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Pseudocyesis History
Pregnancy can be an exciting time for the expecting parents-to-be. Sometimes, though, pregnancy doesn't end as anticipated with a baby. In rare cases, a woman (or even a man) believes he/she is pregnant, and often resembles the condition in every way except for the presence of a fetus. The medical term for a false pregnancy is Pseudocyesis. Pseudocyesis can cause many of the signs and symptoms of actual pregnancy. According to Sigmund Freud’s memoirs, his most famous patient, “Anna O,” believed she was pregnant with the child of her previous psychoanalyst, Josef Breuer. Freud attributed this development to what he called transference, or the strong attachment patients form with their psychoanalysts — a concept that would later form the cornerstone of Freudian theory. Pseudocyesis has been observed and written about since antiquity. Hippocrates set down the first written account around 300 B.C., and recorded 12 different cases of women with the disorder. One of the most famous historical examples is Mary Tudor (1516-1558), Queen of England, who believed on more than one occasion that she was pregnant when she wasn’t. Some even attribute the violence that gave her the nickname "Bloody Mary" as a reaction to the disappointment of finding out that she was not carrying a child. Other historians believe that the queen's physicians mistook fibroid tumors in her uterus for a pregnancy, as fibroids can enlarge a nonpregnant uterus.

Pseudocyesis has become increasingly rare in many parts of the world in which accurate pregnancy tests have become widely available. Cultures that place high value on pregnancy, or make close associations between fertility and a person's worth, still have high rates of the disorder. Juliet Borda in the mid-1960s, Dr. Radebaugh, a young pediatrician, volunteered at a clinic for migrant farmworkers in Rochester, and one evening he got a call that a woman was in labor. When he arrived at the scene, he found the woman with a melon-size stomach, groaning and writhing in pain. “From the condition she was in, we thought she was going to deliver right then and there,” he recalled. Dr. Radebaugh and the clinic workers who came with him decided to forgo a pelvic exam and drive the patient to a hospital emergency room posthaste. As he helped the woman into a wheelchair at the hospital, her water seemed to break, drenching him in clear fluid.But when he called the hospital the next day to check on the patient’s progress, Dr. Radebaugh got an unexpected answer.“Oh, she isn’t here,” the attending doctor told him. “She was discharged last night.”“Last night? How is that possible?” he asked. “She wasn’t in labor at all; she just had a full bladder. It’s a case of pseudocyesis,” the doctor replied, leaving a chastened Dr. Radebaugh to look up the diagnosis. Despite Dr. Radebaugh’s embarrassment, his unfamiliarity with the woman’s condition was hardly surprising. Though scientists are still largely baffled about what causes it in humans, recent case studies and studies of similar conditions in animals are beginning to provide insight, exploring the role of hormones and psychology. Those who suffer from the disorder present a constellation of symptoms that mystify even seasoned practitioners. Not only do they fervently believe they are pregnant, but they also have bona-fide symptoms to back up their claims, like cessation of menstruation, abdominal enlargement, nausea and vomiting, breast enlargement and food cravings.

Signs and symptoms
The symptoms of pseudocyesis are similar to the symptoms of true pregnancy and are often hard to distinguish from such natural signs of pregnancy as morning sickness, tender breasts, and weight gain. Many health care professionals can be deceived by the symptoms associated with pseudocyesis. Eighteen percent of women with pseudocyesis were at one time diagnosed as pregnant by a medical professional. The sign of pseudocyesis that is common to all cases is that the affected patient is convinced that she is pregnant. Abdominal distension is the most common physical symptom of pseudocyesis (63– 97% of women are found to experience this). The abdomen expands in the same manner as it does during pregnancy, so that the affected woman looks pregnant. This phenomenon is thought to be caused by buildup of gas, fat, feces, or urine. These symptoms often resolve under general anesthesia and the woman's abdomen returns to its normal size. The second most common physical sign of pseudocyesis is menstrual irregularity (56–98% of women experience this). Between 48% and 75% of women are also reported to experience the sensation of fetal movements known as quickening, even though there is no fetus present. Some of the other common signs and symptoms include: gastrointestinal symptoms, breast changes or secretions, labor pains, uterine enlargement, and softening of the cervix. One percent of women eventually experience false labor. The most common sign of pseudocyesis, abdominal distension, is thought to be due to excess fat, gaseous distension, fecal and urinary retention, and an exaggerated lumbar lordosis causing forward displacement of the abdominal viscera. The abdominal distension often resolves under general anesthesia. Laboratory Findings Laboratory findings in patients with psprolactin tends to be elevated, and follicle stimulating hormone (FSH) tends to be low. There has been a documented case of a persistent corpus luteum in pseudocyesis.

