SKIP AHEAD. . .
WHAT IS PHANTOM (FALSE) PREGNANCY?
Phantom pregnancy (also known as false pregnancy) is when an ovulator experiences symptoms of pregnancy without any signs of a fetus (1). Phantom pregnancy, medically known as pseudocyesis, is categorized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a somatoform disorder (2), which is a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurological condition (3).
How does this whole phantom pregnancy thing work?
Physical symptoms of pregnancy, like morning sickness and fatigue, are present, however, there is no fetus. This mismatch between the lack of a fetus and the experience of symptoms is unfortunately difficult to explain, and the cause of somatic symptoms cannot be medically diagnosed like a verifiable condition such as diabetes or anxiety.
The experience of these symptoms is unique and can be due to various physical, environmental, and social factors. Because the cause of symptoms is so obscure, the cause of phantom pregnancy is unknown.
Is this a new phenomenon?
Although the cause is unknown, false pregnancy has actually been going on for a long time. Early storytellers and classical Chinese medical documents show that the fallacious phenomenon has been occurring for centuries, and highlight the obscure and quite perplexing symptoms women have showed (5).
During the Ming Dynasty doctors were called upon to treat women who believed to be pregnant without the presence of a fetus, the condition was referred to as “Ghost Fetus.” And from 1890 to 1910 an astonishing 156 cases of phantom pregnancy were documented in English Literature (6).
Even Queen Mary I, aka Mary Tudor or ‘Bloody Mary,’ experienced what historians believed to be a phantom pregnancy (7). More recently, in 2008 obstetricians in North Carolina performed a C-section and were shocked to find a non-pregnant uterus (7)! 😱
What are the emotional implications?
Well, ovulators who experience mental illness such as depression or anxiety are also at risk (1). Because phantom pregnancy is defined and classified in the DSM-5, the original assumption was that phantom pregnancy occurred among those with psychotic and mental disorders. This previous classification and tone of the diagnosis implied that ovulators who experience phantom pregnancies are somehow crazed.
However, newer research suggests that medical professionals are now taking a holistic approach to understanding phantom pregnancy. Those experiencing false pregnancy are not hysterical or simply mentally ill. Rather, major life stressors, such as extreme pressure to conceive, play a large factor in the development of symptoms.
While the rate of phantom pregnancy differs across the globe, the core tenets of the condition remain the same: Those who experience pseudocyesis experience extreme distress.
WHAT CAUSES FALSE PREGNANCY?
In The Journal for Nurse Practitioners, researchers Stephanie Campos and Denise Link suggest that phantom pregnancy occurs mostly among those under extreme distress around their reproductive capabilities. This includes the desire for or fear of childbearing, infertility, miscarriage, and societal and economic pressure to reproduce. Campos and Link also suggest that lower socioeconomic status, less education, relationship instability, and domestic abuse influence the occurrence of phantom pregnancies (1).
Other types of pregnancies
That’s right—there’s more than just a phantom pregnancy! There’s also:
Delusion of pregnancy: When an ovulator believes they are pregnant but there are no physical symptoms or body changes as there are in phantom pregnancies.
Factitious pregnancy: When an ovulator is aware that they are not pregnant but behaves as if they are.
Erroneous pseudocyesis: When an ovulator experiences symptoms such as nausea or vomiting, and mistakes that symptom as a sign of pregnancy, accidentally thinking they are pregnant.
These states of “pregnancy,” are differentially categorized and explored further in the DSM-5.
SYMPTOMS OF FALSE PREGNANCY
According to the DSM-5 (aka the aforementioned Diagnostic and Statistical Manual of Mental Disorders), symptoms include amenorrhea (8) (the lack of menstruation for one or more menstrual period), abdominal growth (what one would consider the presence of a baby bump), sensing “fetal” movement and “labor” pains, nausea, and breast growth (9).
Other symptoms may include (9):
The duration of these symptoms can last for a few weeks, or the entirety of 9 months.
Okay, but literally how can the body change like that if there is no fetus?!
There’s no one answer. Researchers who study the neurological and pathological traits of phantom pregnancy suggest that symptoms appear as a result of disrupted hormonal secretions and pathways.
For example, most cases of phantom pregnancy occur when an ovulator is under intense distress, which can cause an increase in prolactin levels (12). Prolactin is a hormone produced by all bodies which supports our reproductive and immune systems. When prolactin levels increase and there is too much in the blood, unnecessary lactation and an irregular menstrual cycle may occur. This condition is known as hyperprolactinemia, and one of the most common causes is pregnancy. In that same way, increased prolactin can lead to symptoms that mirror of pregnancy (13).
Other studies that explore phantom pregnancy have seen not only an increase in prolactin levels, but also hormones (14) commonly associated with ovulation, lactation, and pregnancy, such as follicle stimulating hormone, progesterone, luteinizing hormone, and growth hormone.
A study conducted by researchers at BioMed Central found that dopamine and norepinephrine activity plays an important role in the symptoms of false pregnancy (9). They found that the almighty chemical dopamine can create a disconnect between the mind and body through disrupting the release and production of hormones.
