Pseudocyesis in a deployed military member

Introduction

Pseudocyesis is defined by the false and fixed belief of being pregnant with associated symptoms of pregnancy. This diagnosis is contrasted with delusion of pregnancy, which differs by lack of physical symptoms. Cases of pseudocyesis in high-income countries are rare and are typically associated with low socioeconomic status, history of infertility, and psychosocial stress.

Case report

A 35-year-old active-duty female Service member with three previous deployments and no history of psychiatric disorders presented for prenatal care of her reported 35-week gestation. She reported conception after return from deployment and validated pregnancy status with symptoms of increased breast and abdominal size as well as frequent nausea and vomiting. The patient also endorsed fetal movement. She endorsed regular monthly menses but noted that they had gotten lighter since she conceived this pregnancy. Obstetric history was notable for previous termination. Her social history was complicated by childhood sexual trauma and spousal emotional abuse. Physical exam and ultrasound showed a healthy weight woman with a non-distended abdomen and nongravid uterus. Qualitative and quantitative b-HCG laboratory findings were negative, and all other laboratory findings including urine drug screen were within normal limits. Psychiatric assessment and mental status exam were unremarkable. After diagnosis of pseudocyesis, indicated treatment involved supportive therapy.

Discussion

This case illustrates a rare incidence of pseudocyesis in a high-income setting. Pathophysiologic etiologies of pseudocyesis suggest neuroendocrine pathway dysregulation associated with underlying mood disorders and psychosocial stressors. Recognition and discernment of pseudocyesis is critical for appropriate intervention and prevention of recurrent episodes.