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False pregnancy, also known as phantom or hysterical pregnancy, or pseudocyesis, is the appearance of clinical or subclinical signs and symptoms associated with pregnancy when the person 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.
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.
The hallmark sign of pseudocyesis that is common to all cases is that the affected patient is convinced that she is pregnant. Abdominal distension is the most common physical symptom of pseudocyesis (60–90%). The abdomen expands in the same manner as it does during pregnancy so that the affected woman looks pregnant. These symptoms often resolve under general anesthesia and the woman's abdomen returns to its normal size.[dubious ]
The second most common physical sign of pseudocyesis is menstrual irregularity (50–90%). Women are also reported to experience the sensation of fetal movements known as quickening, even though there is no fetus present (50–75%). Other common signs and symptoms include gastrointestinal symptoms, breast changes or secretions, labor pains, uterine enlargement, and softening of the cervix. One percent of women eventually experience false labor.
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.
Cases of pseudocyesis have been documented since antiquity. Hippocrates gave the first written account around 300 BC when he recorded 12 cases of women with the disorder. Mary I (1516–1558), Queen of England, was suspected to have had two phantom pregnancies, but this is strongly disputed; some historians believe that the queen's physicians mistook fibroid tumors in her uterus for a pregnancy, while others suspect either a molar pregnancy (proceeding to choriocarcinoma) or ovarian cancer was to blame. John Mason Good coined the term pseudocyesis from the Greek words pseudes (false) and kyesis (pregnancy) in 1823.