Causes
No single theory about the causes of pseudocyesis is universally accepted by mental health professionals. The first theory attributes the false pregnancy to emotional conflict. It is thought that an intense desire to become pregnant, or an intense fear of becoming pregnant, can create internal conflicts and changes in the endocrine system, which may explain some of the symptoms of pseudocyesis. The second theory concerns wish-fulfillment. It holds that if a women desires pregnancy badly enough she may interpret minor changes in her body as signs of pregnancy. The third leading theory is the depression theory, which maintains that chemical changes in the nervous system associated with some depressive disorders could trigger the symptoms of pseudocyesis. Doctors have been aware of pseudocyesis for centuries, but only recently have they begun to understand the psychological and physical issues that are at the root of the condition. Although the exact causes still aren't known, doctors suspect that psychological factors may trick the body into "thinking" that it's pregnant. When a woman feels an intense desire to get pregnant, which may be because of infertility, repeat miscarriages, impending menopause, or a desire to get married, her body may produce some of the signs of pregnancy (such as a swollen belly, enlarged breasts, and even the sensation of fetal movement). The woman's brain then misinterprets those signs as pregnancy, and triggers the release of hormones (such as estrogen and prolactin) that lead to actual pregnancy symptoms. Some researchers have suggested that poverty, a lack of education, childhood sexual abuse, or relationship problems might play a role in triggering false pregnancy. Having a false pregnancy is not the same as claiming to be pregnant for a benefit (such as for profit), or having delusions of pregnancy (such as in patients with schizophrenia). A desire for or fear of pregnancy creates an internal conflict and causes endocrine changes to explain the signs, symptoms, and laboratory findings in pseudocyesis. . Wish-fulfillment theory. Minor body changes initiate the false belief in pregnancy in susceptible individuals. . Depression theory. Pseudocyesis may be initiated by the neuro-endocrine changes associated with a major depressive disorder. There is evidence in the literature to support all of these theories, and one or more may be simultaneously appropriate for patients with pseudocyesis.

Demographics
The rate of pseudocyesis in the United States has declined significantly in the past century. In the 1940s there was one occurrence for approximately every 250 pregnancies. This rate has since dropped to between one and six occurrences for every 22,000 births. The average age of the affected woman is 33, though cases have been reported for women as young as 6-1/2 and as old as 79. More than two-thirds of women who experience pseudocyesis are married, and about one-third have been pregnant at least once.6 Women who have been victims of incest may be at greater risk for developing pseudocyesis. Pseudocyesis is found in some mammals other than humans—most often cats, dogs, and rabbits.

Treatment
Because pseudocyesis is not known to have a direct underlying physical cause, there are no general recommendations regarding treatment with medications. In some cases, however, the patient may be given medications for such symptoms as the cessation of menstruation. Because most patients with pseudocyesis have underlying psychological problems, they should be referred to a psychotherapist for the treatment of these problems. It is important at the same time, however, for the treating professional not to minimize the reality of the patient's physical symptoms. The treatment that has had the most success is demonstrating to the patient that she is not really pregnant by the use of ultrasound or other imaging techniques. “The pituitary gland is located right at the base of the brain, and that’s where all the hormones come from” in pregnancy, he said. “This is one of the classic examples in medicine of how the mind affects the rest of the body.” The quickest way to treat false pregnancy in dogs, he added, is to give them shots of another hormone like testosterone, which quickly brings prolactin levels back into the normal range and stops the associated symptoms. Because study subjects are in such short supply, Dr. Paulman is not optimistic that human pseudocyesis will ever be completely scientifically understood. Still, he hopes that continued study of individual cases will produce a clearer portrait of how the brain can send the endocrine glands into such a frenzy that a woman who is not pregnant can appear to be in screaming labor.

Alternative therapies
There have been reports of patients being cured of pseudocyesis by hypnosis, purgatives, massage, opioids, or after nine months of symptoms, by experiencing "hysterical childbirth," but there are few data available on the effectiveness of these or similar procedures.

Prognosis
Symptoms of pseudocyesis generally last from a few months to a few years. In most cases, symptoms last for a full nine months. There is a high success rate for treatments involving psychotherapy, as it treats the underlying psychological causes of the disorder.

Tests for False Pregnancy
To determine whether a woman is experiencing a false pregnancy, the doctor will usually evaluate her symptoms and perform a pelvic exam and abdominal ultrasound -- the same tests used to feel and visualize the unborn baby during a normal pregnancy. In a case of false pregnancy, no baby will be seen on the ultrasound, and there won't be any heartbeat. Sometimes, however, the doctor will find some of the physical changes that occur during pregnancy, such as an enlarged uterus and softened cervix. Certain medical conditions can mimic the symptoms of pregnancy, including ectopic pregnancy, morbid obesity, and cancer. These conditions may need to be ruled out with tests.