LOGIN SUBSCRIBE

Queen Mary I pictured in 1554, the year before she experienced pseudocyesis.
PHOTOGRAPH BY VCG WILSON, CORBIS/GETTY IMAGES

SCIENCE

The science of phantom pregnancies: a very

real—and very rare—condition
First highly detailed in Queen Mary back in 1555, the uncommon disorder can cause
a woman’s body to mimic signs of pregnancy, from a lack of menstrual periods to a
distended stomach.

BY RO S E M A RY C O U N T E R
PUBLISHED SEPTEMBER 11, 2023

• 7 MIN READ

In April 1555, Queen Mary I—better known to history as “Bloody

Mary”—went into seclusion as she awaited the birth of her first child.
At 38, the eldest daughter of King Henry VIII desperately needed an
heir, preferably male, to secure an alliance with Spain and continued
Catholic rule in England. The stakes were high.

Still, both Mary and the nation were optimistic. The year after she'd
married Philip II of Spain, the Queen looked pregnant: Her breasts
and belly had swelled, and she reported morning sickness and
movement in her womb. As such, the nursery was prepared, wet
nurses were on call, and announcement letters were prepared and
signed, leaving just the date of delivery and sex of the child to be
filled in.

Yet “as the weeks passed, the mood became one of despair,” writes
Anna Whitlock, author of Mary Tudor: Princess, Bastard,
Queen. Rumors spread the Queen was dead, or that the child had
died, and another would be swapped in its place.

The truth was less scandalous: Despite all appearances to the

contrary, Mary had never been pregnant to begin with, having the
misfortune of being history’s first well-documented case of a very
rare phenomenon called pseudocyesis.

Sometimes called false, hysterical, phantom, or delusional pregnancy,

pseudocyesis manifests most or all symptoms of pregnancy, but no
fetus.

For instance, a sufferer doesn’t have a menstrual period, her breasts

get larger and may even express milk, and her stomach is distended,
says Mary Seeman, professor emerita at the University of Toronto’s

Department of Psychiatry. Such physical manifestations also occur

alongside fatigue, nausea, and frequent urination.

“Her body is acting pregnant, so she believes she’s pregnant, but she’s
not otherwise delusional,” says Seeman, who’s long studied the
mental disorder. (Why women’s health concerns are dismissed more
and studied less.)

Most cases have psychological and physiological elements. The

American Psychiatric Association’s diagnostic manual, DSM-5-TR,
places pseudocyesis in the category of other specified somatic
symptom and related disorder, along with other difficult-to-
categorize disorders such as illness anxiety disorder (aka
hypochondria) or factitious disorder (aka Munchausen’s).

How common is pseudocyesis?

In 2007, a review in the International Journal of Reproductive
BioMedicine estimated there are between one and six cases per
22,000 pregnancies in the United States. That’s a huge drop since
1940, when the statistic was one case of pseudocyesis per 250
pregnancies—exactly the likelihood of natural twins.

These numbers climb drastically outside the U.S.

“There are parts of Africa, for example, where pregnancy is very

valued and medical care is hard to access, so pseudocyesis is not
uncommon,” says Seeman, who has encountered about 20 cases in
her practice since 1960.

Because of modern medicine and the wide availability of

Because of modern medicine and the wide availability of
ultrasounds, very few cases of pseudocyesis today go undetected
until apparent “delivery.”

Those that do, like Queen Mary’s, often make headlines. In 2014, for
example, a Quebec woman convinced her town she was expecting
quintuplets. At 34 weeks, she went to the hospital to deliver—where
a nurse discovered there were no babies at all.

“Pseudocyesis is notoriously difficult to study,” says Seeman, mostly

due to its rarity and the complexities of the patient’s mental health.
But there's one common thread: “The patient usually
desperately wants to be pregnant.” (See public places that honor the
grief of pregnancy loss.)

Besides a baby, pregnancy may also provide a woman with particular

benefits, such as better care, attention, and even respect.
Unsurprisingly, Seeman says, pseudocyesis occurs more often in
cultures where married women are expected to produce children.

A still-mysterious condition
“The medical establishment, even within the field of OB-GYN, does
not have a good understanding of pseudocyesis,” says Shannon M.
Clark, a maternal fetal medicine specialist at the University of Texas
Medical Branch who has seen cases of false pregnancy.
 3:38

PREGNANCY 101
While customs and traditions involving pregnancy vary worldwide, the developmental process
is essentially universal. Find out about t... Read More

Understanding what’s happening in the body of a woman with

pseudocyesis would help both treat the condition and reduce the
stigma of the sufferer being labeled as “crazy,” Clark says. (Learn how
increasing temperatures are harming pregnant women.)

Pop culture hasn’t helped: For instance, the lead character in the
upcoming TV show American Horror Story: Delicate experiences
violent and terrifying hallucinations during a supposed pregnancy,
an example of a cinematic trope called “pregnancy horror.”

As always, real life isn’t so dramatic. Though changes in hormones

such as prolactin, estrogen, and progesterone can occur, there’s no
clear pattern or elevation of hormone levels associated with the
condition, Clark says.

