Pseudocyesis, delusional pregnancy, and psychosis: The birth of a delusion

Abstract

Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature (2000-2014) on this subject (women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions.

Keywords: Pseudocyesis; Delusional pregnancy; Infertility; Prolactin; Delusion

Core tip: It is usually impossible to distinguish between pseudocyesis and delusional pregnancy. Both occur primarily in developing countries, and especially where there is strong familial and cultural pressure on women to be fertile. The delusion starts in a climate of apprehension and develops when sensory perceptions are interpreted as signifying pregnancy, despite evidence to the contrary. Understanding this delusion can help to understand other, more unusual false beliefs.