Published on September 20th, 2023 and Updated on January 15th, 2024
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Pseudocyesis, commonly referred to as a “false pregnancy” or “phantom” pregnancy, is a psychopathological condition that causes a woman to exhibit symptoms of pregnancy—both mental and physical—when she is not carrying a child.
Phantom pregnancies are both a rare and real condition. They’re accompanied by verifiable physical symptoms of pregnancy, so patients should receive empathy from their treatment teams and loved ones.
Treating and managing phantom pregnancies in practice requires careful and often long-term care that can accommodate the unique circumstances of the individual affected. Whether you’re confronting pseudocyesis or false pregnancy yourself, trying to support a loved one, or are just curious about this rare condition, we’ll demystify the biological causes of the condition below. We’ll also point to outcomes for a comprehensive, holistic recovery.
What is pseudocyesis?
Few conditions represent the remarkable connection between mental, emotional, and physical health we all share than the phenomenon of phantom pregnancy, or pseudocyesis. Though the condition is believed to have been around for hundreds of years, clinical documentation of the phenomenon began escalating around the mid-20th century.
Scientists, researchers, and clinicians aren’t entirely sure what causes phantom pregnancy, but it’s considered a biopsychosocial illness, meaning the condition is likely caused by interwoven biological, psychological, and social or cultural factors.
However, phantom pregnancies are rare; in every 22,000 births, only 1 to 6 people are thought to have one.
Pseudocyesis Symptoms
Because phantom pregnancies are scarce and stem from the particularities of each affected person’s life, symptoms tend to differ widely between individuals. Some common physical symptom types—which may persist up until 9 months of the perceived pregnancy—include:
- An irregular or absent period
- Weight gain
- Nausea and vomiting (“morning sickness”)
- A distended abdomen
- Changes in breast size
- Changes in breast tenderness
- Changes in areola color
- Anatomical changes in the uterus
- Feelings of fetal movement
- Perceived labor contractions
- Lactation
Who is at risk of pseudocyesis?
While current peer-reviewed research is limited, pseudocyesis appears to predominantly affect:
- Women in their reproductive years (between 20 and 44 years old)
- Women who are married (some 8 in 10 women who develop it are married)
- Women with a preexisting psychiatric condition
- Women with undiagnosed mental illness
- Women with cerebral or neuroendocrinological disorders
Certain life experiences are also common to many women diagnosed with pseudocyesis. These include:
- Women with a history of multiple miscarriages
- Women who have lost a child
- Women with a history of mental or emotional trauma
- Women with a history of sexual abuse
Pseudocyesis: Causes and Explanations
Phantom pregnancy is a tremendously complex illness, and often, each case is the result of a delicate and unique intersection of physical, psychological, and cultural conditions. However, historical and current peer-reviewed research point to several coexisting physical and psychological causes of the condition.
Hormonal and Biological Causes
Researchers have suggested several endocrinal explanations for the physical symptoms that accompany phantom pregnancy. Some current theories include:
- Distortions in the HPO axis – The hypothalamic-pituitary-gonadal (HPG) axis is an endocrinal communications system that underpins much of a woman’s reproductive activity. For instance, a well-functioning HPG axis is essential for maintaining the hormonal interplay needed for the development of eggs, ovulation, and the monthly shedding of the uterine lining.
It’s thought that, in patients with phantom pregnancies, disturbances in this network may lead to excessive activation or impairment of the nervous system. Central nervous system dysregulation is thought to contribute substantially to each symptom.
- Dopamine deficiency – Dopamine serves a variety of vital functions in the endocrine system and our biology overall. One of its central roles is to block reproductive hormones like LH (luteinizing hormone) and prolactin, the pregnancy hormone responsible for breast milk production. For this reason, disruptions in pregnancy hormone and dopamine levels are thought to cause amenorrhea (absent periods) and lactation in women with pseudocyesis.
Social and Psychological Causes
Research also suggests several circumstances that may contribute to psychological factors underpinning phantom pregnancies. These include:
- Fertility challenges – Pseudocyesis often appears in women who have lost the ability to have a baby through natural means.
- Acute stress – Many women who have phantom pregnancies are recovering from a stressful physical or life event. For instance, pseudocyesis can occur after completing a surgery affecting one’s reproductive capacity, like a hysterectomy.
