what's false pregnancyKim Kardashian, Anne Hathaway, and now rumors of a possible Royal Baby #3: looking at the news, it might seem as if the whole world were pregnant.

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 sharply 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 cannot be sustained, as is the case with miscarriage, those affected wonder about the adequacy of their body, 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.  These can lead to depression, which is often severe.

Brain and Behavior Research Foundation

It’s not surprising then, that at times unhealthy psychological defense mechanisms to shield people from this unbearable pain 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 to once again be able to feel hopeful, albeit only temporarily until the truth is revealed.

Some of us may have had times we thought we were pregnant, but those thoughts were dispelled with a pregnancy test that came out negative. False pregnancy is different: these women remain firmly convinced they are pregnant, even long after a negative pregnancy test (if a test is even done). In my decades as a psychiatrist specialized 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 is a condition that 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 in our modern world with ready access to online information, it remains relatively unheard of. The woman who suffers from false pregnancy has 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 was sparked by several patients referred to me for treatment as they were about to experience the challenge of an ultrasound doctors had prescribed in order to convince them their strongly-held belief that they were pregnant was unfounded. I am hopeful that my novel, The End of Miracles, whose central character suffers a tragic late miscarriage after finally conceiving on the heels of many difficult years of infertility — and who then unravels psychologically after her second, miraculous “pregnancy” is proven false — will help bring this condition into the public eye.

Here is some of what we now know about this challenging, yet fascinating condition:

How It Begins

Pseudocyesis develops in the context of loss, primarily the absence of fertility or loss of a pregnancy. Strong feelings are triggered, such as deprivation, anger and envy, and depression can ensue. During the false pregnancy, these feelings become substantially weakened 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 where 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 accept the truth, support is critical. In the best of circumstances, brief psychotherapy will be recommended by her physician, or sought out by the woman herself. 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 her 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.

Pregnancy test photo available from Shutterstock