Bump start: An overview of delusions of pregnancy

Delusions of pregnancy are relatively rare and have been reported in both males and females (although it is more common in men). The first documented case of delusional pregnancy was reported by Esquirol at the turn of the nineteenth century. Among women it can occur right across the age range including virginal young women and post-menopausal women. It has been associated with a variety of different disorders including general delusional disorders, organic brain syndromes (e.g., senile dementia), mental retardation, schizophrenia, schizoaffective disorder, epilepsy, metabolic syndrome, neuroendocrine abnormalities, sexual identity confusion, cerebral syphilis (following encephalitis), polydypsia, and drug-induced lactation.

A 1996 paper by Dr. Shabari and Dr. G.K. Vankar published in the Indian Journal of Psychiatry, made the important distinction between delusions of pregnancy and four other related – but psychologically different – disorders. Exactly the same observations were made in a 2009 issue of the European Journal of Psychiatry by a Hungarian team led by Dr. Maria Simon. The four pregnancy-related disorders were:

• Pseudocyesis (whereby false ‘pregnancy’ occurs in either women or men with marked bodily signs of pregnancy but where the individuals are not actually pregnant).
• Couvade Syndrome (whereby the male partners of pregnant women experience empathetic pregnancy-like symptoms including loss of appetite, morning sickness, constipation, etc. The male knows he is not pregnant)
• Malingering (whereby individuals – male or female – claims to be pregnant knowing that they are not).
• Pseudo-pregnancy (whereby a somatic state resembling pregnancy occurs in women that is triggered by organic factors, such as ovarian tumours causing endocrinal changes leading to pregnancy-like symptoms).

In a 1994 issue of the British Journal of Psychiatry, Dr. A. Michael and his colleagues reported five cases of pregnancy delusion (three females and two males) that included one case where the delusion had lasted 20 years. Other case reports by Dr. K.N. Chengappa and colleagues – also in the British Journal of Psychiatry – found that he same individuals can have multiple delusional pregnancies over long periods as well as believing they are having multiple births. There doesn’t seem to be any common characteristics among those with pregnancy delusions as demonstrated by these four reports from various cases reported in psychiatric journals.

• Report 1: A 51-year old American man turned up to a hospital insisting he was pregnant. The man was said to have no organic cerebral pathology but had a 20-year history of chronic delusional disorder. He even inserted a knife into his anus to facilitate delivery of the “baby”. The delusion of pregnancy subsided over a four-month period following a course of chlorpromazine (reported in the American Journal of Psychiatry, 1991).
• Report 2: Delusions of pregnancy were reported in five women aged over 64 years. All five women were reported as having major depressive episodes with mood-congruent delusions. The symptoms were discussed in relation to other delusions such as Cotard’s Syndrome (reported in the International Journal of Geriatric Psychiatry, 1995).
• Report 3: While on chlorpromazine medication, a psychotic 15-year old female developed a delusion of pregnancy. The delusions were initiated because the girl developed galactorrhea (breast milk production) – one of the side effects of taking high doses of chlorpromazine. It was concluded that the incidence of pregnancy delusions may be higher among female institutionalized patients treated with chlorpromazine (reported in the American Journal of Psychiatry, 1971).
• Report 4: A 43-year old man presented with a persistent pregnancy delusion. The man suffered from chronic schizophrenia and was described as coming from a background of poor sexual adjustment (reported in the journal Psychopathology, 1995).

A 2002 study by Dr. D.S. Rosch and his associates published in the International Journal of Psychiatry in Medicine was the first to utilize a standardized mental disorder assessment tool (the Brief Psychiatric Rating Scale) to compare a group of 11 women with delusional pregnancy with a group of 11 female controls. Compared to the control group, women with pregnancy delusions had significantly higher levels of hostility, higher rates of prescribed poly-pharmacy, and a trend toward higher antipsychotic medication dosages. The authors reported that their findings may be suggestive of greater resistance to treatment in women with pregnancy delusions.

A more recent 2008 study published in the journal Psychosomatics by Dr. N. Ahuja and colleagues looked at the association between pregnancy delusions and antipsychotic-induced hyperprolactinemia. Among 12 patients taking such medication, six of them had erroneous ideas of being pregnant (four delusional and two non-delusional).

Most of the literature comprises case studies and therefore the literature base is limited by relatively few cases and by those who present for treatment. As Dr. Maria Simon and her colleagues concluded in their paper in the European Journal of Psychiatry:

“Case reports usually reveal demographic characteristics, describe response to treatment, and/ or suggest etiology. Patients with delusional pregnancy have been reported to be more hostile and treatment resistant compared with matched controls. Possible etiological factors in delusion of pregnancy are typically limited to neurophysiologic, endocrine and traditional psychodynamic factors. Given the growing evidence of cognitive and affective models of delusion formation, an integrated, individualized model of delusion of pregnancy can advantageously contextualize the phenomenology and course of the illness”.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Adityanjee, A.M. (1995). Delusion of pregnancy in males: A case report and literature review. Psychopathology, 28, 307-311.

Ahuja, N., Moorhead, S., Lloyd, A.J. & Cole, A.J. (2008). Antipsychotic-induced hyperprolactinemia and delusion of pregnancy. Psychosomatics, 49, 163-167.

Ali, J.A., Desai, K.D. & Ali, L.J. (2003). Delusions of pregnancy associated with increased prolactin concentrations produced by antipsychotic treatment.International Journal of Neuropsychopharmacology, 6, 111-115

Bitton, G., Thibaut, F. & Lefevre-Lesage, I. (1991). Delusions of pregnancy in a man. American Journal of Psychiatry, 148, 811-812.

Camus,^, V., Schmitt, L., Foulon, C., De Mendonça Lima, C.A. Wertheimer, J. (1995).Pregnancy delusions in elderly depressed women: A clinical feature of Cotard’s syndrome? International Journal of Geriatric Psychiatry, 10, 1071-1073.

Chengappa, K.N., Steigard, S., Brar, J.S., & Keshavan, M.S. (1989) Delusion of pregnancy in men. British Journal of Psychiatry 155, 422-423

Cramer, B. (1971). Delusion of pregnancy in a girl with drug-induced lactation. American Journal of Psychiatry, 127, 960-963.

Dutta, S. & Vankar, G.K. (1996). Delusions of pregnancy – A report of four cases. Indian Journal of Psychiatry, 38, 254-225.

Manjunatha, N. & Saddichha, S. (2009). Delusion of pregnancy associated with antipsychotic induced metabolic syndrome. World Journal of Biological Psychiatry, 10, 669-670.

Michael A., Joseph A., Pallen A. (1994) Delusions of pregnancy. British Journal of Psychiatry, 164, 224-246.

Rosch, D.S., Sajatovic, M. & Sivec H. (2002). Behavioral characteristics in delusional pregnancy: A matched control group study. International Journal of Psychiatry in Medicine, 32, 295-303.

Simon, M., Vörös, V., Herold, R., Fekete, S., Tényi, T. (2009). Delusions of pregnancy with post-partum onset: An integrated, individualized view. European Journal of Psychiatry, 23, 234-242.

Tényi, T., Herold, R., Fekete, S., Kovács, A., & Trixler, M. (2001). Coexistence of delusions of pregnancy and infestation in a male, Psychopathology, 34, 215-216.