Hysterical pregnancy in men (Couvade syndrome): causes, symptoms, diagnosis, treatment
Pseudocyesis or ‘hysterical pregnancy’ in medicine and psychology refers to the appearance of clinical or subclinical symptoms and signs typically associated with pregnancy in individuals who are NOT actually pregnant
The appearance of symptoms and signs of pregnancy, in its absence, is fundamentally caused by trauma of a psychological nature and – often – the excessive desire to be a mother in individuals (females and males) who, for various reasons, cannot be.
The false belief of being pregnant includes various signs and symptoms such as a painful chest with discharge, abdominal growth and subjective feelings of a foetus moving inside the abdomen.
Psychotherapy, pharmacotherapy with antidepressants or antipsychotics and, in rare cases, hormone therapy or surgery, are necessary as treatment.
Synonyms for pseudocyesis are ‘hysterical pregnancy’ or ‘false pregnancy’ or ‘pseudopregnancy’ or ‘phantom pregnancy’
False pregnancy is sometimes referred to as ‘delusional pregnancy’, although the two expressions are not exactly equivalent.
The word pseudocyesis is derived from the Greek word ‘pseudes’ meaning ‘false’ and ‘kyesis’ meaning ‘pregnancy’.
Hysterical pregnancy can affect both sexes at any age, however it tends to affect more women at a younger age, generally between 30 and 35.
In men it generally strikes between the ages of 30 and 40.
Couvade syndrome (sympathetic pregnancy)
Although more common among women, hysterical pregnancy can also affect men and in this case is called Couvade syndrome or ‘sympathetic pregnancy’.
In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), false pregnancy is a somatoform disorder listed as ‘not elsewhere classified’, which means that it is in a category of its own, different from other somatic symptom disorders such as functional neurological symptom disorder (formerly known as conversion disorder).
Causes risk factors of hysterical pregnancy in men
The specific causes of hysterical pregnancy in men have not yet been fully elucidated, but it is now certain that there may be two types of factors behind it, which may act individually or in synergy: psychological/psychiatric factors and biological/neuroendocrine factors.
In some cases, certain drugs may favour the appearance of certain symptoms.
Psychological and psychiatric factors of hysterical pregnancy in men
Most cases of pseudocyesis are caused by psychological factors and in this sense are considered ‘somatoform disorders’.
In medicine and psychology, ‘somatoform disorder’ (somatic symptom disorder) identifies a group of various types of psychic disorders characterised by the presence of physical symptoms that apparently suggest illnesses or conditions of an organic nature, whereas in reality they are partly or wholly caused by a psychic distress and at the root of which it is not possible to trace documentable pathophysiological phenomena, at least according to current scientific knowledge.
The field of study that deals with somatoform disorders is psychosomatics.
To simplify the concepts: in the majority of hysterical male pregnancies, a psychological discomfort is ‘somatised’ by the subject, i.e. it is transformed into symptoms or signs typical of pregnancy.
Psychological conditions that can favour false pregnancy are:
- psychological discomfort present in individuals who, although born male, identify with the female sex;
- empathy towards a pregnant partner or wife;
- recent loss of a child;
- recent abortion by one’s wife or partner;
- infertility or sterility problems in the couple;
- any difficulty preventing pregnancy.
Psychiatric disorders, such as anxiety or mood disorders, personality disorders and schizophrenia may favour false male pregnancy.
Some depressed men may gain weight due to reduced physical activity and poor eating habits, which also occurs in some patients with bulimia nervosa and binge eating disorder.
Possible biological factors that may favour false male pregnancy are:
- gallstones;
- large abdominal tumours;
- hormone-secreting tumours;
- alcoholic hepatopathy with liver megalysis
- cholecystitis;
- urinary tract infections;
- severe constipation;
- increased concentration of female hormones.
Some drugs, such as antipsychotics, can induce pregnancy-like symptoms.
Risk factors that increase the chances of suffering from hysterical pregnancy in men are:
- age between 30 and 40 years;
- depression, schizophrenia, anxiety and personality disorders or other psychiatric disorders;
- low level of education;
- identification with the female sex;
- marital problems;
- history of abortions preceding the false pregnancy;
- unstable relationship patterns;
- history of parental abuse;
- social deprivation;
- poverty;
- low socio-economic status;
- unemployment;
- overweight or obesity;
- high alcohol intake;
- intake of certain drugs;
- recent loss of a child.
Symptoms and signs
The symptoms of pseudocyesis are similar to the symptoms of true pregnancy and – on superficial investigation – is often indistinguishable from it.
Various signs and symptoms are present, including:
- morning sickness
- frequent episodes of vomiting;
- sudden and unusual change in taste;
- increased sense of smell;
- progressive increase in body weight;
- increased volume of the abdomen;
- abdominal tension;
- increase in breast volume;
- tension and pain in the breasts;
- leakage of fluid from the nipples;
- fetal movement sensations and contractions;
- frequent urination.
The duration of symptoms typically ranges from several weeks to nine months.
Conversion disorder
Hysterical pregnancy usually arises as a result of intense psychological stress and may be one of the symptoms of conversion disorder (hysterical neurosis).
‘Conversion disorder’ or ‘conversion hysteria’ or ‘hysterical neurosis’ or ‘hysteria’ (hence the acronym ‘CD’, or ‘functional neurologic symptom disorder’) in medicine and psychology refers to a specific type of somatoform disorder consisting of the presence of physical, usually neurological symptoms caused by a psychic or emotional conflict that are unconsciously converted by the patient into symptoms with characteristics similar to those of an organic disease or condition.
Other possible symptoms of conversion disorder are hysterical blindness, hysterical deafness, convulsions, paralysis and hysterical amnesia.
Diagnosis of hysterical pregnancy in men
In the presence of a man showing signs of pregnancy, unless it is a woman who has had a sex change while keeping her reproductive system intact, it is obviously easy for the doctor to guess that he is dealing with a false pregnancy.
To convince the patient that he or she is indeed suffering from a hysterical pregnancy, the absence of the foetus can be shown to him or her by ultrasound.
However, the doctor must never underestimate the patient’s symptoms: in some cases, false pregnancy symptoms may mask serious underlying medical conditions such as advanced abdominal tumours, large gallstones, various types of hormone-secreting tumours, alcoholic hepatopathy, cholecystitis, urinary tract infection or severe constipation.
Based on the specific symptoms, medical examinations and imaging (e.g. CT and/or MRI) are then recommended to rule out potentially life-threatening conditions.
Therapy for hysterical male pregnancy
A false male pregnancy can have multiple underlying causes, so there is no one-size-fits-all treatment, but rather there are various different types of treatment depending on the underlying causative factor.
For instance, if the symptoms are caused by a drug, it may be necessary to stop taking it.
If, on the other hand, the false pregnancy is caused by a large abdominal tumour, surgery will be necessary to remove the tumour.
In the majority of cases, however, the underlying cause of a hysterical pregnancy in men is a psychological distress that the subject is unable to cope with alone: in these cases, the psychotherapeutic approach is particularly useful.
Psychotherapy allows patients to confront reality and accept symptoms as illusions and offers an opportunity to resolve other psychological stressors and traumas that may be involved in manifestations of false pregnancy.
There is no direct evidence to treat false pregnancy with pharmacotherapy, but drugs can be used in some cases, for instance to address a psychiatric condition such as depression.
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