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Royal Hysteria! Is Hyperemesis Psychosomatic?

Is severe morning sickness all in her head?

If you’ve been hiding under a rock for the past week you may not have heard: Kate and William are expecting their first child.

(For the rock hiders: Prince William and Kate Middleton are members of the British Royal Family. It’s Prince Charles and Diana’s kid and his wife. William is Queen Elizabeth’s handsome, famously balding grandkid. You remember Elizabeth, she jumped out of a helicopter with James Bond at the Olympics. But you knew that.)

And right on the heels of that blessed news was the chilling revelation that Kate has been hospitalized for a rare and dangerous condition called Hyperemesis Gravidarum (HG), a syndrome that afflicts 1-2% of expectant mothers. HG causes severe vomiting that results in weight loss and dehydration - at the time when food and water are quite beneficial for mother and fetus. It’s a horrible disease, described as ”an extremely uncomfortable and unpleasant condition” that is “a thousand times morning sickness.” The etiology of this condition is historically controversial - for centuries, extreme morning sickness was thought to be "all in her head." 

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Back in graduate school I was honored to join ranks with a dream team of researchers as we collaborated on the most unlikely of projects: examining the psychological factors of HG. Our findings created a bit of a stir.

First author Dr. Stephen Simpson graciously shared his thoughts on his groundbreaking HG research:

RH: Why did (or do?) people think HG was psychological?

SS: The standard myth, which still persists in some circles, is that the woman is seeking "secondary gain." In other words, it's attention-seeking behavior rather than a genuine physiological problem. Go back as little as 10 - 20 years, however, and the medical folklore becomes truly bizarre. Articles in peer-reviewed medical journals espoused theories ranging from HG as a means of avoiding sex to being an unconscious wish to orally expel the fetus. 

There's a broader issue, however, which I call the "hysteria" problem. When women have a medical problem that a physician can't diagnose, the problem is likely to be labeled as psychosomatic or "hysterical." The medical professional thinks, "Well, if we can't diagnose it, the problem must be psychological." In other words, if we don't know what it is, it must be in her head. Try telling this to a woman with severe nausea and vomiting and you're likely to lose a limb, or at least get puked on. 

RH: How did you conduct the research?

SS: We gave a variety of psychological tests and medical history questionnaires to pregnant women with and without HG. We also tested blood hormone levels. Then we tested women with a history of HG when they were no long pregnant along with a control group who'd had a pregnancy with no complications.

RH: What did you find?

SS: Short answer: Vomiting all the time makes you kind of crazy. 

Long answer: The results were fascinating. When the women with the HG were pregnant, the results of the psychological tests resembled people suffering from acute mental illness such as mood disorders and psychotic disorders. However, when the women with HG were no longer pregnant, they were fine, no different than women with no history of HG. We also found that women who suffer from HG might be more sensitive to biochemical changes than women who don't. For example, if a woman has a history of bad PMS, she's more likely to have HG when she gets pregnant. A woman's body undergoes massive biochemical changes when she's pregnant. If a woman's brain is sensitive to biochemical changes, it might identify the hormonal gradient as something toxic in the body. That's when the puking starts. 

RH: How did people respond to this research?

SS: For the most part, it was a breath of fresh air to women suffering from HG. Try to imagine being pregnant, vomiting all the time, and having a your physician respond with a dismissive attitude because all they know is medical folklore that explains HG as psychosomatic. Murphy Goodwin, the MD from USC who collaborated in our study, went on the Oprah Winfrey show to discuss our research. Nowadays, I think it's unusual to find an OBGYN who believes that HG has psychological causes. It's almost always treated as a medical complication of pregnancy.

Of course, there's still work to be done in terms of research and raising awareness. Since it's a relatively rare disorder, it's hard to get the large sample sizes needed for thorough research. And there are still pockets of the medical community that aren't up on the latest HG research. When I went to my hometown for Christmas a few years ago, I met up with a bunch of high school friends for a reunion. Someone asked me about my research and I spent several minutes explaining our findings. One of the women there was an OBGYN. Someone asked her what she thought about HG. Despite everything I'd just reported, the OBGYN casually stated, "HG usually involves secondary gain." Some myths die hard. 

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My guest, Dr. Stephen W. Simpson, is Director of Clinical Training at Fuller Graduate School of Psychology, author of several books including What Women Wish You Knew About Dating: The Christian Guy’s Guide to Romantic Relationships,” and writes for the Good Faith blog at the Good Men Project.

Interested in supporting research in this area? Check out this site.

I usually write about psychotherapy. If that interests you, take a look at my facebook and website. Warning: may induce nausea.

Psychological Factors and Hyperemesis Gravidarum (2001). Steven W. Simpson, T. Murphy Goodwin, Sean B. Robins, Albert A. Rizzo, Ryan A. Howes, Deborah K. Buckwalter, and J. Galen Buckwalter. Journal of Women's Health & Gender-Based Medicine. June 2001, Vol. 10, No. 5: 471-477.

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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