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|Other names||Phantom pregnancy, hysterical pregnancy, pseudocyesis|
False pregnancy is the appearance of clinical or subclinical signs and symptoms associated with pregnancy when the woman is not actually pregnant. False pregnancy may sometimes be purely psychological. It is generally believed that false pregnancy is caused by changes in the endocrine system of the body, leading to the secretion of hormones that cause physical changes similar to those during pregnancy. Some men experience the same illnesses as a woman would experience while pregnant when their partner is pregnant (see Couvade syndrome), possibly caused by pheromones that increase estrogen, prolactin, and cortisol levels.
Signs and symptoms
The symptoms of pseudocyesis are similar to the symptoms of true pregnancy and are often hard to distinguish from it. Such natural signs as amenorrhoea, morning sickness, tender breasts, and weight gain may all be present. Many health care professionals can be deceived by the symptoms associated with pseudocyesis. Research shows that 18% of women with pseudocyesis were at one time diagnosed as pregnant by medical professionals.
To be diagnosed as true pseudocyesis, the woman must actually believe that she is pregnant. When a woman intentionally and consciously feigns pregnancy, it is termed a simulated pregnancy.
There are various explanations, none of which is universally accepted because of the complex involvement of cortical, hypothalamic, endocrine, and psychogenic factors. Proposed mechanisms include the effect of stress on the hypothalamo-pituitary-adrenal axis, constipation, weight gain, and the movement of intestinal gas.
Pseudocyesis is not known to have a direct underlying physical cause and 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. When some 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.
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 girls as young as 6 and women 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.
The perception of false pregnancy, or pseudocyesis, has evolved over time. In the late 17th century, French obstetrician François Mauriceau believed that the enlarged abdomens of falsely pregnant patients were caused by bad air. Physicians slowly began to acknowledge other potential causes of pseudocyesis, including its origin in the mind and in the body. By 1877, a clinician named Underhill observed that physical symptoms can convince a woman of pregnancy, or a “disordered brain” can convince her that ordinary abdominal pains or bowel movements are instead fetal movements. The idea that pseudocyesis could result from a woman's perception of herself led to investigation into the role of emotions in cases of pseudocyesis. An investigator in the early 20th century observed that strong emotions can dry a woman's milk supply. The investigator went on to infer that the opposite was also true, and it was believed that strong emotions could also bring about its production in women who are not pregnant. Alternatively, some physicians questioned the legitimacy of pseudocyesis as a condition. For instance, French obstetrician Charles Pajot stated in the 19th century, “there are no false pregnancies, only false diagnoses.”
Pseudocyesis has long fooled both women and their physicians. But physicians were expected to notice minute differences in cases of pseudocyesis that would indicate the absence of a fetus. Although the symptoms overlap, pregnancy symptoms in cases of pseudocyesis do not present as intensely. The abdomen becomes enlarged in both conditions, but in cases of pseudocyesis, the woman's navel does not turn outward. Women experiencing false pregnancies also tend to report uncharacteristically vigorous fetal movements for their supposed gestational state.
Despite the availability of modern ultrasound technology, women with false pregnancies are still mistaken for women in labor. In the mid-1960s, a young physician, John Radebaugh, responded to a woman who appeared to be in labor. She was not properly examined because delivery appeared imminent. The woman's water broke on Radebaugh, drenching him. But she had a false pregnancy, and the expelled liquid was urine. In 2010, a woman in the United States who was suspected of being in labor was given a C-section only to discover there was no fetus.
Mary Tudor, also known as "Bloody Mary," had a false pregnancy. After coming to terms with it, she reportedly believed that God had not made her pregnant because she had not sufficiently punished heretics.
Anna O, Sigmund Freud's most famous patient, experienced false pregnancy in the context of preexisting mental health problems. After being diagnosed with hysteria, she believed she was pregnant by Josef Breuer, her therapist. She even believed she was in labor as she was trying to have another session with Breuer.
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