Generality
Hysterical (or pseudocytic) pregnancy is a rare clinical syndrome, in which a woman believes she is pregnant, although no real conception has occurred. This conviction is associated with physical changes and subjective symptoms (such as nausea) that can simulate a pregnancy.
Pseudociesi appears as the consequence of psychological and neuroendocrine mechanisms that mutually influence the balance between mind and body . The syndrome can appear when there is a very strong desire to have a baby and this cannot be fulfilled. The problem can also arise in the opposite case, that is when there is an uncontrolled fear of being pregnant and not desired.
Women who suffer from hysterical pregnancy almost always manage to overcome this moment, but they need psychotherapeutic support. This approach seeks to investigate the underlying causes of the disorder with the aim of bringing the patient to live the desire for motherhood in a healthy and balanced way.
Synonyms
Hysterical pregnancy is also referred to as pseudocytic or false pregnancy .
Hysterical pregnancy: an ancient disorder
Hysterical pregnancy is not a recent phenomenon: for centuries, this condition has captured the interest of doctors and others.
The first references to the disorder were found in the writings of Hippocrates (300 BC); the problem is also reported by some medieval documents and was later treated by Freud. Many historians claim that the Queen of England, Maria Tudor (called the Sanguinaire or "Bloody Mary") suffered from pseudociesis.
Epidemiology
There are no reliable statistics to help explain how women experience a hysterical pregnancy. In fact, the phenomenon has been observed in all ethnic and socio-economic groups.
The condition appears to be more common in women aged 20 to 39 years, but has also been described in girls before menarche and in post-menopausal elderly women.
Although the precise figures relating to the prevalence of pseudocytes are not available, it was found that the phenomenon tends to occur in cultures that give absolute value to pregnancy (and the role of mother) and for which fertility is a prerequisite for marriage or for a stable relationship.
In a historical document dating back to the 17th-18th century, attention was paid to the fact that most of the patients had been married and about half of them had already completed a previous pregnancy.
Today, the incidence of hysterical pregnancy appears to be decreasing in developed countries. This may be related to the tendency towards a reduction in family size and the awareness that a woman's primary role is no longer just to raise children.
The risk of incurring this syndrome, however, remains in cultures in which having descendants is considered a very important element.
Note. Hysterical pregnancy is not a manifestation limited only to humans: the phenomenon has also been observed in other mammals, such as dogs and mice.
Causes
Pseudociesi is classified as a " somatoform disorder " in the Diagnostic and Statistical Manual of Mental Disorders, a reference publication prepared by the American Psychiatric Association.
The development of pseudocytes involves psychological and neuroendocrine mechanisms that mutually influence the balance between mind and body. Emotional stress, the search for woman-mother identity and strong social pressure seem to be at the base of this pathology. Therefore, the hysterical pregnancy can appear when the woman manifests a very strong desire to have a baby or, on the contrary, is overwhelmed by the uncontrolled fear of being pregnant when she is not wanted, for personal reasons and / or cultural considerations .
Scholars of the phenomenon argue that this psychological malaise can determine the involvement of the hypothalamic-pituitary-ovary axis, altering its function. This would result in an abnormal secretion of hormones (including estrogen and prolactin), capable of inducing, in the woman's body, a series of physical changes similar to those found in the actual gestation period.
Furthermore, when a deep depressive state is present, it is possible that neurotransmitters (such as serotonin) and biogenic amines, involved in the regulation of reproductive hormones, are affected.
Risk factors
Factors that can promote the emergence of a hysterical pregnancy include:
- An exasperated desire to become a mother or, on the contrary, fear of conceiving children;
- Infertility or loss of reproductive capacity (for example, after menopause, abortion or hysterectomy);
- Interpersonal pressures (attempt to maintain a relationship, loneliness or difficult relationships with significant family members);
- Low self-esteem;
- Tendency to misunderstand somatic stimuli;
- Ingenuity on medical issues;
- Presence of some psychological or anxiety problem with the idea of pregnancy.
Even the cultural pressure to give birth to a child of a specific sex can affect the disorder. In susceptible women, pseudocytes were found in the context of hepatic failure, systemic lupus erythematosus, abdominal neoplasms, hyponatremia, and cholecystitis.
Who is most at risk?
They present a greater risk of developing pseudocytes:
- Women with profound depression who tend to convert their mental trauma into the physical symptoms of pregnancy.
- Women with infertility who have tried to conceive a child for a long time.
- Women who have recently suffered an abortion (spontaneous or induced).