And the psychiatric drugs doctors might prescribe to a patient,

meanwhile, could actually worsen her health.

For instance, some antipsychotic drugs raise levels of prolactin, a

hormone responsible for lactation, which may just further convince
hormone responsible for lactation, which may just further convince
the patient—and her body—that she’s indeed pregnant.

Prolactin levels also increase with stress, and “it’s safe to say that a
woman who’s convinced she’s pregnant when a test repeatedly says
she’s not is certainly under severe stress,” says Seeman.

Who suffers from pseudocyesis?

Immense stress was likely the trigger for Queen Mary’s pseudocyesis,
experts say.

Nearly a year into her so-called pregnancy, Mary finally emerged

from her chamber and no one spoke of it again (at least officially).
She died three years later, childless, and the throne passed to her
Protestant half-sister, Elizabeth I.

“Pseudocyesis affects people from all ethnic, racial, and

socioeconomic groups,” notes Clark. And although it’s most common
in those aged 20 to 39, it can occur in post-menopausal women as
well. (Learn how AI could offer more insight into neglected women’s
health issues.)

Pseudocyesis in men is even scarcer, though medical literature

documented examples of the phenomenon in two American men, in
1984 and 1995. In April 2022, scientists reported a 28-year-old
American transgender woman who presented as pregnant with
twins.

Unlike many cisgender women with pseudocyesis, these three

individuals all demonstrated severe mental illnesses.
A widespread denial
Just as Queen Mary did for nearly a year in 1555, modern patients
with pseudocyesis will not accept evidence that they’re not pregnant,
Seeman says.

“They might think their husband doesn’t want them to be pregnant,

that he’s colluding with the doctor or hospital. They might think their
in-laws are involved. I’ve seen people who believe the doctor has
impregnated her but won’t admit it,” she says.

“These delusions can take so many forms because the person can’t
accept anyone’s reality but their own. Their reality is they look and
feel pregnant, so as far as they’re concerned, they are.”

Fortunately, the medical establishment has started treating these

unusual cases with increased interest and sensitivity, Seeman says.

“General psychiatry is paying more attention to issues that they used

to consider ‘just’ women’s syndromes,” she says.

From the rest of us, adds Clark, “more understanding and empathy
and less judgment and shaming are needed on all fronts.”

READ THIS NEXT

 READ THIS NEXT

SCIENCE M I N D , B O D Y, W O N D E R

Why schizophrenia in women is so misunderstood

Not enough is known about how the disease affects women, who are more
likely than men to be overlooked—and more likely to d…

H I STO RY M AGA Z I N E
The story of the Belgian princess became empress of Mexico

SCIENCE
Detox your uterus? Debunking popular myths about PCOS

SCIENCE M I N D , B O D Y, W O N D E R
Some vitamins and minerals work better when eaten together
 GO FURTHER

ANIMALS

ANIMALS ANIMALS AN
W I L D L I F E WATC H
Why does Pantone have a color of the Cro
year? It started with birds Paradise or parking lot? A Florida Flo
ecosystem is a battleground.

E N V I RO N M E N T
ENVIRONMENT PA I D C O N T E N T F O R A DV E RT I S E R ENV

Is cooking oil really the future of flying— Connecting with curiosity Wh

or a distraction? 2°C

H I S T O RY & C U LT U R E

H I STO RY M AGA Z I N E H I S TO RY & C U LT U R E HIS

The quest for the Holy Grail began long How an ancient revolt sparked the Wh
before King Arthur Festival of Lights pho

SCIENCE
SCIENCE SCIENCE SCI
2023 IN REVIEW
A young tyrannosaur’s last meal gives Salm
new insight 7 medical breakthroughs that gave us pro
hope in 2023

T R AV E L

T R AV E L PA I D C O N T E N T F O R A DV E RT I S E R TRA

How to spend a day exploring 5 of the best alternative art cities The
Melbourne, Australia fair

THE BEST OF NATIONAL GEOGRAPHIC

DELIVERED TO YOUR INBOX
 DELIVERED TO YOUR INBOX

Sign up for more inspiring photos, stories, and special offers from National
Geographic.
SIGN UP

LEGAL OUR SITES JOIN US FOLLOW US

Terms of Use Nat Geo Home Subscribe

Privacy Policy Attend a Live Event Customer Service

Your US State Privacy Rights Book a Trip Renew Subscription

Children's Online Privacy Buy Maps Manage Your Subscription

Policy
Inspire Your Kids Work at Nat Geo
Interest-Based Ads
Shop Nat Geo Sign Up for Our Newsletters
About Nielsen
Visit the D.C. Museum Contribute to Protect the
Measurement
Planet
Watch TV
Do Not Sell or Share My
Personal Information Learn About Our Impact

Support Our Mission

Masthead

Press Room

Advertise With Us
United States (Change)

Copyright © 1996-2015 National Geographic Society

Copyright © 2015-2023 National Geographic Partners, LLC. All rights reserved