Pseudociesis: the causes and mysteries behind a hysterical pregnancy

The menstrual cycle disappears; the breasts become firm and enlarged, causing milk to come in; urination intensifies, going to the bathroom to pee three times as often; his belly swells, becoming a big belly… The whole body prepares for a pregnancy, and then for a birth. But at the time of giving birth to the child, that child is not there.

Science fiction? No, reality. This phenomenon is defined in scientific jargon as «pseudocyesis”better known as hysterical pregnancy: “The woman's body behaves as if she were pregnant, so she believes she is pregnant, but in reality she really isn't,” she states in an interview with National Geographic the doctor Mary Seemanprofessor emerita in the Department of Psychiatry at the University of Toronto, who has long studied mental disorder.

Because this is what it is: the diagnostic manual of the American Psychiatric Association – the DSM-5-TR – places pseudocyesis in the category of mental disorders with specific somatic symptomsas hypochondriasis, factitious disorder or Münchhausen syndrome.

Pseudocyesis: its diffusion in the world

Compared to almost eighty years ago, the manifestation of pseudocyesis has greatly decreased, at least in the United States: in 2007, a review published in the International Journal of Reproductive BioMedicine, reported from 1 to 6 cases every 22 thousand pregnancies, compared to 1 case every 250 detected in 1940.

“There are parts of Africahowever, where pregnancy is highly appreciated and medical care is difficult to access, therefore pseudocyesis is not rare”, reports Seeman, who from 1960 to today has counted approximately 20 cases of pseudocyesis during his service on site.

Today, however, it is simpler diagnose the episode of pseudocyesis at birth, thanks to increasingly modern instruments and increasingly early control ultrasounds.

Pseudociesis: cases in history and on the small screen

One of the most famous and emblematic cases of pseudocyesis was that of Queen Mary I of England, known as the Bloody: in 1555 she was expecting her firstborn by her consort Philip II of Spain. The birth of that heir should have ensured a firm alliance with Catholic Spain, to continue religious hegemony over England. But that child was never born, as the Queen never became pregnant. This was the first case of pseudocyesis confirmed in history.

Pseudocyesis is also mentioned in the TV series American Horror Story: Delicate, where the protagonist reports during an alleged pregnancy violent and terrifying hallucinations, thus fueling it however stigma of delusional madness around this phenomenon.

Pseudociesis: the causes

Stress related to the strong desire for a child they are probably the triggering factors of pseudocyesis which, although it is more common in people aged 20 to 39, it can also occur in post-menopausal women.

«The problem exists in the moment of truth: although reality highlights the state of non-pregnancy, patients with pseudocyesis still today do not accept that they are not pregnant – reports Seeman – They often think about conspiracies plotted by the spouse together with the treating doctors. These women cannot accept anyone's reality but their own. And their reality is that they look and feel pregnant, so as far as they're concerned, they are.”

Pseudocyesis: the reaction of the medical community

«The medical establishment, even in the field of obstetrics and gynecology, does not have a good understanding of pseudocyesis – says the doctor Shannon M. Clark, maternal-fetal medicine specialist at the University of Texas, who has seen cases of hysterical pregnancy up close – Although they can occur changes in hormones such as prolactin, estrogen and progesterone, There is no clear pattern or increase in hormone levels associated with the condition.”

Not only that, care must be taken that psychiatric treatment does not exacerbate the physical condition: for example, some antipsychotic drugs increase prolactin levels, a hormone responsible for breastfeeding, which could further convince the patient – and her body – that she is actually pregnant. AND this hormone increases its production further when under stress“We can say with certainty that a woman who is convinced she is pregnant when a test repeatedly says she is not is certainly under great stress,” adds Seeman.

«Fortunately, the medical establishment has begun to treat these unusual cases with greater interest and sensitivity – says Seeman – For us doctors, not just psychiatrists, they are More understanding and empathy and less judgment and shame are needed on all fronts.”