1161169

case-report2023
ICR0010.1177/11795476231161169Clinical Medicine Insights: Case ReportsDas et al

Delusion of Pregnancy: A Case Report Clinical Medicine Insights: Case Reports

Volume 16: 1–6

and Literature Review © The Author(s) 2023

Article reuse guidelines:
sagepub.com/journals-permissions
Soumitra Das1, Sakshi Prasad2 , Shivakumar Ajay Kumar3, DOI: 10.1177/11795476231161169
https://doi.org/10.1177/11795476231161169

Rutendo Denise Makonyonga4 , Mayada Saadoun5

and Reid Mergler6
1Emergency Mental Health, Sunshine Hospital, Melbourne, VIC, Australia. 2Faculty of Medicine,
National Pirogov Memorial Medical University, Vinnytsya, Ukraine. 3ESIC Medical College &
PGIMSR, Bengaluru, Karnataka, India. 4Ivano Frankivsk National Medical University, Ukraine.
5Institute for Behavioral Health, Brandeis University, Waltham, MA, USA. 6 Department of

Psychiatry, Tufts Medical Center, Boston, MA, USA.

ABSTRACT: Delusion of pregnancy is defined as a persistent belief that one is pregnant despite concrete evidence to the contrary. Despite
being reported as an isolated event, delusion of pregnancy has been reported in many patients with underlying psychiatric conditions such as
schizophrenia, bipolar disorder, psychotic depression, and other physiological disorders of mental function. This case study reports a case of
a 44-year-old, drug-naïve female with delusion of pregnancy affected by paranoid schizophrenia. Pharmacological treatments are frequently
insufficient in controlling this condition and are often supplemented with adjunctive psychotherapy.

Keywords: Case report, delusion of pregnancy, delusion, pseudocyesis, review

RECEIVED: August 13, 2022. ACCEPTED: February 11, 2023. Declaration of conflicting interests: The author(s) declared no potential
conflicts of interest with respect to the research, authorship, and/or publication of this
TYPE: Case Report article.

Funding: The author(s) received no financial support for the research, authorship, and/or CORRESPONDING AUTHOR: Sakshi Prasad, Faculty of Medicine, National Pirogov
publication of this article. Memorial Medical University, Pirogova Street, 56, Vinnytsya 21018, Ukraine. Email:
sakshiprasad8@gmail.com

Introduction syndrome, pseudopregnancy, and simulated pregnancy.4,15,20

Delusion of pregnancy is defined as a persistent belief that one
is pregnant despite concrete evidence to the contrary.7,11
Despite being reported as an isolated event, delusion of preg-
nancy has been reported in many patients with underlying psy-
chiatric conditions such as schizophrenia, bipolar disorder,
psychotic depression, and other physiological disorders of
mental function.1,7,15 The Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition ( DSM5) describes delusion
of pregnancy as a somatic type of delusional disorder when it
occurs independently, within the spectrum of schizophrenia or
other psychotic disorders.23 Previous studies have associated
delusion of pregnancy with hyperprolactinemia resulting from
the use of antipsychotic medication including haloperidol,
olanzapine, and risperidone.11,23 In patients with delusions of
pregnancy and hyperprolactinemia, the pregnancy delusions
were resolved by treating the hyperprolactinemia.6,12 Other
conditions have been associated with the delusion of preg-
nancy, including the false perception or interpretation of
bodily sensations known as coenesthesia,15 constipation in the
elderly,25 urinary tract infections, Hashimoto thyroiditis,
hyponatremia syndrome, metabolic syndrome, and polydipsia.
As such, the delusion of pregnancy is associated with multiple
conditions.5,15,24
Delusion of pregnancy is applied when there are no obvious
physical signs of pregnancy, a distinct feature used to differen-
tiate it from pseudocyesis, a somatic condition of having
all signs and symptoms of pregnancy in the absence of a fetus.
This condition should also be differentiated from couvade
Delusion of pregnancy has been reported in women across all
age ranges,3,7,15,20 including postmenopausal women,18 women
who had a hysterectomy, and prepubertal girls.10 However, the
emergence of delusion of pregnancy in men has been strongly
associated with impaired cerebral function, a history of male
sexual abuse, and contact with pregnant women.
More cases have been reported on the delusion of preg-
nancy in developing countries as compared to developed
countries.3,20 Sociocultural factors play an important role in
explaining this observed difference.1,11,15,23 The desire of
achieving pregnancy might be very high among women who
live in cultures where motherhood is viewed as the ultimate
goal of womanhood. In these cultures, the delusion of preg-
nancy has been reported in infertile couples where infertility is
frequently blamed on women, leading to significant distress.18
Thus, it is important to acknowledge the relationship between
the delusion of pregnancy and chronic psychological stress.
Other cases of delusion of pregnancy were reported in women
who wanted pregnancy after the loss of their child in women
experiencing acute loneliness or in those with ambivalent
feelings about pregnancy.5,15,24 In some cases delusion of
pregnancy has been reported in association with other types
of delusions such as delusion of infidelity, persecution, and
erotomania.7,24
Case Report
A 44-year-old married female patient presented to the clinic
with suspiciousness toward others for the past 24 years and

