Things that go bump: A brief overview of Couvade Syndrome

In a previous blog, I briefly reviewed a number of different types of pregnancy delusion. One of the more interesting of these and somewhat controversial male psychological conditions that have been reported relatively frequently in the psychological research literature is Couvade syndrome (sometimes called sympathetic pregnancy) but is not generally recognized as a bone fide medical condition. There are two derivations of the name. The first derives from the French verb ‘couver’ meaning ‘to brood, to hatch’). The second derivation comes from a misunderstanding of the idiom ‘faire la couvade’ (“to sit doing nothing”). The term is over 150 years old and was used by Edward Burnett Taylor (an English anthropologist) to describe cross-cultural fatherhood rituals during their partners’ pregnancies. For instance, in 1865, Taylor described various cultures where it was the father who took to bed with labour pains while the pregnant mother continued to work in the fields. Taylor also described how the midwife stayed with the father rather than the mother.

Most health practitioners would agree that it appears to be a more psychosomatic condition and occurs when males appear to experience similar symptoms to that of their pregnant partner. Some of the more commonly reported symptoms have included morning sickness, increased or decreased appetite, strange food cravings, toothache, sleep disturbances (e.g., insomnia), indigestion, diarrhea, constipation, backache, hormone level fluctuations, nosebleeds, and weight gain. In more extreme cases, there have been reports of sympathetic stomach and labour pains, breast changes, breast secretions, hardening of the nipples, and postnatal depression. In these extreme cases, there are reports of expectant fathers gaining up to 30 pounds in weight and growing a belly similar to a 7-month pregnant woman (the so-called ‘false pregnancy syndrome’).

A paper by Dr. S. Masoni and colleagues in the Journal of Psychosomatic Obsteterics and Gynecology noted that thesevarious symptoms have been described in the partners of pregnant women with an incidence ranging from 11% to 65%, and that the most common of these symptoms were (a) appetite variations, (b) nausea, (c) insomnia and (d) weight gain. Physiological studies (such as those by Dr. A. Storey and his colleagues published in the journal Evolution and Human Behavior) have indicated that males living with their pregnant partners show sympathetic hormonal changes in cortisol, testosterone, estradiol, and prolactin, across the pregnancy and a few weeks after birth.

Dr. Arthur Brennan and colleagues carried out a critical review of the Couvade Syndrome in a 2007 issue of the Journal of Reproductive and Infant Psychology. They noted that the syndrome was a global phenomenon occurring in many industrialised countries worldwide but had wide international variance on terms of the symptoms that men displayed. Their review asserted that expectant fathers were most affected during the first and third trimesters of their partner’s pregnancy. They concluded that the syndrome’s relationship with socio‐demographic factors was “inconsistent, with the exception of ethnicity”. However, they also make the point that the differences in findings may simply “reflect methodological problems in the syndrome’s definition or criteria and type of measurement across studies”.

There are no definitive explanations for Couvade Syndrome but there have been no shortage of theories. In a 1991 issue of the International Journal of Psychiatry Medicine, Dr H. Klein overviewed several psychological theories. Reasons as to why men experienced sympathetic pregnancy symptoms included pregnancy envy, pseudo-sibling rivalry, paternal ambivalence, and paternal identification with the unborn baby. More specifically, psychodynamic theories argue that men are envious of their partner’s ability to procreate or that they are becoming rivals for the pregnant woman’s attention. However, Klein sits on the fence somewhat and concludes that: “It is likely that the dynamics of couvade may vary between individuals and may be multi-determined”. Evolutionary psychologists speculate it is about the minimizing of gender differences and/or balancing of gender roles. The critical review by Brennan and his associates rightly pointed out that these theories have not been systematically investigated, and those that have been examined haven’t shown consistent findings. In one online summary of the disorder, it has also been noted that in some cultures, Couvade symptoms are often attributed to attempts at keeping spirits and demons from the mother or seeking favour of supernatural beings for the child.

The same authors also recommended that future research should utilize qualitative approaches to further uncover “the syndrome’s characteristics, definition and perceptions as seen by male partners”. They then followed their own recommendation and published a qualitative study (again in the Journal of Reproductive and Infant Psychology) interviewing 14 expectant fathers with pregnant partners aged 19–48 years (across different social and ethnic backgrounds). Their interviews revealed some key themes including (i) ‘Nature, Management and Duration of Symptoms’ (physical symptoms were more commonplace than psychological ones) and (ii) ‘Explanatory Attempts for Symptoms’ (symptoms influenced by cultural beliefs and conventions such as religion, alternative medical beliefs or through the enlightenment by healthcare professionals).

More recently (2010), Dr. Brennan also carried out a national online survey on Couvade Syndrome in Australia among 1439 men. He examined men’s health during and after their partner’s pregnancy. The diagnostic criterion that Brennan used for Couvade Syndrome was that men had to have experienced at least eight physical or psychological symptoms. The study found that 31% of Australian men were ‘diagnosed’ with Couvade Syndrome (compared to 25% found previously in a 2007 UK population carried out by Brennan, and 23% found in a 1982 study published by Dr. M. Lipkin and Dr. G. Lamb in the Annals of Internal Medicine). The most commonly reported symptoms were weight gain (26%), tiredness (45%), and “feeling stressed / anxious” (37%). The incidence of ‘abdominal distension’ – the so-called ‘phantom pregnancy’ was 7%.

Because Couvade Syndrome does not appear in any medical textbook, there does not appear to be any standardized and/or mainstream treatment. Anecdotally, expectant fathers suffering Couvade-type symptoms are simply told verbally that such symptoms are relatively commonplace and not to worry. Other simple interventions such as herbal remedies, relaxation techniques (e.g., meditation) and/or yoga can be employed.

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

Further reading

Brennan, A. (2010). Couvade Syndrome in Australian Men: A National Survey, 2010. Located at: http://www.abc.net.au/catalyst/fatherhood/CatalystCouvadeSurveyAustralia.pdf

Brennan, A., Ayers, S., Ahmed, H. & Marshall-Lucette, S. (2007). A critical review of the Couvade syndrome: the pregnant male. Journal of Reproductive and Infant Psychology, 25, 173- 189.

Brennan, A., Marshall-Lucette, S. Ayers, S., & Ahmed, H. (2007). A qualitative exploration of the Couvade syndrome in expectant fathers. Journal of Reproductive and Infant Psychology, 25, 18-39.

The Free Dictionary (2012). Couvade Syndrome. Located at: http://medical-dictionary.thefreedictionary.com/Couvade+Syndrome

Klein, H. (1991). Couvade syndrome: male counterpart to pregnancy. International Journal of Psychiatry Medicine, 21, 57-69.

Lipkin, M. & Lamb, G.S. (1982) The couvade syndrome: an epidemiological study. Annals of Internal Medicine, 96, 509-511.

Masoni, S., Maio, A., Trimarchi, G., de Punzio, C. & Fioretti, P. (1994). The couvade syndrome. Journal of Psychosomatic Obsteterics & Gynecology, 15, 125-131.

Storey, A.E.,  Walsh, C.J,  Quinton, R.L. & Wynne-Edwards, K.E. (2000). Hormonal Correlates of Paternal Responsiveness in new and expectant fathers. Evolution and Human Behavior, 21, 79–95

Taylor, E.B. (1865). Researches Into the Early History of Mankind and the Development of Civilization. London: John Murray.

Wikipedia (2012). Couvade Syndrome. Located at: http://en.wikipedia.org/wiki/Couvade_syndrome