Monica N. Starkman M.D.

On Call

The Heartbreaking Phenomenon of False Pregnancy

... and how to support someone who experiences it.

Posted Feb 25, 2016

Public Domain
Source: Public Domain

Pregnancy is happy news for sure, but for women who are struggling with infertility or have suffered a miscarriage, the magazine covers featuring glowing women with healthy bumps can be a painful reminder of what they don’t have.

The inability to bear a child, or the frustration of trying again and again to conceive to no avail, is one of the most trying experiences imaginable. The sensitivities involved are deeply connected to an individual’s identity and self-esteem. Understandably, when conception is elusive or unsustainable, as with miscarriage, those affected wonder about the adequacy of their body. They wonder about their identity as a woman (or man), and even their worth as a person. They feel somehow damaged and defective—as well as utterly lacking control over the present and the future. The results can be profound anxiety, despair and grief, which can lead to depression, often severe.

It’s not surprising then, that to shield people from this unbearable pain, unhealthy psychological defense mechanisms sometimes kick in. Which brings me to one that is at the same time serious, little known, and intriguing: Some women crushed by struggles with infertility and miscarriage actually develop the symptoms of pregnancy despite not having conceived—missed periods, distended abdomen, the sensations of fetal movement, and even breast secretions. These "false pregnancies"—a phenomenon known as pseudocyesis—allow women and their partners the ability to feel hopeful once again, albeit only temporarily until the truth is revealed. 

Some of us may have had times when we thought we were pregnant, but a negative pregnancy test dispelled those thoughts. False pregnancy is different: These women remain firmly convinced that they are pregnant, even long after a negative pregnancy test (if they even do a test). In my decades as a psychiatrist specializing in mind-body interactions, I have encountered women presenting with pseudocyesis, and their plight is truly heartbreaking.

Pseudocyesis is not a common condition, but it is a serious one and deserves public awareness. It has been recognized throughout the ages. Hippocrates, the father of medicine, reported a dozen cases of women who imagined themselves pregnant. Mary Tudor, Queen of England and daughter of Henry the Eighth, had symptoms of pregnancy lasting nine months on two occasions, each terminating in an episode of false labor. But today, even with ready access to online information, it remains relatively unheard of. A woman who suffers from false pregnancy has likely never heard of it, and those who might be supportive are taken aback by something they consider totally "weird" and unique.

My own interest and concern sparked from several patients referred to me for treatment. They were about to experience the challenge of an ultrasound doctors had prescribed in order to convince them that their strongly-held belief they were pregnant was unfounded. I am hopeful that my novel, The End of Miracles, and the movie that is now being developed from it, will help bring this condition into the public eye. Its central character suffers a tragic late miscarriage after finally conceiving on the heels of many difficult years of infertility—and then unravels psychologically after her second, miraculous "pregnancy" is proven false.

Here is some of what we now know about this condition:

How it begins: Pseudocyesis develops in the context of loss, primarily the absence of fertility or loss of a pregnancy. This loss triggers strong feelings, such as deprivation, anger, and envy, and depression can ensue. During false pregnancy, these feelings become substantially weaker and joy overlays them.

The symptoms: Women experiencing a false pregnancy may present nearly all of the physical signs of pregnancy without actually being pregnant. This includes the ceasing of the menstrual cycle, abdominal enlargement, and breast enlargement. Patients experience typical pregnancy symptoms such as nausea, vomiting and weight gain, and even report feeling fetal movements. However, if a pregnancy test comes back negative and the woman affected insists that the test or even a series of tests is flawed, there is good reason to suspect pseudocyesis—especially if it occurs on the heels of grief. 

The confrontation: When denial continues in the face of negative pregnancy tests, the next step is to carry out procedures that physically demonstrate the woman is not pregnant. The most definitive of these is an ultrasound, which shows that the uterus is small and empty: There’s no fetus to be seen.

The aftermath: Once the woman concerned is confronted with irrefutable evidence, it will be very difficult for her to digest the news that she is not, in fact, pregnant. Upon accepting reality, she will abruptly lose the hopeful narrative that was protecting her. The situation can be extremely complex, however. I have seen cases in which the partner is so eager for the woman he’s with to be pregnant—perhaps a contributing factor to the development of the condition in the first place—that he insists to the doctor that the tests must be wrong. When she does finally accept the truth, support is critical. In the best of circumstances, her physician will recommend brief psychotherapy, or the woman herself will seek it out. In more extreme cases, unexamined and unresolved issues may result in a future re-awakening of the fantasy that she is again pregnant.

How to Help

  • Recognize that the woman involved has experienced a trauma and is mourning.
  • If she confides the truth, your prior awareness about pseudocyesis will be helpful. You can offer support by saying you know that this sometimes happens, and you are sorry for the pain she must be experiencing.
  • In many cases, she won’t mention the cause of the loss of a pregnancy she has proudly displayed and spoken of. If the cause is not revealed, then you will be relating and responding to her exactly as you would to any woman who has suffered the loss of a pregnancy. Acknowledge the loss by saying you’re sorry for it, and show compassion. You can start by telling her how sorry you are for her loss, giving her a hug and then leaving space for her to respond. This speaks volumes in emotional support.

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