According to Campo and Link (1), other symptoms such as abdominal enlargement and “labor pain,” can be a result of “abdomino-phrenic dyssynergia,” and the growth of “abdominal adipose tissue,” which refers to muscle contractions due to bloating and the growth of abdominal fat, all of which can be due to a variety of factors.
Basically, when we’re in distress, bodies can become confused. The surge in hormones to compensate for the confusion can create symptoms of pregnancy, even if there is no fetus. Although the exact causes and mechanisms are unknown, it is important to note that while the pregnancy is not real, the symptoms are. In other words, if you are experiencing this, it’s not all in your head.
What happens if you have a phantom pregnancy?
Unfortunately, because phantom pregnancy cannot be classified under a general medical condition and is not considered life-threatening, little research is funded to explore this phenomenon, devise treatment plans, or determine what truly causes it.
But what’s important is that you are your own expert! You know your body the best. Because phantom pregnancy is so ambiguous, the only formal treatment is to confirm the absence of a fetus via ultrasound or doppler, and even then one may still feel confused.
It is encouraged to either write things down or keep a mental log of symptoms you experience, changes in your body, what you crave, things that make you feel good, etc. to help determine what may have caused a phantom pregnancy. Exploring your body, along with the help of medical technology and a great practitioner, can help with the emotional implications of phantom pregnancies, which can be significant for those seeking pregnancy or dealing with infertility.
Talk to someone about your experiences, and build an understanding community of people to share knowledge and empower each other. If you’re experiencing this, you’re not alone.
Tests for phantom pregnancy
The tests that a healthcare provider would use to test for a phantom pregnancy are the same as the ones that a provider would use to test for a pregnancy in general. A urinalysis will usually be able to tell if a pregnancy is false, as will an ultrasound—if there’s no fetus, you won’t be able to see one (4).
If you think you may be pregnant...
You can take a pee-on-a-stick pregnancy test to see what your hormones say (and read more about that here), and then from there, you may want to schedule a visit with your OBGYN or midwife.
Who's at risk?
Data suggests that out of 22,000 pregnancies, 1 to 6 will be a phantom pregnancy. Those who experience phantom pregnancy are most commonly between the ages of 20-44, and 80% are married (1).
Globally, the incidence of phantom pregnancy differs across countries, communities, and cultures. Most researchers conclude, however, that there are higher rates of phantom pregnancy in developing countries (9). It is theorized that developing countries and cultures who rely on childbearing for social, economic, and political stability, place immense pressure on those who can reproduce. Unfortunately, the lack of reproductive technologies and health care professionals in developing countries also influence the ability of ovulators to differentiate between conception and phantom pregnancy.
Written by: Kayla Bert, women’s health advocate and peer educator at Penn State.
Medically reviewed by: Danielle LeBlanc, RN
All content found on this Website, including: text, images, audio, or other formats, was created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Campos, Stephanie J. and Denise Link. 2016. “Pseudocyesis.” The Journal for Nurse Practitioners 12 (6) (06): 390-394.
Oksman, Olga. “‘Phantom Pregnancy’ Is One of the Most Bizarre Medical Mysteries.” Tonic. October 20, 2017. Accessed March 07, 2019. https://tonic.vice.com/en_us/article/59ymj5/phantom-pregnancy-is-one-of-the-most-bizarre-medical-mysteries.
Spratt, Eve G. “Somatoform Disorder.” Medscape. December 06, 2017. Accessed March 07, 2019. https://emedicine.medscape.com/article/918628-overview.
Wu, Yi-Li. “Ghost Fetuses, False Pregnancies, and the Parameters of Medical Uncertainty in Classical Chinese Gynecology.” Nan Nü 4, no. 2, 170-206.
Upadhyay, Sarita. “Pseudocyesis.” Journal of Nepal Medical Association47, no. 171 (2008): 147-50. https://www.researchgate.net/publication/23660214_Pseudocyesis.
“Mary I’s Phantom Pregnancy.” History Extra. October 15, 2018. Accessed March 07, 2019. https://www.historyextra.com/period/tudor/mary-is-phantom-pregnancy/.
Donaldson James, Susan. “Doctors Perform C-Section and Find No Baby.” ABC News. Accessed March 13, 2019. https://abcnews.go.com/Health/ReproductiveHealth/pregnant-mother-section-doctors-find-baby/story?id=10262881.
“Amenorrhea.” Mayo Clinic. April 26, 2018. Accessed March 07, 2019. https://www.mayoclinic.org/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299.
Tarín, Juan J., Carlos Hermenegildo, Miguel A. García-Pérez, and Antonio Cano. “Endocrinology and Physiology of Pseudocyesis.” Reproductive Biology and Endocrinology 11, no. 39 (May 14, 2013): 1-12. https://rbej.biomedcentral.com/articles/10.1186/1477-7827-11-39.
Lennartsson, Anna-Karin, and Ingibjörg H. Jonsdottirab. “Prolactin in Response to Acute Psychosocial Stress in Healthy Men and Women.” Psychoneuroendocrinology 36, no. 10 (November 2011): 1530-539. https://www.ncbi.nlm.nih.gov/pubmed/21621331.
Seeman, Mary V. “Pseudocyesis, Delusional Pregnancy, and Psychosis: The Birth of a Delusion.” World Journal of Clinical Cases 2, no. 8 (2014): 338-44. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133423/.