Snapshot A 21-year-old woman presents to her primary care physician for prenatal care. The patient states that her last menstrual period was approximately 5 months ago. She has experienced breast tenderness and increased urinary frequency. Prior to this event, she reports feelings of stress due to cultural pressures for her to become pregnant. She does not take any medications, supplements, or home remedies. On physical examination there is mild abdominal enlargement. 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 Pathophysiology unclear but may involve psychological mechanisms neuroendocrine mechanisms 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 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 patients 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