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2 Clinical Medicine Insights: Case Reports 
believes that she is pregnant and had delivered 15 children in
the past 8 years.
The patient exhibited a long-term pattern of stubbornness
and had a complicated obstetric history, which include an
intrauterine fetal demise at 5 months gestational age, 2 Medical
Termination of pregnancies (MTPs), and a voluntary hysterec-
tomy in 2009. Her obstetric history at the time of presentation
consisted of 0 term delivery, 0 preterm, 3 abortions, and no
living child. The patient presented with delusions of reference,
believing others are talking about her. Two months following
the hysterectomy, the patient’s delusion of pregnancy started
and reported that she is 3 to 5 months pregnant and also
reported quickening. She was apprehensive that someone was
trying to take the baby away from her and frequently asked her
husband to return the baby to her. She used to visit several
obstetricians to check the status of her baby and complained
saying that the doctor had taken away the baby if confronted
that she is not pregnant. Occasionally, she would complain of
intermittent labor pain and would force her husband to take
her to the hospital.
The patient at the time of admission showed very strong
delusional tendencies and reasserted her delusions by stating
that in the past, she had become pregnant 15 times, and
believed her urine pregnancy test (UPT) and ultrasonography
(USG) were done while she was asleep. She reported that her
family members got away with all her medical reports and also
delivered her babies while she was asleep. She claimed that “my
clothes were soiled, no slippers to be found the next morning,
and my abdomen was greatly distended.”
On the mental status exam, she was alert and attentive, with
a cooperative attitude, fair hygiene, good eye contact, and no
noted psychomotor agitation. Normal rate, volume, rhythm,
and tone of speech were noted along with no latency and good
articulation. Her language was fluent, the thought-form was
coherent and linear with evidence of paranoid and persecutory
delusions in her thought content. Anxious and depressed mood
was noted while admission, along with below-average intellect,
poor insight, limited judgment, and fair impulse control.
She endorsed a normal childhood and didn’t report any his-
tory of sexual or marital abuse, albeit admitted to feeling pres-
sured for having babies as part of her duty as the woman of the
house. The patient had gotten married to her husband at the
age of 15 to 16 years of age and had completely lost touch with
her maiden home to account for family history.
The patient was admitted with the above complaints and
was administered lurasidone 120 mg per day and clozapine
150 mg per day for a period of 7 days. She developed akathisia
with lurasidone, which was tapered and stopped. Clozapine
trial failed i/v/o intolerability due to constipation and sedation.
She was then observed on olanzapine 20 mg per day, however
the pt. developed pain in the legs and restlessness. The patient
eventually showed partial improvement with ECTS. Therapy
was then focused on behavior and not psychotic symptoms.
The husband explained the prognosis of her condition. Family
therapy was advised. Her husband was asked to observe her
behavior at home and to readmit her on a Si Opus Sit (SOS)
basis for family therapy and treatment rationalization. The
condition at discharge was only mildly improved.
On a follow-up after 1 month, she claimed that her husband
was poisoning her food, giving her nightly injections to kill her,
and because of the poison, a few babies had become disabled,
and a few had died. The patient would explain that she could
become pregnant despite hysterectomy through in vitro fertili-
zation and sometimes through inserting an artificial uterus. On
further investigation, poor drug adherence along with stressful
marital conditions was suspected to potentially hinder improv-
ing her symptoms.
Discussion
Delusion of pregnancy is known to have a multifactorial etiol-
ogy and is predominantly observed in developing countries.29
Albeit, the disorder is more common in females, multiple cases
have been documented in men as shown in Table 1.3,8 Although
incidence has been reported across multiple age groups, accord-
ing to a study by Bera and Sarkar, around 25% of the cases were
observed in the age group of greater than 50 years with equal
prevalence in males and females. The elderly in the non-repro-
ductive age group have been more vulnerable to the delusion of
pregnancy due to associated conditions such as senile demen-
tia, metabolic syndrome, and frontotemporal lobar degenera-
tion. Physician dismissal of symptoms in patients of this age
group contributes to their vulnerability.26
In general, delusions can be explained by 2 models, and they
often have 3 stages. The motivational model interprets delu-
sions as a method of relief from distress and anxiety whereas
the deficit model interprets delusion as a product of cognitive
dysfunction and abnormalities in perception.5 The develop-
ment of delusion of pregnancy occurs in 3 stages. The first
stage called “das trema,” is a general stage of apprehension,
according to Conrad, and occurs after the loss of a loved one.
The second stage involves the formation of a sensory percep-
tion related to weight gain, vaginal spotting or abdominal
movements, and increased frequency of micturition. In this
stage, the patient ends up searching for the significance behind
these perceptions. The third stage involves attaching meaning
to a neutral sensation to help deal with difficult situations (false
belief of being pregnant to help deal with difficult situations
such as losing a child or being diagnosed with infertility).30,31
Biological and psychological factors have been put forth to
explain the pathogenesis of delusion of pregnancy. Psychosocial
factors such as real or imagined loss of pregnancy, loss of a
loved person/object, and loneliness have been implicated in the
development of delusion of pregnancy. In addition, sociocul-
tural factors such as societal pressure to have children, social
deprivation, belief in wizardry, and spiritual deities have also
been known to cause delusion of pregnancy.11,26 In some cases,
low socioeconomic status and illiteracy were also associated
with intensified belief.2 The loss of a loved one, perceived
Table 1. Studies Reporting Delusion of Pregnancy.

