What Is a False Pregnancy (Pseudocyesis)?

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You have a swollen belly, morning sickness, tender breasts, no period and are completely exhausted. All signs and symptoms point to a possible pregnancy, except one thing is missing: a baby. How is this possible?

Pseudocyesis, more commonly known as phantom pregnancy or false pregnancy, is a very real but rare condition where a person experiences many of the physical and emotional symptoms of pregnancy, despite not being pregnant. 

It’s a phenomenon that has baffled medical professionals for centuries and is heart-wrenching for those desiring a real pregnancy. It is even believed that Mary Tudor, Queen of England, experienced “phantom pregnancies” during her reign.

Saira Kalia, MD, a psychiatrist with Banner - University Medicine, shares what is known about pseudocyesis, its causes and treatment options. 

What is pseudocyesis?

Pseudocyesis is a rare disorder that affects all ethnic, racial and socioeconomic groups. 

“It is most common in women aged 20 to 44 years but can occur in children during early menstruation and in postmenopausal women,” Dr. Kalia said. “It is estimated that it occurs in about 1-6 out of every 22,000 births.”

Pseudocyesis is believed to occur more frequently in cultures where undue importance is placed on a person’s ability to reproduce.

What are the signs of pseudocyesis?

To a person experiencing a phantom pregnancy, the symptoms can very much resemble those felt in pregnancy. These symptoms may include missed periods, abdominal (belly) swelling, breast tenderness, nausea, vomiting, weight gain and even labor pains.

“The most common sign, abdominal enlargement, occurs without the typical changes you would see during pregnancy, such as when your innie belly button becomes an outie,” Dr. Kalia said. “This can be due to gas, excess fat, lumbar lordosis (or swayback) and/or fecal/urinary retention.”

Many people also experience changes to their period, ranging from irregular to amenorrhea (no period at all). 

In rare cases, some people experience the sensation of “fetal movement” (like baby kicks) in an atypical pattern with varying intensity and length. “These, however, are believed to be related to contractions of the abdominal wall muscles or bowel peristalsis (involuntary muscle movements in the digestive system),” Dr. Kalia noted.

What causes pseudocyesis?

Experts are not completely sure what causes this disorder, but many believe there is a mind-body connection, where the mind could be responsible for the false pregnancy.

Currently, there are three main ideas about how this condition develops:

Psychophysiologic hypothesis: Depressive disorders or stress may change the chemicals of the brain that affect reproductive hormones. As a result, a person could experience pregnancy-like symptoms.

Psychosomatic hypothesis: Psychological factors like stress or a strong desire to be pregnant may change the body’s hormones and cause pregnancy-like symptoms. 

“This can happen when someone has experienced a loss related to pregnancy or reproduction capabilities (such as infertility or menopause) or when they are in a culture where having children is highly valued,” Dr. Kalia said.

Somatopsychic hypothesis: Sometimes, changes in the body can make a person believe they are pregnant, even if they are not. This can happen in people who are more sensitive to physical sensations and may misinterpret certain body changes as a clear sign of pregnancy.

Some cisgender men experience sympathetic pregnancy, or Couvade syndrome, where they experience pregnancy symptoms alongside their pregnant partner.

How is pseudocyesis diagnosed?

The only way to know for sure if someone is experiencing a false pregnancy versus a real pregnancy is through a pregnancy test or ultrasound. 

If both tests come back negative, but concerning symptoms linger, further testing and psychological evaluations may be conducted to determine if it is related to pseudocyesis or another mental health or medical issue.

How is pseudocyesis treated? 

Typically, negative tests are enough to make many people’s symptoms of pregnancy stop. However, this is not always the case. 

For some, the symptoms occur due to some physical medical condition. For others, it could be related to behavioral health issues. 

“The goals of treatment are to reduce pregnancy symptoms, restore menstruation and alleviate any psychological or social pressure contributing to the belief of pregnancy,” Dr. Kalia said. “We also want to improve their functioning and engagement in other activities and prevent a recurrence.”

Treating a false pregnancy is very difficult since it is a very complex and delicate situation, especially for those who have a strong desire to be pregnant. 

“It is really helpful to engage family and friends in the treatment process and clarify goals for them,” Dr. Kalia said.

Takeaway

It’s rare to experience pseudocyesis or false pregnancy. Symptoms may resemble a real pregnancy, except there is no baby. 

Talk to your healthcare provider or a licensed behavioral health specialist if you think you might struggle with pseudocyesis or undue fertility-related stress. They can confirm a pregnancy and help you with treatment options.