“My Doctor Doesn’t Believe I’m Pregnant!”
Pseudocyesis—also known as false pregnancy, phantom pregnancy, or hysterical pregnancy—is a form of somatoform disorder (i.e., a psychosomatic condition) that causes a woman to believe she is pregnant despite medical evidence to the contrary. In some cases, women suffering from this disorder have even been known to manifest physiological symptoms of pregnancy, including missed periods, breast tenderness, morning sickness, and even the swollen abdomen commonly regarded as “pregnancy belly.”
Symptoms of Pseudocyesis
Many women who suffer from false pregnancy delusions show no medical signs of pregnancy whatsoever. These cases are the easiest to spot, and a woman who is affected in this way can be encouraged by her friends and family to get the help she needs for her obvious mental illness. The irony concerning hysterical pregnancy is that, as a somatoform disorder, it is more easily diagnosed in the absence of symptoms.
In many cases, however, the affected woman’s conviction that she is pregnant is bolstered by actual physical symptoms like those listed above; in some cases, the breasts may even produce colostrum. In addition to the nausea and morning sickness, most women who experience phantom pregnancies report that they can feel the movements of the “baby” inside them. A common characteristic of this condition is the patient’s refusal to believe she is not pregnant even when confronted with evidence—such as a doctor’s assurance that no baby can be seen with an ultrasound examination, even though the patient believes herself to be 32 weeks along.
Perhaps more puzzling than the subjective symptoms—or even objective signs such as morning sickness—is the abdominal distension seen in many of these cases. The cause of this phenomenon is unclear, and may vary from one patient to the next.
Causes and Risk Factors
The psychological cause of pseudocyesis is difficult to pin down, and is likely not the same in all cases. False pregnancy most often occurs in women who either have an intense (and unfulfilled) desire to be pregnant or an intense fear of becoming pregnant. It has been noted that there are much higher incidences of false pregnancy in societies that value motherhood in such a way as to induce anxiety or feelings of inferiority in women who do not have children. In some cases phantom pregnancy occurs in women who have been trying unsuccessfully to have children for a long time, or who have been diagnosed with fertility problems.
The physiological causes of the apparent symptoms of pregnancy are even harder to determine—especially the swollen belly. None of the proposed explanations—which include hormonal activity, intestinal gas, and weight gain—are universally accepted. Nevertheless, approximately 60 percent of women who experience false pregnancy display this symptom. In some cases the woman suffering from phantom pregnancy is not causing herself to show pregnancy signs, but rather is selectively interpreting unrelated symptoms—for example, ordinary weight gain or a late period—as evidence of pregnancy.
Progression and Complications
While phantom pregnancy may be heartbreaking for those involved, at least it is generally a self-limiting condition, one that cannot sustain itself too far beyond 40 weeks. Eventually the “due date” comes, there is no baby, and the woman who has been subject to this delusion must finally face it.
Until that day comes, however, most pseudocyesis sufferers will insist that they are pregnant in the face of all evidence to the contrary. They will find fault with doctors who try to explain that blood testing and ultrasound examination show there is no baby. They will complain to friends, and say things like, “My doctor doesn’t believe I’m pregnant! He won’t listen to me! I need to find another doctor.” Some may even come to believe the entire medical community is involved in some sort of conspiracy against them. Others, however, may never seek medical attention in the first place. Either way, when nine months have passed and no baby arrives, depression often sets in, and the affected woman may be at risk for alcohol abuse, or even suicide.
Diagnosis and Treatment
Diagnosing pseudocyesis is often simple enough—no baby on an ultrasound image means no baby in the womb, and a blood test that does not show the presence of the hCG hormone likewise indicates that the patient is not pregnant.
Convincing the affected woman to get the help she needs, however, is not always so simple. Many take offense at the suggestion of mental illness (“My doctor said I’m crazy! I’m not going back to him!”), and remain stubborn in the face of evidence. Moreover, the symptoms of pregnancy displayed by many pseudocyesis sufferers are quite convincing, and even medical professionals can sometimes be fooled. A few years ago, two North Carolina physicians were disciplined after spending two days trying to induce labor in a woman only to discover—after attempting an emergency C-section—that she was not pregnant .