- Women who are afraid of an unwanted pregnancy (for example, a rape victim) or feel guilty after having sexual relations.
Signs and symptoms
The clinical presentation of hysterical pregnancy has both psychological and physiological aspects.
Women affected by the disorder have a strong and rooted belief of being pregnant and have one or more of the following characteristic signs or symptoms of the gestation period:
- Enlarged abdomen;
- Irregularity of the menstrual cycle;
- Nausea, vomiting and dizziness;
- Weight gain;
- Mood swings;
- Breast changes (nipple secretions, breast tenderness, etc.);
- Increased urinary frequency;
- Perception of fetal movements.
Despite the aforementioned manifestations, women suffering from this psychosomatic condition are not physically pregnant and do not have a series of signs: during an ultrasound scan, for example, the fetal heartbeat is not found.
The most common sign, abdominal enlargement, occurs without the navel extroflexion typically observed in pregnancy. The increase in belly volume is determined, in reality, by gaseous distension, excess fat, pronounced lumbar lordosis or fecal and / or urinary retention; often, this manifestation resolves with the administration of a general anesthetic.
Changes in the menstrual cycle associated with hysterical pregnancy range from irregularities in the appearance of the flow to the complete absence of menstruation (amenorrhea).
As for breast changes, a sense of tension and tenderness, breast enlargement, pigmentation changes, nipple secretion and galactorrhea (milk production) can occur.
The subjective sensation of perceiving fetal movements tends to present itself, instead, in an atypical manner, in terms of intensity and duration; this may be due to the contraction of the abdominal wall musculature or to intestinal peristalsis. In the most serious cases, moreover, a woman suffering from pseudocytes may even have the typical symptoms of labor.
Diagnosis
To the doctor, the initial presentation of the hysterical pregnancy can result for routine prenatal examinations to which the woman is subjected convinced of being in an interesting state or due to a problem accused by the patient about the presumed gestation (for example: abdominal pain, blood vaginal discharge and suspected decrease in fetal activity).
First of all, the hysterical pregnancy is diagnosed excluding that it is a true gestation. In addition to the physical examination, the doctor will then have to carry out a pregnancy test and an abdominal ultrasound to check the size of the uterus.
Women experiencing this disorder may have various alterations in the concentration of prolactin, estrogen, progesterone, follicle stimulating and luteinizing hormone. However, there is no common profile for all cases of hysterical pregnancy and the endocrinological changes may be inconsistent.
Despite the symptoms, the pregnancy test result is always negative.
Note. In some cases, the pregnancy test performed by the patient may give weak positive and false negative results.
In the context of this psychosomatic disorder, being the emotional state able to influence the secretion of hormones, this result could depend on the increase of gonadotropins.
At the gynecological examination, the uterus of the woman experiencing hysterical pregnancy is not increased in volume. During abdominal ultrasound, the absence of the product of conception is demonstrated and no fetal heartbeat can be detected.
Warning! It is possible that the impression of being pregnant is due to some real health problems, such as ovarian dysfunction, uterine pathologies or various endocrine alterations. Therefore, when there is a swelling of the abdomen although there are no reasons to think about a pregnancy, it is advisable to consult a doctor.
Prognosis
Usually, the symptoms of a hysterical pregnancy last from a few weeks to nine months or more (sometimes even for years). Recovery can be spontaneous, but sometimes it is preceded by a symptomatic episode similar to labor. Women can experience a single or multiple episodes of pseudocytes.
The prognosis of hysterical pregnancy depends, to a large extent, on the resolution of the specific psychological and / or interpersonal factors that have been involved in the development of the condition in the patient.
In some cases, pseudocytes announce the development of another psychiatric disorder, most often depression, but hypomania or psychosis may also occur. Some women with a hysterical pregnancy may even attempt suicide.
Treatment
The goals of the treatment of pseudocytes include:
- Resolution of physical signs and symptoms of hysterical pregnancy;
- Improvement of interpersonal dynamics;
- Reduction of the risk of relapse.
Being a psychosomatic disorder, hysterical pregnancy does not require pharmacological or surgical treatments aimed at real organic diseases.
Most women can be convinced not to wait for a child to face the evidence of ultrasound examination or other imaging techniques.
In general, for the resolution of the problem, in addition to support from those close to us, psychotherapy is recommended. This approach aims to investigate the underlying causes of the disorder and lead the woman to live the desire for motherhood in a healthy and balanced way (or to accept the impossibility of achieving this desire).