Name of study, Type of Associated Disorder Intervention Outcome

country; year Study
Das et al

Grover and Dua1; Case Report • Severe depression with • Antidepressant The delusional belief continues to remain as such
India psychotic symptoms • Antipsychotic
• Delusional disorder • electroconvulsive therapy (ECT)

Khasnobis et al2; Case Report Delusional disorder • Antipsychotic The delusional belief continued with decreased conviction
India • BZD

Gaikwad et al3; Case report Delusional disorder (Male patient) Antipsychotic Patient improved within 3 weeks of treatment with
India Trifluoperazine

Gupta et al4; India Case report Paranoid Schizophrenia Antipsychotics 60-65% Improvement

Goyal et al5; India Case report • Paranoid Schizophrenia • Antipsychotics Patient improved
• Diabetes Mellitus • Psychoeducation
• Cholelithiasis

Ahuja et al6; UK Case report BPD • Valproate semi-sodium Patient improved after 2-4 weeks of admission and symptoms
• Olanzapine resolved completely. Valproate semi-sodium was continued,
olanzapine dose was reduced

Tsai and Shen7; Case report • Psychotic mania • Mood stabilizer Delusion of pregnancy resolved on 16th day of hospitalization
Taiwan • Antipsychotic

Suresh Kumar Case report • Delusional disorder • Antipsychotic Delusion completely resolved after 3 weeks of treatment
et al8; India • Benzodiazepines

Onda et al9; Japan Case report • Schizophrenia • Antipsychotics (Clozapine, Improved after 6 months of hospitalization
• Hyperprolactinemia Aripiprazole)

Rush Ortegon Case report Brief psychotic disorder Antipsychotics (Chlorpromazine) Delusions resolved after 2 months of treatment
et al10; USA

Mascarenhas and Case report Paranoid Schizophrenia Antipsychotics (Olanzapine) Patient improved after starting treatment (Duration not
Crasta11; India specified)

Pang et al12; Case report • Schizoaffective disorder Antipsychotics Patient recovered completely in a few days after up titration of
Singapore • PCOS Olanzapine from 15 to 20 mg

Leal and Beito13; Case report Hypothyroidism • Levothyroxine Symptoms improved 1 month after admission and treatment
USA • Olanzapine

Penta and Case report • Paranoid schizophrenia • L-thyroxine Reduction in persecutory themes and remission of auditory
Lasalvia14; Italy • Hashimoto-related • Antipsychotics (aripiprazole) hallucinations after 3 weeks of antipsychotic treatment. Delusion
hyperprolactinemia • Cognitive Behavioral Therapy( CBT) of pregnancy became less intense after 4 weeks.

