DelusionsofPregnancy

ALBERTMICHAEL,ANILJOSEPHandALPHIEPALLEN

Casereportsereportfivecasesofdelusionsofpregnancyofwhom

threewerewomenandfourhadchronicschizophrenia.

Wedrawtheattentionofclinicianstothissymptom

whichisnotasrareashaspreviouslybeenthought.

BritishJournalofPsychiatry(1994),164,244â€”246

Theliteratureondelusionsofpregnancyisscanty(Shankar,1991;Bittoneta!,1991),withthetotalnumberofcasesreportedinEnglishbeingonly15.ThefirstcaseofadelusionofpregnancywasreportedbyEsquirolinthe19thcentury(Jenkinset

a!,1962).Delusionsofpregnancyhavebeenreported

inawidevarietyoforganicpsychiatricconditions(Jenkinseta!,1962;Chaturvedi,1989)andfunctionalpsychiatricconditions(dePauw,1990;Milner&Hayes,1990;Miller&Forcier,1992;Shankar,1991).Delusionsofpregnancyhavebeenreportedmorecommonlyinmenthaninwomen(Jenkinseta!,1962;Chaturvedi,1989;Miller&Forcier,1992).Delusionsofmultiplepregnanciesanddeliverieshavealsobeenreported(Chengappaeta!,1989).Delusionofpregnancyhastobedistinguishedfrom:(a)pseudocyesis,characterisedbytheconvictionofanon-pregnantwomanthatsheispregnant,inassociationwiththedevelopmentofthe

signsandsymptomsofpregnancy

(b)simulatedpregnancy,whenapersonprofessestobepregnantknowingheorsheisnot(c)pseudopregnancycausedbyatumourcreatingendocrinechangessuggestiveofpregnancy(Hardwick&Fitzpatrick,1981)(d)Couvadesyndrome,whereamandevelops

symptomsofpregnancywhenhiswife

becomespregnantbutknowsthatheisnotpregnant.Someauthorsconsiderthatinpseudocyesistheconvictionofpregnancyisnotinvariablyassociatedwiththesomaticmanifestationsofthegravidstate(Cohen,1982;dePauw,1990),andhencesomecasesofpuredelusionalpregnancyhavebeenreportedaspseudocyesis(dePauw,1990;Milner&Hayes,1990)andviceversa(Bittoneta!,1991).Wereportfivecasesofdelusionsofpregnancy

whichoccurredoveraperiodofsixmonthsina

175-bedpsychiatrichospital.

Case1

Bwasa39-year-old,single,femaleschizophrenicpatientwith

treatment-resistantpsychoticsymptomsincludingdelusionsofpregnancyof20years'durationandamenorrhoeafortheprevious18years.Onexaminationshewasconvincedthatshehadatripletpregnancyâ€”¿woboysandagirlâ€”¿ffourmonthsgestationalage.Shereportedthattheymovedaboutinsideherabdomenandalsotalkedtoher.Whenshewas19,herdancingpartnerkissedherandshebelievedthathehadbeenrepeatedlyimpregnatingherbymeansofthesamekiss.Regardingherpreviouspregnanciesshebelievedthattheirfatherdidnotwanthertodeliverthemandhenceheâ€˜¿withdrew'hem.Shedidnothaveanyphysicalsymptomsofpregnancyotherthanamenorrhoeaandattributedthistotheâ€˜¿supernaturalature'ofthepregnancy.

Case2

Cwasa52-year-oldmarried,nulliparous,femalelong-stay

patientwithschizophreniaof23years'durationand

amenorrhoeaformanyyears.Shepresentedtotheantenatal

cliniccomplainingofmorningsicknessandinsistedthatshehadconceivedforthesecondtime.Ayearbeforethispresentationshehadclaimedtobepregnantandninemonthslaterreportedthatshehadgivenbirthtotwobabies.Shehadnophysicalsymptomsotherthanamenorrhoeaand

hadnoevidenceofmorningsickness.

Case3D,a65-year-oldmotheroffourwitha17-yearhistoryof

manicâ€”depressiveillness,wasreadmittedwitharelapseofmania.Shehadattainedmenopauseatage45.Thedayafterheradmissionshedemandedanantenatalexaminationas

shebelievedherselftobepregnant.Shesaidshebecameâ€œ¿awareâ€•fthepregnancysixmonthsbeforeadmissionwhen

shehadaâ€œ¿pregnantsensationinhertummyâ€•.Shealso

maintainedsomewhatincontradictiontotheabovethatshehadbeenpregnantfortheprevious20years,thatissinceshehadstoppedmenstruating.Herhusbandhaddied22years

previously,andshehasneverhadanysexualcontactssince.Shedidnotknowhowshebecamepregnantandsheexpectedtodeliverwhenshehadlabourpains.Thisdelusionsubsidedalongwiththemanicsymptomsafteraperiodofthreeweeks.

