Author Information
Ostwal P*, Balsarkar GD**, Mahale N***
(* Senior Resident, ** Professor, *** Junior Resident, Nowrosjee Wadia Maternity Hospital, Mumbai, India.)
Abstract
Pseudocyesis is a psychosomatic condition in which the patient displays signs and symptoms of being pregnant in absence of actual pregnancy. It may be secondary to severe psychological distress to the woman owing to socio-cultural factors. In this paper, the authors describe one such case.
Introduction
In our society, childbirth is considered as a requirement for validation of marriage and generational continuity. Infertility puts undue psychological pressure on the woman involved. This may lead to manifestation of pseudocyesis or phantom pregnancy. These patients exhibit all the signs and symptoms of pregnancy except for the actual presence of pregnancy. Such patients are psychologically volatile and the woman as well as the family needs proper counseling. This situation requires a different approach by the clinician and awareness of the phenomenon goes a long way in preventing consequent complications. It is therefore incumbent on the treating obstetrician to keep pseudocyesis as one of the possibilities when such a patient presents. This phenomenon has incited comment time and again, and a few reports can be found in psychiatry literature. The authors wish to bring it to the notice of fellow obstetricians to be aware of its possibility in similar cases.
Case Report
A 33 year old illiterate woman presented to us with complaints of severe lower abdominal pain since 6 hours, (which she insisted was labor pain) and bleeding per vaginum. She gave history of amenorrhea since 8 months. She had once visited a local doctor to get urine pregnancy test and per-vaginum examination done. She was not given any assurances about pregnancy but was strongly convinced that she was pregnant with twins. She recounted experiences of repeated tiredness, nausea, vomiting, progressive abdominal enlargement, breast enlargement and fetal movements.
On presentation, her general examination revealed normal vital parameters, and abdominal and vaginal examination also confirmed a non-pregnant status. When interviewed, she revealed her stressful relationship with husband and in-laws. She had been unsuccessfully undergoing treatment for infertility for ten years and due to the social pressures and financial burden, there was disharmony in marital life leading to domestic violence. A missed period had convinced her and the family members of her being pregnant.
After being confronted with the truth, she became hysterical and was in state of denial, and the husband became abusive. After counseling, both calmed down and the woman was discharged with an advice to follow up for further counseling with a psychologist.
Discussion
Derived from the Greek roots, ‘pseudo’ (meaning false) and ‘kyeis’ (meaning pregnancy), pseudocyesis has also been called as phantom pregnancy, spurious pregnancy, hysterical pregnancy, meteorism, phantom tumor and tympanites, amongst others.[1] Earliest descriptions are found in a 300 BC text by Hippocrates. Since then there have been multiple records surfacing about similar incidences, mostly in western world. It describes a clinical syndrome in which a non-pregnant woman manifests a strong conviction of being pregnant associated with signs and symptoms mimicking the experience of being pregnant.[2,3]
Diagnostic and Statistical Manual-5 (DSM-5) has classified pseudocyesis under “Other Specified Somatic Symptom and Related disorders”, as opposed to a delusional disorder (wherein the manifestations are only psychological symptoms, not physical) or malingering (wherein the patient feigns symptoms consciously to gain advantage).[4]
Most of these cases generally belong to the age group of 20-44 years and 80 % of them are married,[5] which was the case in our patient too. The time interval upto which the symptoms may last vary from few weeks to 8- 9 months or longer.[6] In modern era with radiological facilities, demonstration of absentia of fetus and placenta leads to conclusive diagnosis.[7] The strength of conviction of our patient in her pregnant status is evident by the fact that she came with 8 months amenorrhea.
The causative factors involved in pseudocyesis are still unclear. The psychological factors that can have major impact etiologically are very strong fear factor, or strong desire or wish to be pregnant, which stems from socio-cultural pressures leading to physical manifestations as a stress response. This goes on to explain the occurrence of the condition in settings of second or third marriages or infertility, as was the case with our patient.[8] Our patient came from a low socioeconomic strata, a finding which was echoed in various studies.[9] In majority of previously reported cases, pseudocyesis occurred in the backdrop of some pre-existing psychiatric illness though this was not the case with our patient.
In clinical obstetric practice, it has become extremely important to document properly the clinical findings and confirm them with investigations. In an increasingly litigious society like ours, the prevalent socio-cultural milieu and conditions like pseudocyesis spawn fertile grounds for mistrust and litigation.
Conclusions
- It is important for obstetricians to be aware of the phenomenon of pseudocyesis and keep it as a differential diagnosis in those with no physical or investigational evidence of pregnancy. These patients should be counselled adequately and require proper psychological profiling to reach the root cause of the disorder and remedial measures to prevent further problems.
- Kulcsar DD. Pseudocyesis. Can Med Assoc J. 1951; 64(4): 305–308
- Brockington I. Obstetric and gynaecological conditions associated with psychiatric disorder. In Gelder MG, Lopez-Ibor JJ, Andreasen N, editors. New Oxford Textbook of Psychiatry. 1st ed. Oxford: Oxford University Press 2000; pp. 1195–209
- Apefel RJ, Mazor MD. Psychiatry and Reproductive Medicine. In Kaplan HI, Sadock BJ, editors. Comprehensive Textbook of Psychiatry. 5th ed. Baltimore: Williams & Wilkins 1989; pp. 1332-35.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington: APA publishing; 2013.
- Paulman PM, Sadat A. Pseudocyesis. J Fam Pract. 1990; 30(5):575–6
- Brown E, Barglow P. Pseudocyesis - a paradigm for psychophysiological interactions. Arch Gen Psychiatry. 1971; 24(3):221–9
- Small GW. Pseudocyesis: An overview. Can J Psychiatry. 1986; 31(5):452–7
- Steinberg A, Pastor N, Winheld EB, Segal HI, Shechter FR, Colton NH. Psychoendocrine relationships in pseudocyesis. Psychosomat Med. 1946; 8:176–9
- Dafallah SE. Pseudocyesis and infertility. Saudi Med J. 2004; 25(7):964–5.
Citation
Ostwal P, Balsarkar GD, Mahale N. Pseudocyesis: A Tale Of Phantom Twin Pregnancy. JPGO 2018. Volume 5 No.4. Available from: http://www.jpgo.org/2018/04/pseudocyesis-tale-of-phantom-twin.html