Denial of Pregnancy: an Exploratory Investigation

Wessel

2018

Preprint

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. Reversely, pseudocyesis is explained as an attempt to obtain a psychologicallyindispensable 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.

Section: Current Knowledge On Psychosomatic Disorders Of Gravida Statusmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Wessel

2018

Preprint

“…While the signs of pregnancy are usually obvious to the concerned woman as well as to her surroundings after several weeks or months, some women remain unaware of their gravid state during an abnormally long period of time; sometimes up to a totally unexpected delivery (Brezinka et al, 1994;Wessel et al, 2002). In these cases, physiological manifestations of pregnancy can be misinterpreted, significantly reduced or even absent (Brezinka et al, 1994;Milstein and Milstein, 1983;Milden et al, 1985;Spielvogel and Hohener, 1995;Bascom, 1977;Lee et al, 2006;Spinelli, 2010). Even labor and delivery pain can be minimized (Spinelli, 2010).…”

Section: Introductionmentioning

confidence: 99%

A systemic explanation of denial of pregnancy fitting clinical observations and previous models

2015

Preprint

Introduction:The etiology of denial of pregnancy remains poorly understood. Neither necessary nor sufficient conditions can be synthesized from the risk factors identified from psychological analyses. Furthermore, the involvement of mother-fetus interactions cannot result only from psychology causes in the mother. Although instructive, the few available evolutionary and systemic explanations proposed remain insufficient. This article synthesizes and extends previous knowledge within a systemic model which is fully compatible with clinical observations. Methods: A systemic intrapersonal conflict theory opposing primitive, evolutionary-inherited forces to psycho-sociological forces embodied across individual's childhood is developed. Results: As members of a social species, human beings have a dual character of independent organisms and of social group members that is a source of customized intrapersonal conflicts. Authors explain denial of pregnancy as a standby-in-tension response to such an unresolved intrapersonal conflict between forand against-pregnancy forces. As long as the woman's brain is unable to renounce one option in favor of the other, denial of pregnancy offers a standby-in-tension means to postpone conflict resolution. It may thus be considered as temporarily adaptive response. Conclusions:The proposed systemic psycho-evolutionary explanation of denial of pregnancy is fully consistent with clinical observations. It brings into agreement the previously reported models with the advantage of being more synthetic. It is thus compatible with a large diversity of causative events in accordance with the actual life story of each woman concerned. The systemic intrapersonal conflict approach developed herein provides a new means of investigating body-mind problems, especially pseudocyesis.

“…Even if the analogy between these two dysfunctions is known 4,11,12,13 , they were studied separately and attributed to psychological causes 13 . Del Giudice did however notice the insufficiencies of psychological explanations of DP 14 .…”

mentioning

confidence: 99%

Denied and false pregnancies: Opposite settings of a single evolutionary conflict

2016

Preprint

Abstract:Aim: A woman in denial of pregnancy is pregnant but remains unaware of her gravid state. In the case of a false pregnancy; the woman is not pregnant but believes she is and presents signs and symptoms of pregnancy. These syndromes correspond to opposite contradictions that were mainly explored separately. Our aim is to explain them by a common and consistent etiology. Method:We explore internal conflicts inherited from the evolutionary transition from solitary animals to social species. Results:The solitary and social characters are contradictory. They induce internal conflicts intrinsic to the human condition. At the reproduction level, those conflicts oppose primitive interests (genes transmission) to social identity ones (to become a parent). Both syndromes are described by powerful identity interests in contradiction with the actual physiological state: i) actual pregnancy but unacceptable motherhood (denial), and ii) imperative motherhood in a non-pregnant woman (false pregnancy). The physiological symptoms results from a temporarily adaptive artifice hiding the internal tension and fulfilling simultaneously (but superficially) the incompatible demands. Conclusion:The proposed model explains clinical observations satisfactorily. It complies with a huge diversity of causative events for the identity tensions involved as reported in literature.The model also elucidates the temporary adaptive character of those psychosomatic dysfunctions. To explain those syndromes in a rational and understandable way will facilitate health professional information, thus favoring the detection and follow-up of cases. The acceptation of their condition by concerned women will also be made easier. Keywords: Denial of pregnancy, false pregnancy, gene transmission, to become a parent, evolution, solitary-social conflict, standby-in-tension response, etiology.As a dysfunction, denial of pregnancy (DP) is as mysterious as astonishing. It happens that a woman life course is deeply transformed by a totally unexpected delivery (with a rate of about 1/2500 births following Wessel 1 ). Stories are numerous and striking. For instance a young and slim woman arrives to the emergency unit complaining of abdominal pain and delivers a 3kg newborn. One week earlier, she was on a naturist beach and no one of accompanying people did notice her pregnancy 2 . Such a scenario is only possible thanks to a deep transformation of the physiological course of the gestation. The fetus lays vertically, to the detriment of the diaphragm and other internal organs, rather than horizontally as in a normal pregnancy 3 . The other symptoms associated with a gravid state may also be significantly reduced or absent. In Brezinka study 4 , none of the 11 women who experienced an unexpected delivery did present nausea symptoms that affect normally from 50% to 80% of pregnant women. Regular bleedings appraised as periods are also reported in numerous cases. Even fetus movements can be unnoticed or associated to gastric disturbances.It happens however than tho...