Couvade Syndrome

The term couvade is derived from the early French word (Couver "to hatch") and originally referred to the medieval Basque custom in which the father, during or immediately after the birth of a child, took to bed, complained of having labour pains, and was accorded the treatment usually shown women during pregnancy or after childbirth. The medical term for this rare condition is sympathetic pregnancy.

Couvade "involves a father experiencing some of the behavior of his wife at near the time of childbirth, including her birth pains, postpartum seclusion, food restrictions, and sex taboos"

Western medicine has tended to see the couvade as a medical syndrome or pathology.

Symptoms

Couvade is a common but poorly understood phenomenon whereby the expectant father experiences apparently physical symptoms during the pregnancy for which there is no recognized physiological basis. Symptoms commonly include indigestion, increased or decreased appetite, weight gain, diarrhea or constipation, headache, and toothache... Couvade has been seen as an expression of somatized anxiety, pseudo-sibling rivalry, identification with the fetus, ambivalence about fatherhood, a statement of paternity, or parturition envy. It is likely that the dynamics of couvade may vary between individuals and may be multidetermined (Klein, 1991).

In some extreme cases, fathers can grow a belly similar to a 7 month pregnant woman and gain approximately 25 to 30 pounds. Other symptoms include and are not limited to developed cravings, suffered nausea, breast augmentation and insomnia.

In "Psycho-Evolutionary" theory, it is thought that couvade is a way to minimize sexual differences in the pregnancy and birthing experience. The couvade may also be a way to establish the father's role in the child's life and to give balance to the gender roles. An earlier theory suggested that the couvade was evidence of male envy. Couvade is more common where sex roles are flexible and the female is of a dominant status.

Causes

Studies have shown that the male partner cohabitating with a pregnant female will experience hormonal shifts in his prolactin, cortisol, estradiol and testosterone levels; typically starting at the end of the first trimester and continuing through several weeks post-partum. Various explanations of how and why this occurs have been given, including an interaction of factors (some of which are little-researched) such as pheromones, circadian rhythms, simple stress, and mitogenetics.

Couvade has been reported by travelers throughout history, including the Greek geographer Strabo and the Venetian traveler Marco Polo. It has been observed and studied by anthropologists in modern times and is often seen in tribal societies. In some indigenous societies, "sympathetic pregnancy" is attributed to demons or spirits inflicting the symptoms in an attempt to cause problems for the family.

Currently, scientists are at a loss to whether or not Couvade syndrome should be considered psychosomatic, as the syndrome is brought on by a psychological effect (i.e.) the pregnancy of the wife, but was formerly considered a form of Munchausen syndrome. Formerly a number of elaborate psychological explanations were given for it, but today the thought is shifting to a more physical explanation based on hormones.

Some studies report that nosebleeds are sometimes a symptom, indicating that it cannot be totally psychosomatic, as nosebleeds are a symptom caused primarily by mechanical means (e.g. atmospheric conditions) or by the thinning of the wall of the nose. Furthermore, the Couvade phenomenon seems to exist everywhere, and the syndrome does not appear in other, psychologically similar stress situations.

Pseudocyesis

Pseudocyesis also known as false pregnancy, can cause many of the signs and symptoms associated with pregnancy, and can resemble the condition in every way except for fetal presence. Other names include - spurious pregnancy, feigned pregnancy, imaginary pregnancy, hysterical pregnancy, phantom pregnancy and grossesse nerveuse ("mental pregnancy"). John Mason Good coined the term pseudocyesis from the Greek words pseudes (false) and kyesis (pregnancy) in 1923. False pregnancy is common in many mammals and is a method of providing milk for the group's offspring, most often cats, dogs, and rabbits.

History

Cases of pseudocyesis have been documented since antiquity. Hippocrates gives us the first written account around 300 B.C. when he recorded 12 different cases of women with the disorder. Mary Tudor (1516-1558), Queen of England, was perhaps the most famous of western historical examples, who believed on several occasions that she was pregnant, when she was in fact not. Some even attribute the violence that gave her the nickname "Bloody Mary" to be a reaction to her disappointment on realising she was without child. Other medical historians believe that the queen's physicians mistook fibroid tumors in her uterus for a pregnancy.

Signs and symptoms

The symptoms of pseudocyesis are similar to the symptoms of true pregnancy and are often hard to distinguish from it. Such natural signs as amenorrhoea, morning

sickness, tender breasts, and weight gain may all be present. Many health care professionals can be deceived by the symptoms associated with pseudocyesis. Research shows that 18% of women with pseudocyesis were at one time diagnosed as pregnant by medical professionals.

The hallmark sign of pseudocyesis that is common to all cases is that the affected patient is convinced that she is pregnant. Abdominal distension is the most common physical symptom of pseudocyesis (60– 90%). The abdomen expands in the same manner as it does during pregnancy, so that the affected woman looks pregnant. This phenomenon is thought to be caused by buildup of gas, fat, feces, or urine. These symptoms often resolve under general anesthesia and the woman's abdomen returns to its normal size.

The second most common physical sign of pseudocyesis is menstrual irregularity (50–90%). Women are also reported to experience the sensation of fetal movements known as quickening (medical), even though there is no fetus present (50%-75%).Other common signs and symptoms include: gastrointestinal symptoms, breast changes or secretions, labor pains, uterine enlargement, and softening of the cervix. One percent of women eventually experience false labor.

Causes

There are various explanations, none of which are universally accepted. Psychodynamic theories attribute the false pregnancy to emotional conflict. It is thought that an intense desire to become pregnant, or an intense fear of becoming pregnant, can create internal conflicts and changes in the endocrine system, which may explain some of the symptoms of pseudocyesis. Another theory concerns wish-fulfillment. It holds that if a women desires pregnancy badly enough she may interpret minor changes in her body as signs of pregnancy.

Biological mechanisms proposed include the effect of stress on the hypothalamo-pituitary-adrenal axis, constipation, weight gain and the movement of intestinal gas.

Demographics

The rate of pseudocyesis in the United States has declined significantly in the past century. In the 1940s there was one occurrence for approximately every 250 pregnancies. This rate has since dropped to between one and six occurrences for every 22,000 births. The average age of the affected woman is 33, though cases have been reported for women as young as 6-1/2 and as old as 79. More than two-thirds of women who experience pseudocyesis are married, and about one-third have been pregnant at least once. Women who have been victims of incest may be at greater risk for developing pseudocyesis.

Treatment

Because pseudocyesis is not known to have a direct underlying physical cause, there are no general recommendations regarding treatment with medications. In some cases, however, the patient may be given medications for such symptoms as the cessation of menstruation. Because most patients with pseudocyesis have underlying psychological problems, they should be referred to a psychotherapist for the treatment of these problems. It is important at the same time, however, for the treating professional not to minimize the reality of the patient's physical symptoms.

The treatment that has had the most success is demonstrating to the patient that she is not really pregnant by the use of ultrasound or other imaging techniques.

Alternative therapies

There have been reports of patients being cured of pseudocyesis by hypnosis, purgatives, massage, opioids, or after nine months of symptoms, by experiencing "hysterical childbirth," but there are few data available on the effectiveness of these or similar procedures.