Definition and Diagnosis
Pseudocyesis is a rare condition in which an individual develops objective physical signs of pregnancy, such as abdominal distension, breast changes, and perceived fetal movement, together with a firm belief that they are pregnant, in the absence of an actual pregnancy on examination or investigation.
Epidemiology
Pseudocyesis is uncommon in modern clinical practice with widespread access to pregnancy testing and ultrasound, though it is reported worldwide and appears more frequently in settings with strong sociocultural pressure to conceive or limited access to confirmatory testing.
Risk Factors
Risk factors include intense desire for pregnancy or, conversely, intense fear of pregnancy, infertility or pregnancy loss, a history of trauma or significant psychosocial stress, low socioeconomic status and limited health literacy, and, in some cases, underlying mood or psychotic disorders.
Symptoms and Subtypes
Presentation includes a firm, sustained belief of being pregnant accompanied by physical changes such as abdominal enlargement, amenorrhea, breast engorgement, nausea, and subjective sensations of fetal movement, all in the absence of an actual fetus, mediated through neuroendocrine and psychological mechanisms.
Diagnosis
Diagnosis requires definitive exclusion of true pregnancy and other medical causes of abdominal distension or amenorrhea through pregnancy testing, pelvic ultrasound, and relevant hormonal studies, combined with careful, empathetic psychiatric assessment of the underlying psychological drivers.
Treatment
Management centers on sensitive, non-confrontational disclosure of the ultrasound and test findings, supportive psychotherapy addressing underlying grief, infertility, or psychosocial stressors, and treatment of any co-occurring mood or psychotic disorder. Abrupt or dismissive disclosure can be experienced as highly distressing and should be avoided.
Prognosis
Symptoms typically resolve once the individual accepts the diagnosis, particularly with a supportive, gradual approach to disclosure and ongoing psychological support; outcomes are generally good, though underlying psychosocial stressors such as infertility often require continued attention.
Reference
Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).