Evolutionary-rooted models for denial of pregnancy, concealment of pregnancy and pseudocyesis

Women in denial of pregnancy remain unaware of their gravid state. Typically women in labor present to emergency units while attributing their pain to unrelated causes. In higher risk cases, women experience unassisted delivery in a non-hospital setting. In concealment of pregnancy, the woman knows about her pregnancy but keeps it secret for diverse reasons. This induces also a lack of prenatal care and increased perinatal risks for mother and child. Such cases are very challenging to clinicians because of increased medical risk and psychological needs. Better understanding of these psychosomatic disorders is necessary to address the public-health issues raised.

In regard to denial and concealment of pregnancy, in which a pregnant woman thinks or says she is not pregnant, pseudocyesis corresponds to the opposite configuration in which a non-pregnant woman believes, claims and presents objective signs to be pregnant. Pseudocyesis takes therefore place in the same psychosomatic issue to be addressed. This paper aims to explain satisfactorily these psychosomatic disorders of gravida status.

We consider human reproduction in regard to evolution with emphasis on the various forms of parenting existing among sexually reproducing species. This evolutionary study highlights that for some pregnant women, the forthcoming maternal status may be internally appraised as psychologically-unacceptable because of diverse personalized causes. The ongoing pregnancy enters then into conflict with the intense fears triggered by the promise of motherhood. From this perspective, denial and concealment of pregnancy are satisfactorily explained as transitory means to cope with such an internal conflict by pursuing pregnancy while containing associated fears. In the absence of conflict resolution, the avoidance means is protracted over time, sometimes until an unexpected delivery.

Conversely, pseudocyesis is explained as an attempt to obtain a psychologically-indispensable maternal status in the absence of actual pregnancy. Specific conflict formulations are elucidated for each type of psychosomatic disorder of gravida status considered. These formulations, related to subjective internal appraisals, comply with the huge diversity of causative events reported in literature and specific to each woman concerned.

These explanations will help clinicians in caring those high-demanding patients and in exploring individualized causative events of such challenging experiences.