal implantation has occurred at the uterine level.

Treatment of pseudocyesis

Treating pseudocyesis is a challenge, as it’s considered an eminently psychological condition. In any case, professional portals indicate that one of the best approaches is to show the woman undeniable evidence that she isn’t pregnant. After proving that the pregnancy is false, it may be necessary to carry out certain psychological analyses.

In the case that the woman doesn’t accept her diagnosis (something very probable), resorting to psychotherapy is crucial. Professional assistance will help you understand what you’re feeling and, if possible, find the underlying cause of your symptoms. It’s important to keep in mind that psychiatric treatment of trauma is time-consuming and laborious, so short-term results may not be seen.

There’s no evidence that pharmacology helps to treat pseudocyesis, but some professionals also choose to prescribe medications to balance the concentration of hormones and neurotransmitters in the woman’s body. Therefore, it’s possible to use hormone replacement therapies, antipsychotics, and antidepressants if all else fails.

A very complicated clinical entity

Pseudocyesis, or psychological pregnancy, is a fascinating clinical entity on a psychological level, but it’s very difficult to treat with only pharmacology alone. For this reason, most of the documents consulted place more emphasis on the psychiatric approach than on the administration of drugs. The physical symptoms should disappear once the emotional condition is treated.

In any case, it’s necessary to highlight as a final note that there are very few reports of pseudocyesis in medical literature. Most likely, if you perceive the aforementioned symptoms, you’re pregnant or, failing that, you’re likely to be suffering from a disease with similar signs. Psychological pregnancy isn’t at all common, so don’t consider it unless it’s diagnosed by a professional.