Snapshot A 22-year-old woman presents to her primary care physican for prenatal care. The patient reports to having menstrual irregularities for the past 4 months. She says that she has been experiencing mild breast tenderness, increased urinary frequency, and that she can feel the baby move. Beyond these symptoms, she denies any headache or galactorrhea. She takes a daily multivitamin and does not take any medications or home remidies. She feels relief for being pregnant due to the amount of pressure her family places on her, emphasizing to her that becoming pregnant will ensure a happy marriage. On physical examination, there is increased pigmentation of the areola and a mildly enlarged abdomen without effacement of the umbilicus. Urine β-hCG is negative. Introduction Clinical definition a rare somatic symptom disorder where a non-pregnant and non-psychotic woman thinks she is pregnant patients also exhibit signs and symptoms of pregnancy Epidemiology Incidence not known decreased incidence in developed countries where there is a trend towards having a smaller family Demographics female 20-39 years of age Risk factors perhaps more common in cultures that highly value childbearing which may lead to psychological stressors misinterpretation of somatic stimuli ETIOLOGY Pathophysiology unclear but may involve psychological mechanisms neuroendocrine mechanisms Presentation Symptoms belief that they are pregnant menstrual irregularities feeling that there is fetal movement urinary frequency breast changes such as breast tenderness nipple and areola pigmentation Physical exam abdominal enlargement (most common) no effacement of the umbilicus, as would be seen in normal pregnancy Studies Diagnostic criteria the patient must not be pregnant and psychotic exhibits signs and symptoms of pregnancy Differential Pregnancy Delusion of pregnancy these patients have relatively absent symptoms suggestive of pregnancy and may have a psychotic disorder Medical conditions such as gestational trophoblastic disease (e.g., hydatidiform mole) prolactinoma pelvic tumors Factitious disorder or malingering Treatment Conservative explaining the diagnosis in a therapeutic manner indication a key type of intervention in patients with pseudocyesis counseling indications for treating patients with pseudocyesis Complications Patients may become depressed if not appropriately managed Prognosis Natural history of disease not well described; however, symptoms can last a few weeks, 9-months, or years patients may experience spontaneous recovery patients may have more than one episode of pseudocyesis Prognostic variables positive probably resolving the psychological and/or interpersonal factors that may have contributed to the patient developing pseudocyesis