- Antipathy towards pregnancy – Individuals who fear becoming pregnant or have a negative attitude toward becoming a parent may also develop pseudocyesis.
- Religious or spiritual beliefs – Being a member of a strict religious group or experiencing feelings of chronic social isolation can also lead to the development of pseudocyesis.
Notably, pseudocyesis is far more common in developing nations such as Sudan and Nigeria. It’s suspected that phantom pregnancy predominates in these regions because of the pressure women face to bear and rear children.
Pseudocyesis: Treatment and Management
If you’re investigating phantom pregnancies because of concern for yourself or a loved one, know that understanding the etiology of the condition is one of the most crucial steps in treating the illness. Building a base of knowledge can help to ground pseudocyesis patients back in reality and come to a place of willingness to accept clinical and psychological support.
Additionally, the following steps are recommended for a thorough and effective course of treatment.
Confirming the Absence of Pregnancy
The first step in combating pseudocyesis is to confirm the absence of true pregnancy with a healthcare provider. Often, this requires several pregnancy tests to be conducted by a clinician to rule out the possibility of a false negative pregnancy test result.
It’s important to note that many women have a difficult time accepting a diagnosis of a phantom pregnancy, particularly those who are attached to the idea of having a child themselves. This resistance may take the form of:
- Minimizing or refusing to acknowledge a physician’s diagnosis
- Refusing gynecological exams
- A heightening of pseudocyesis symptoms
Often, aside from a pregnancy test, clinicians will show patients an ultrasound to help them understand that they are not carrying a fetus. Patients with amenorrhea may also be recommended hormonal therapies to help them recuperate a normal menstrual cycle. Additionally, care providers may perform exams to rule out certain cancers that can interfere with the HPG axis and contribute to phantom pregnancy symptoms.
Psychiatric Assessment
As mentioned, phantom pregnancies are typically comorbid with mental health conditions, whether preexisting or undiagnosed. A psychiatric assessment plays a critical role in helping individuals recover in both the short- and long-term.
Depending on a psychiatrist’s evaluation, patients may undergo:
- Psychiatric medications
- Cognitive behavioral therapy
- Regular sessions with a counselor or therapist
Women living with a psychiatric disorder may also respond to their diagnosis in ways commensurate with their condition. For instance, people diagnosed with anxiety may experience heightened disassociation; people with bipolar disorder may experience an elevation of grandiose thoughts or actions.
To protect the safety of the affected person, it’s crucial to establish a care plan that can support recovery in the long term.
Long-Term Social Support
Though every phantom pregnancy is different, cases often affect individuals who feel socially alienated—whether or not it’s observable to an outsider. Strengthening social bonds is considered critical for the care of the affected person.
If a loved one of yours is going through a phantom pregnancy, one of the most helpful things you can do for them is to show support to the best of your ability.
Recovery Outcomes for Pseudocyesis
Recovery outcomes for phantom pregnancies are highly individual. While some physical symptoms can persist for the length of a natural pregnancy, others may recede after a pregnancy can’t be clinically confirmed—in the span of months or even a few weeks.
Even when physical symptoms abate, however, there are often many emotions to work through, like grief, shame, or anxiety. If the individual still has a desire to start a family, alternative pathways to parenthood like assisted reproductive technologies (ART) or adoption should be pursued under the guidance of a mental health counselor and primary care provider.
Remember, in many ways, phantom pregnancies are not “unreal” or illusory: They’re attended by physical symptoms—often intense ones—that can make a diagnosis very difficult to accept. Often, the road to recovery requires both long-term care and a strong social network to help the person find well-being in multiple dimensions.
The good news is that a holistic approach to treatment can often support a higher quality of life, both physical and emotional, for the long haul.
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Sources:
- National Library of Medicine. Biopsychosocial view to pseudocyesis: A narrative review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894469/
- Cleveland Clinic. Pseudocyesis. https://my.clevelandclinic.org/health/diseases/24255-pseudocyesis
- National Library of Medicine. Physiology, Hypothalamus. https://www.ncbi.nlm.nih.gov/books/NBK535380/
- National Library of Medicine. Psychosocial and cultural aspects of pseudocyesis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738334/
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