A very small percentage of people with ovaries may experience a pregnancy that's real in all ways except one: There's no growing fetus. In cases of pseudocyesis (sometimes called "phantom pregnancy," "false pregnancy," or "pseudopregnancy"), although there's no true pregnancy, the individual still has the classic physical signs — including a swollen stomach, missed periods, and lactation. The pregnancy may not be real, but the condition and symptoms very much are.
"The vast majority of people who experience pseudocyesis also have an intense desire to become pregnant," explains Modern Fertility staff therapist Meghan Cassidy, LCSW-C. "It seems like this condition provides an emotionally protective factor for the individual, meaning that the body is responding to the intense emotional desire to become pregnant by creating symptoms that allow the individual to believe that they are pregnant." Meghan adds that the emotional stress could actually impact hormone levels, resulting in those physical symptoms of pregnancy — but symptoms may also be caused by pre-existing hormone levels or something else entirely (like medication) and seem linked to a pregnancy.
Below, we're exploring what you need to know about phantom pregnancy if you or someone in your life is diagnosed with it (or if you just want to learn about the condition). Here's an overview of what we'll cover:
- Phantom pregnancy, or pseudocyesis, is a disorder that can cause pregnancy-like symptoms — including the sensation of fetal movement, stomach and breast/chest enlargement, and contractions.
- The medical community doesn't yet fully understand phantom pregnancies. Some experts (here and here) believe it's caused by a chemical imbalance, some say there's a relationship to past trauma, and some connect the condition to societal pressures to have children.
- Treatments for a phantom pregnancy may include therapy (Meghan recommends somatic experiencing), antidepressants, antipsychotics, hormone treatment, or uterine curettage (where any tissue left behind by a past pregnancy is removed).
What is a phantom pregnancy?
The fifth volume of the Diagnostic and Statistical Manual of Mental Disorders (DSM) defines pseudocyesis (aka phantom pregnancy) as a "false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy." These symptoms can include:
- Abdominal distention (a swollen stomach) and weight gain
- Amenorrhea (no periods)
- The sensation of fetal movement
- Nausea (morning sickness)
- Swollen, tender breasts/chests with secretion (lactation)
- Labor pains around the expected time of delivery
How do these symptoms occur without a true pregnancy? We'll get into some of the possible causes a little later, but research has associated phantom pregnancy symptoms with changes in hormone production, pre-existing out-of-range hormone levels, or even symptoms from medications (like stopped periods or lactation) that overlap with the symptoms of an actual pregnancy.
A diagnosis of phantom pregnancy is different from a “deceptive” or “simulated” pregnancy (where the person knows they're not really pregnant), as well as a “delusion of pregnancy” (where there are no physical symptoms of pregnancy).
How common is phantom pregnancy?
"Pseudocyesis cases have reduced significantly in the United States in recent decades, likely due to the increased access to technology like ultrasounds," Meghan says. (Side note: Some experts believe that Mary Tudor, the Queen of England in the 1500s, may have experienced pseudocyesis.)
Today, the incidence of phantom pregnancy may be as low as one to six out of 22,000 pregnancies. Researchers have noted that married people with ovaries between the ages of 20 and 44 years old are most likely to experience phantom pregnancies. The length of a phantom pregnancy episode can vary anywhere from a few weeks to nine months. Though it's rare, this disorder can sometimes affect people assigned "male" at birth as well.
What causes phantom pregnancy?
There's still a lot that the medical community doesn't understand about phantom pregnancies because they happen so infrequently, but there are three prevailing theories about potential causes. Some of these theories position the condition as "psychosomatic," while others suggest that the physical changes come first.
Theory #1: Phantom pregnancy is caused by social pressure.
"We are seeing cases continue especially in parts of the world that do not have easy access to early care and fetal monitoring — and especially within cultures where the idea of motherhood is heavily ingrained into the worth of womanhood," Meghan says. In those cultures, phantom pregnancy could be a "defense mechanism" if someone has trouble getting pregnant.
Theory #2: Phantom pregnancy is caused by extremely low dopamine levels.
Many people with phantom pregnancy also have abnormally low dopamine levels. This, in particular, may explain some of the physical signs associated with the disorder: A dopamine deficiency can lead to increased prolactin levels (the "milk hormone") and other pregnancy-like symptoms.
Theory #3: Phantom pregnancy is caused by psychological disorders.
Medical experts understand that there's a connection between this condition and psychological issues like depressive disorders, anxiety disorders, schizophrenia, and personality disorders. Prescribed medications (like antipsychotics) that on their own interrupt menstrual cycles or trigger lactation may make a belief in pregnancy feel more real. People who experience phantom pregnancy may also have a history of sexual abuse or other trauma.
What are some other risk factors for phantom pregnancy?
We don't yet know what causes phantom pregnancy, but we do have an idea of possible risk factors associated with the condition (beyond the theories highlighted above):
- Loss of a loved one or child
- Loss of the ability to get pregnant (e.g., infertility, menopause)
- Deep desire to have children
- Being afraid of becoming pregnant
How is phantom pregnancy diagnosed?
Because the symptoms of a phantom pregnancy can be identical to a real pregnancy, the only way to confirm a pregnancy is through:
- An ultrasound, which will detect the presence of a fetus.
- A urine or blood pregnancy test, which can accurately confirm the presence of the "pregnancy hormone" human chorionic gonadotropin (hCG).
How is phantom pregnancy treated?
A collaborative team of healthcare providers may suggest therapy, antidepressants, antipsychotics, hormone treatment, or even uterine curettage (where any tissue left behind by a past pregnancy is removed) to manage the symptoms of phantom pregnancy.
Modern Fertility staff therapist Meghan Cassidy, LCSW-C says her number-one recommendation for those experiencing a phantom pregnancy is to find an expert (a therapist or other wellness professional) who's trained in somatic experiencing, which is a form of trauma therapy that helps people "explore and heal from hard emotions and trauma by releasing emotions from where we hold them in our bodies." Meghan recommends working with the trained expert to understand what previous experiences may have caused the phantom pregnancy.
"More and more in the field of mental health, we are understanding that there is a connection between the mind and body — and that emotions are held in our bodies," Meghan explains. "This is why our shoulders can get tight or stomachs can hurt when we are stressed and upset — our bodies try to protect us emotionally by storing the pain." A phantom pregnancy could be the brain’s way of trying to protect the person from a perceived pain or past trauma. If that pain or trauma is worked through, you can take steps to detach the physical symptoms from your experience.
The bottom line
While very rare, phantom pregnancy is a clear example of the powerful way in which our bodies and minds are connected. What's important to understand is that anyone who's experiencing a phantom pregnancy isn't "making it up" — the symptoms, and the factors that may have triggered them, are very real.
If you're looking for support for anything related to fertility or pregnancy, consider joining the Modern Community. It's a safe space where you can learn from fertility experts and from other people’s experiences. We hope to see you there.
This article was medically reviewed by Dr. Eva Marie Luo, MD, MBA, OB-GYN at Beth Israel Deaconess Medical Center and Clinical Lead for Value at the Center for Healthcare Delivery Science at Beth Israel Deaconess Medical Center.