AlZamil et al15; Case report • Schizophrenia First and second generation Complete resolution after 18 days of inpatient treatment
Saudi Arabia • Tuberous sclerosis Antipsychotics

Larner16; UK Case report Frontotemporal dementia with - Patient died 18 months after diagnosis of FTD/MND
Motorneuron disease (FTD/MND)

(Continued)
3
Table 1. (Continued)
4
Name of study, Type of Associated Disorder Intervention Outcome
country; year Study

Lopes et al17; Case report • Delusional disorder • Levothyroxine Patients delusional disorder persists even after usage of
Brazil • Hypothyroidism • Hellere’s myotomy antipsychotic
• Anorexia Nervosa • Antipsychotics
• Esophageal achalasia

Sidana and Jain18; Case report Paranoid schizophrenia Risperidone Complete resolution of symptoms after 3 weeks of treatment
India

Vasudev and Case series Major depressive disroder with Olanzapine Resolution of psychotic symptoms after 3 weeks of treatment,
Sharma19; Canada psychosis (1 year) residual depression after 7 weeks of starting treatment

Kornischka and Case report • Schizophrenic psychosis Antipsychotics (Haloperidol/flupenthixol No resolution of symptoms for 25 years with over 4
Schneider20; • Capgras syndrome decanoate/ fluphenazine decanoate,g
Germany clozapine, risperidone, olanzapine,
amisulpride, and quetiapine)

Bhattacharya21; Case report Delusional disorder • Risperidone Improvement and complete resolution after 2 months only with
India • Electroconvulsive therapy Pimozide
• Flupenthixol
• Pimozide

Manoj et al22; India Case report Delusional disroder (with history of • 6 ECTs Patient gradually improved over time
sexual abuse) • Symptomatic treatment

Chatterjee et al23; Case report • subclinical hypothyroidism • Risperidone Psychotic symptoms gradually decreased, and conviction of
India • Iron and folic acid tablet pregnancy became less after 2 weeks. By fourth week she
• Levothyroxine ( Eltroxin) agreed she may be wrong about the pregnancy, and she
became almost free from symptoms after 45 days

Simon et al24; Case report • schizoaffective psychosis • mood stabilizer( lithium carbonate) Psychotic symptoms gradually vanished and by fourth week she
Hungary • antipsychotics( haloperidol switched presumed fetus had been absorbed. Discontinued on medication
to olanzipine) after asymptomatic year but readmitted to psychiatric clinic with
schizoaffective psychosis(without delusion of pregnancy)

Guilfoyle et al25; Case series Case 1: Mixed Alzheimer’s disease/ Case 1:Prior medication (Escitalopram). Case 1: The patient’s delusion was intermittent for 12 h and then
Ireland Vascular Dementia, dehydration, On admission:fluids, antibiotics and disappeared
pneumonia, reduced mobility laxatives

Case 2: Delusion persisted for Case 2: Prior medication (Oxycodone). Case 2: Depression, delirium secondary to dehydration, acute
3 days and delirium for 7 days. On admission: Haloperidol, stool renal impairment, constipation
Unable to recall delusion afterward softeners and enemas

Case 3: Delusion of pregnancy Case 3: Prior medication (Trazodone, Case 3: Alzheimer’s disease, Parkinson’s disease, fecal
persisted for 4 days and resolved Tramadol). On admission: laxatives and incontinence
about the same time as constipation. enema

Case 4: Delusion lasted several Case 4: Prior medication (Alprazolam, Case 4: Vascular Dementia, Chronic depression, delirium,
hours only Escitalopram). On admission: stool dehydration, acute renal impairment
softeners and enemas

