Phantom pregnancy or pseudocyesis is a rare condition in which a mentally stable woman believes that she is pregnant, experiences the usual symptoms of pregnancy, but the presence of a fetus is not evidenced. In addition, there are objective features of pregnancy in the woman, such as amenorrhea and enlargement of the belly.

Pseudocyesis is associated with normal or raised basal prolactin concentrations, and normal or raised luteinizing hormone (LH) levels. Both the hormones show exaggerated pulsatility.

Prevalence of the condition

The condition is most common in women who are in the reproductive age group, especially between 20 and 39 years of age. It has been described from ancient Greek times. Its prevalence is higher in developing countries where the pressure on women to produce a child is higher, and in immigrant communities in the developed world. In some reports the prevalence rate in earlier studies was up to 1 in 25 of all self-diagnosed pregnancies. At present, rates in the US are only 6 per 22 000 pregnancies.

The most common time when the symptoms of pseudocyesis begin tends to be when friends or relatives become pregnant. Pseudocyesis may be a psychological reaction, sometimes in response to feelings of loss or trouble. The loss may be of a lover, of a child, or of the capability to conceive and bear a child.

Symptoms

Many of the usual symptoms of pregnancy are reported in women with pseudocyesis, such as:

• Amenorrhea
• Morning sickness
• Food cravings
• Increase in weight
• Abdominal enlargement, which does not, however, push out the umbilicus (unlike most pregnancies)
• Breast changes, occurring in 8 out of 10 women (such as tenderness, white or milky secretion, as well as increased pigmentation of the areola)
• Quickening and fetal movements

Diagnosis and treatment

With modern means of diagnosing pregnancy, including human chorionic gonadotropin (hCG) testing and ultrasound imaging, it is easy to rule out the presence of pregnancy. The levels of hCG are at normal non-pregnant levels. Once it is determined that the woman is not pregnant, the simplest and best approach is to tell her the truth. This usually leads to a quick disappearance of most symptoms and signs, including flattening of the distended abdomen and weight loss.

In some cases, the patient may not believe the truth, and may even go into depression. Recurrence of pseudocyesis is also a possibility. For this reason, the healthcare providers who see the patient must include a psychologist or psychiatrist, as well as an obstetrician, who can decide on the type of psychotherapy that is best.