Delusion of Pregnancy: A Rare Persistent False Belief That One Is Expecting

A 44-year-old woman is brought to a clinic and believes that she is pregnant and has delivered 15 children in the past 8 years. However, her medical history contradicts her claim. Her reports show that the woman has a complicated obstetric history. The woman experienced a loss of a child at 5 months gestational age, had three abortions, has no living child and had a voluntary hysterectomy. The woman had an established mistrust and suspicion towards others who according to her were trying to harm her children. Experts have recognized this case as one of delusion of pregnancy, a persistent belief that one is pregnant despite concrete evidence to the contrary.

Delusion of pregnancy is an isolated psychological phenomenon which has been reported in patients who had other underlying psychiatric conditions like schizophrenia (as the woman mentioned above), bipolar disorder, psychotic depression, and other psychological disorders. The condition when happens alongside other psychiatric disorders is known to become treatment-resistant and antipsychotics alone have not been sufficient in treating the condition. As per studies, cognitive and supportive psychotherapy when combined with drug treatment can show positive results.

What causes it?

The patient reported earlier had an established apprehension that somebody was trying to take away her babies. The patient reported that her family members got away with all her medical reports and took away the delivered babies when she was asleep. She also reported that her abdomen was distended.

The condition is known to occur more often in developing countries than in developed ones. As per theories, delusion of pregnancy is established in three stages. In the first stage, it is apprehension that might develop after the actual or imaginative loss of a loved one/object. The second stage might involve the formation of a sensory perception related to weight gain, vaginal spotting or abdominal movements, and increased frequency of urination. The patient might end up searching for the significance behind the perception. The third stage usually involves the establishment of the false belief that one is pregnant to deal with a difficult situation such as the loss of a child or being diagnosed with infertility.

Psychosocial factors such as real or imagined loss of pregnancy, loss of a loved person/object, and loneliness have been instrumental in the development of delusion of pregnancy. In addition, sociocultural factors such as societal pressure to have children, social deprivation, belief in wizardry, and spiritual deities have also been known to cause delusion of pregnancy. In some cases, low socioeconomic status and illiteracy can also intensify the belief. Very rarely, it does occur in men also as an expression of frustrated creativity, identification with their own mothers or feelings of envy towards the wife’s ability to become pregnant.

Distinguishing it from other conditions

While making a diagnosis, it is crucial to distinguish the condition from other disorders that might mimic this delusion. Pseudocyesis which mimics the delusion of pregnancy is unlike the latter associated with objective signs and reported symptoms of pregnancy such as abdominal enlargement, reduced menstrual flow, subjective sensation of foetal movement and others. Delusion of pregnancy also comes with other delusions like that of persecution or harm.