Case 5: osmotic and stimulant laxatives
Case 5: Delusion persisted for 4 days despite resolution of
constipation, continued cognition improvement and gentle
correction by staff. Delusion ceased spontaneously on day 10 of
acute illness
Clinical Medicine Insights: Case Reports 
Das et al
societal pressure and low socioeconomic status are the main
contributors to the index patient’s delusions. Delusion of preg-
nancy in men can be psychodynamically interpreted as an
expression of frustrated creativity, envy toward his wife’s ability
to become pregnant, and expression of identification with their
own mothers.26-28
Delusions have also been attributed to being a response to
chronic stressors. Stress-induced hyperprolactinemia is known
to cause menstrual irregularities, breast engorgement, and
mood changes which can be mistaken for pregnancy. There are
multiple drugs such as sertraline, amitriptyline, fluoxetine,
alpha-methyldopa, and verapamil which are also known to
cause hyperprolactinemia.33
DSM-5 defines pseudocyesis as a false belief of being preg-
nant that is associated with objective signs and reported symptoms
of pregnancy, which may include abdominal enlargement, reduced
menstrual flow, amenorrhea, subjective sensation of fetal move-
ment, nausea, breast engorgement and secretions, and labor pains
at the expected date of delivery. There have been cases reported in
the past of patients diagnosed with delusion of pregnancy pre-
senting with physical symptoms such as abdominal distension,
sensation of fetal movements, and shortness of breath.
Although it is more common in pseudocyesis, a clear distinc-
tion cannot be made between the 2 conditions based on the
presence or absence of signs and symptoms of pregnancy.11 The
latter is considered a symptom of psychosis and when present
independently is called somatic type delusional disorder
according to DSM-5 within the realms of schizophrenia and
other psychotic disorders. Although this index patient reports
the sensation of fetal movements, there are no other signs or
symptoms pointing toward a diagnosis of pseudocyesis.
Delusion of pregnancy is known to present more commonly
with multi-thematic delusions (multiple delusions such as
delusion of reference, the delusion of infidelity, the delusion of
persecution) than monothematic delusions. In this index
patient, there is a presence of delusion of reference and perse-
cution associated with the delusion of pregnancy.29 There are
no such associations present in pseudocyesis. There is also a
history of chronic psychological stressors in the form of losing
a fetus at 5 months of gestation, undergoing 2 MTPs, and a
hysterectomy. The presentation of multi-thematic delusions, a
history of chronic psychological stressors, and a lack of other
physical symptoms favor a diagnosis of delusion of pregnancy
over pseudocyesis.
Other conditions which imitate pregnancy and should be
differentiated from the delusion of pregnancy are pseudopreg-
nancy and couvade syndrome. Pseudopregnancy is a somatic
state resembling pregnancy caused by organic factors. The
physical symptoms here can be caused by endocrine tumors.23
Couvade syndrome is a somatic symptom disorder where in
response to a female partner’s pregnancy, the male partner
develops symptoms such as anxiety, weight gain, GI dis-
turbances, and insomnia. The behavior will resemble that of a
5
pregnant woman, but insight into not being pregnant is pre-
served here.32
Management of delusion of pregnancy must consider any
associated underlying medical conditions to prevent life-
threatening delays in diagnosis and treatment. In patients with
antipsychotic-induced hyperprolactinemia, prolactin-sparing
antipsychotics such as quetiapine, ziprasidone, and aripiprazole
can be considered. Although they are known as prolactin-spar-
ing antipsychotics, they are known to cause hyperprolactinemia
and it is therefore recommended to monitor prolactin levels in
such patients regularly. ECT has shown minimal and tempo-
rary improvement in this condition in the past. The index
patient showed improvement with ECT. However, there is a
lack of adequate literature to establish its long-term effective-
ness. Delusion of pregnancy with underlying psychiatric condi-
tions is known to be treatment-resistant and success with
antipsychotics is not observed by their usage alone. Thus, cog-
nitive and supportive psychotherapy should also be included
with pharmacotherapy to achieve acceptable outcomes. Family
therapy and psychoeducation about the condition can ensure
the family members cope better with such diagnoses.5,33
A huge tally of patients show minimal improvement with
the above interventions. Since treatment modalities take differ-
ent routes, further in-depth exploration and research is neces-
sary to draw a clear distinction between the delusion of
pregnancy and pseudocyesis to make sure the patient is better
managed.
Conclusion
In conclusion, delusion of pregnancy is a broad condition that
can manifest throughout a range of neuropsychiatric syn-
dromes. Social, psychological, and biological factors can con-
tribute to the development of delusion. Treatment should focus
on pharmacotherapy along with cognitive and supportive
psychotherapy.
Author Contributions
SD and SP were responsible for conception and supervision,
data proofing and writing the final manuscript. SP, SAK, and
RDM wrote the initial two drafts and was responsible for
obtaining data images and incorporating laboratory data into
the manuscript. MS and MR wrote the third draft, peer review
changes and approved the final draft after editing. All authors
approved the final manuscript and agreed to be equally account-
able for this work.
Ethical Approval
Ethical approval was waived by the patient for this case report.
Informed Consent
Written informed consent was obtained from the patient(s) for
their anonymized information to be published in this article.
The subject had the decision capacity to provide written
informed consent.
6 Clinical Medicine Insights: Case Reports 

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Rutendo Denise Makonyonga https://orcid.org/0000 16. Larner AJ. Delusion of pregnancy: a case revisited. Behav Neurol.
2013;27:293-294.
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of achalasia in a patient with life-threatening emaciation. Oxf Med Case Reports.
2014;2014:52-54.
18. Sidana A, Jain R. Delusion of twin delivery in a post-menopausal woman:
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