Delusion of Pregnancy: An Atypical Presentation of Schizophrenia

INTRODUCTION

Delusion of pregnancy is defined as a persistent belief that one is pregnant despite concrete evidence to the contrary. This unusual phenomenological symptom is observed in both sexes and may appear either alone or as a component of another disorder.¹ The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes delusions of pregnancy as a somatic type of delusional disorder when it occurs independently, within the spectrum of schizophrenia or other psychotic disorders.² Delusion of Pregnancy is rare in developed countries due to recent advancements in more specific and accurate methods of detecting pregnancy. Although the prevalence of this phenomenon is more in the developing countries, the research, however, in India is very scanty. The use of antipsychotic medications for managing psychotic symptoms resulted in marked hyperprolactinemia, which in turn produced physiological changes, most notably amenorrhea and galactorrhea. These drug-induced manifestations mimicked signs of pregnancy and inadvertently strengthened their false belief of being pregnant.^3,4

Here, we describe about a 50-year-old female with a history of schizophrenia and intake of psychotropic medications presenting with the belief of being pregnant.

CASE REPORT

A 50-year-old married, postmenopausal woman, with no history of pregnancy or childbirth, presented to the Psychiatry Outpatient Department accompanied by her husband with complaints of a firm belief of being pregnant for the past six months. She reported sensations of fetal movements in her abdomen and expressed certainty that she was carrying a child. She had begun to modify her lifestyle accordingly, consuming a more nutritious diet, avoiding junk food and heavy work, taking adequate rest, and increasing her water intake to ensure a “healthy pregnancy.” She pointed to her “growing abdomen” as evidence, although it appeared due to fat accumulation.

She had become increasingly withdrawn, spending most of her time alone, and reacted with irritability when questioned about her beliefs. She also expressed persecutory ideas, claiming that her family members were conspiring to harm the “growing foetus.”

Six months prior, she had consulted a gynaecologist, who performed comprehensive investigations including serum β-hCG, ultrasonography of the abdomen and pelvis, and other biochemical tests, all of which ruled out pregnancy. The same tests, repeated one month later, produced similar negative results. Her psychiatric history revealed a diagnosis of schizophrenia for the past 20 years. Initially, she had presented with persecutory delusions and third-person auditory hallucinations with derogatory content. She had been maintained on regular antipsychotic medication with good functional outcomes over the years.

On current admission, detailed physical, psychological, and gynaecological examinations were performed. Repeat serum β-hCG, ultrasonography, and neuroimaging showed no evidence of pregnancy or structural brain abnormalities. Her current symptoms were consistent with a delusion of pregnancy secondary to schizophrenia.

Her existing antipsychotic regimen was optimized by increasing the dosage and adding short-term benzodiazepines to manage anxiety and agitation. Over the following weeks, her conviction regarding pregnancy gradually diminished, although occasional doubts persisted early in the course of treatment. With continuous pharmacological management and supportive psychotherapy, her insight improved progressively.

DISCUSSION

Delusion of pregnancy is most often observed in schizophrenia and related psychotic disorders [Figure 1], yet it crosses diagnostic boundaries. The phenomenon appears nosologically nonspecific, occurring in schizophrenia, mood disorders, organic brain disease, and delusional disorder.⁵ In our case delusion of pregnancy was secondary to Schizophrenia. Several reports emphasize the role of hyperprolactinemia, whether drug-induced (e.g., Risperidone, haloperidol, olanzapine) or due to endocrine disorders (e.g., Hashimoto’s thyroiditis), in triggering delusional pregnancy, firmly grounded in bodily sensations such as galactorrhea or amenorrhea.⁶ In our case, all related blood investigations didn’t reveal any such abnormality. From a cognitive perspective, faulty interpretations of benign bodily sensations (e.g., fullness, abdominal movements) may be misattributed as fetal signs supported by various theories.⁷ In schizophrenia associated cases, delusional pregnancy may be accompanied by external hallucinations of fetal voices, fetal movement, multiple foetus beliefs, and bizarre identity or gender shifts (e.g., belief that the patient is a pregnant woman).⁸ In our case, we found that there was a report of sensation of fetal movement. Overall, around 61–64% of cases respond favourably to treatment with antipsychotics and psychotherapy. In our case, we also got a good response on increasing and adjustment of antipsychotic dose. When hyperprolactinaemia is implicated, switching to prolactin-sparing agents (e.g., Aripiprazole) and addressing endocrine abnormalities may facilitate resolution.⁹ In our case, the patient was a postmenopausal woman. The loss of reproductive potential may further contribute to the formation of such delusional beliefs.

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Figure 1:

Common diagnoses associated with delusion of pregnancy

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Delusion of pregnancy in schizophrenia exemplifies a compelling intersection of sensory misperception, hormonal disruption, cognitive distortion, and deep psychosocial meaning. A holistic, integrated treatment approach is required to address the biological triggers, cognitive restructuring, and psychosocial needs within the individual’s cultural context.¹⁰ The management should adopt a comprehensive biopsychosocial framework, combining pharmacotherapy with appropriate psychological interventions. Optimization of antipsychotic treatment remains the cornerstone, while cognitive restructuring techniques can help challenge the fixed false beliefs. Additionally, psychoeducation and family involvement play a crucial role in fostering insight and adherence.Given the influence of cultural and social values surrounding fertility and motherhood, clinicians must approach such cases with empathy and cultural sensitivity to avoid confrontation and facilitate trust.

CONCLUSION

Delusion of pregnancy represents a rare but clinically significant phenomenon, most often observed in the context of schizophrenia and other psychotic disorders. It embodies a complex interplay of biological, psychological, and social factors, including dopaminergic dysregulation, cognitive distortions, unmet emotional needs, infertility, and sociocultural emphasis on motherhood. A timely and accurate diagnosis is essential to differentiate delusional pregnancy from pseudocyesis and other medical or endocrine conditions. A multidisciplinary collaboration between psychiatrists, psychologists, and gynecologists enhances diagnostic clarity and treatment adherence.