Case4E,a41-year-oldsinglemanwithschizophreniahadbeen

persistentlypsychoticdespitetreatment.Twomonthsafter

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ELUSIONSOFPREGNANCYafterahomosexualcontact,hedevelopedthedelusionthathewaspregnant.Hearguedthatanyonecouldbecomepregnantfollowingsexualcontactwithmen.Thisdelusion

disappearedafterthreeweeks,althoughotherpsychotic

symptomsincludingincludingbizarredelusionspersisted.Case5

F,a38-year-oldsinglemanwithschizophreniaof14years'

duration,becameconvincedthathewaspregnant.He

refusedtodiscussthedetailsbecausehefelthehadtherighttowithholdpersonalinformation.Healsodemandedan

antenatalcheck-up.Hewasmaintainedonthesame

medicationandwheninterviewedaweeklaterhestatedthat

nomancouldeverbecomepregnant.

Discussion

Thisisthelargestseriesofcasesofdelusionsofpregnancyreported.Mostofourpatientswerewomenasopposedtothetrendintheliterature.Oneofourcases(case1)hadadelusionofpregnancyforthepast20years:thelongestdurationsreportedpreviouslywereacaseofintermittentdelusionsofpregnancy(dePauw,1990)andacaseofashareddelusionof

pregnancy(Mimer&Hayes,1990),bothoftenyears'

duration.Therehasbeenonlyonereportofretrospectivedelusionofpregnancy(Chengappaeta!,1989),wherethedelusionwasbackdatedtoayear.Oneofourpatients(case2)backdatedherdelusionofpregnancyto20years.Inthetwomenreportedhere,thedelusionofpregnancyconstitutedashorteventinthecourseoftheirchronicschizophrenicillness.Theaetiologyofdelusionofpregnancyislikelytobeheterogeneous.Contrarytoearlierreports,mostofourcaseshadchronicschizophreniawithsymptomsresistanttodrugtreatment.Theirdelusionscouldnotbeattributedtofactorssuchaspsychodynamicconflicts(Jenkinseta!,1962)orcontactwithpregnantwomen(Miller&Forcier,1992).Nonehadanyclinicalevidenceoforganicity(Chaturvedi,

1989).

Intheliteraturethesuggestedaetiologyofdelusionofpregnancyandpseudocyesiswassimilar.DePauw

(1990)andMilner&Hayes(1990)suggested

that,inpsychoticpatients,neuroleptic-inducedhyperprolactinaemia,galactorrhoeaandintestinaldilatationmaystimulate,confirm,andreinforcethedesire,fear,orbeliefofbeingpregnant.Thedelusionsinbothconditionshavebeenattributedtomisinterpretationofsomaticsensations(Chengappa

etal,1989;Bitteneta!,1991).Bothconditionswere

seenaspossiblybeingduetomonosymptomatichypochondriacalpsychosis(dePauw,1990),lossofloveorlossofalovedobject(Shankar,1991),ormentalhandicap(Jenkinseta!,1962;Chaturvedi,1989).

Someoftheaetiologicalfactorssuggestedfor

pseudocyesiswerepresentinourcasesofdelusion

ofpregnancy.Theoriginsofthedelusioninpseudo

cyesishavebeentracedtochronicsocialdeprivation

(Hardwick&Fitzpatrick,1981).Fourofour

caseswerelong-staypatients,theonlyshort-staypatient(case3)waswidowedandthreeofthemwereunmarried.Cohen(1982)suggestedthatpseudocyesisisfoundespeciallyinsocietieswherethereismuchculturalpressureonwomentohavechildren.Among

thethreewomeninourseries,twowerechildlessand

hencethismighthavebeenrelevantforthem.

Pseudocyesishasbeenattributedtohysteria,wish

fulfilment,neglectbyparents,projection(Hardwick&Fitzpatrick,1981),andrebirthfantasy(Jenkins

eta!,1962).Noneofthesefactorsseemedtobe

importantinourcases.

Oneshouldbecautiousinacceptingtheabove

factorsascontributingtothedelusionofpregnancy:infouroutoffiveofourcasesthiswasonlyoneofmanydelusionspresent.Despiteapparentoverlapinaetiologyandphenomenology,aclinicaldistinctionbetweenpseudocyesisanddelusionofpregnancybasedonthepresenceorabsenceofphysicalsignsandsymptomsofpregnancyispossible(Hardwick&Fitzpatrick,1981).Onlybymaintainingsuchadistinctionwillwebeabletofurtherelucidateandclarifythephenomenologyandaetiologyoftheserelatedbutdifferentphenomena.Itseemsthatthisinterestingphenomenon,thoughnotcommon,isnotasrareaspreviouslythought.

Acknowledgements

TheauthorswishtothankDrL.K.Hanniffy,RMS/Chief

Psychiatrist,StFintan'sHospital,Portlaoise,Ireland,forpermittingustoreportthecases,andDrPeterO'Hara,ConsultantPsychiatrist,RegionalHospital,Limerick,Ireland,forhelpfulcriticalcomments.

References