When Cristal Lujan started experiencing typical early pregnancy symptoms, including tiredness, dizziness, and cramping, she was confused. Lujan did multiple home pregnancy tests, but they kept showing negative results. It was only when her belly started growing a few months later—causing her to look visibly with child—that she sought medical attention. She even had Braxton Hicks contractions—commonly experienced in the third, and sometimes second, trimester—when she believed herself to be at the 13-week mark.
"I just felt so pregnant," says the 31-year-old licensed practical nurse. "It was a very emotional time and I cried a lot. I felt aggravated and vulnerable."
Lujan was sent for an ultrasound to rule out anything sinister such as tumors or fibroids, as well as to see if she was really pregnant after all. It came back negative. She was stunned.
"I went to see my doctor feeling distraught after realizing my uterus was empty," she explains. "She told me I wasn't pregnant and there was no signs of conception. That was it—I was sent on my way and left to figure it out and deal with the aftermath of what had happened with no help, advice or support."
Watch: Is It Worth Your Time and Money to Freeze Your Eggs?
Another doctor later diagnosed Lujan with an unusual medical condition known as pseudocyesis, sometimes called phantom or false pregnancy. Though the condition is rare—affecting only one to six for every 22,000 births—there have been recorded examples throughout history. The British Tudor queen Mary I was one of the most famous cases, suffering great embarrassment and failing to produce an heir when no child was born—despite the growing belly and severe morning sickness that led her to retire to give birth in the royal chamber. Some historians have argued that this heartbreak was the reason for the anti-Protestant tyranny of her reign, leading to her nickname Bloody Mary.
Perhaps due to its rarity, it remains poorly understood by many medical practitioners. Some argue that it is purely psychological and is caused by a woman strongly desiring pregnancy, whereas others link it to problems with the pituitary gland—a structure at the base of the brain that is important for hormone production.
Dr. Monica Starkman, the associate professor of psychiatry at the University of Michigan, has written several articles on phantom pregnancy, as well as a novel about the condition, called The End of Miracles. I ask her whether she believes it to be a physical or psychological condition. "I am one of the first people that did hormonal studies into the condition," she says. "Although my team did find some hormone abnormalities in each patient we studied, they were not identical. Not one pattern seems to be present in pseudocyesis.
"I think it is a combination of a physical and psychological condition. The evidence favours it being psychosomatic, a.k.a. when the original stimulus is in the mind and then affects the body. It often—though not necessarily—occurs in the context of loss, such as continued infertility or miscarriage."
Lujan already had a six-month-old baby when her symptoms first occurred, and was using breastfeeding as her only form of birth control. (The lactational amenorrhea method, or LAM for short, is based on how the body naturally stops ovulating if women exclusively breastfeed their babies.) "My phantom pregnancy came from fear of being pregnant, so I wasn't trying to conceive at the time," she says. "Later, I discovered that not dealing properly with my feelings about being disappointed at my baby's gender also contributed to the development of my delusion."
Once she received her negative ultrasound, Lujan began to recover five months after the beginning of her symptoms. But some women can find it difficult to accept what their doctors tell them—and pseudocyesis can go on for a lot longer. Last year, UK tabloids recorded the suspected case of a woman who believed that she was 15 months pregnant and could hear the baby's heartbeat. In 2013, doctors in Brazil performed an emergency Caesarian on a woman who insisted that she was nine-months pregnant, only to find nothing in her womb.
"Giving women with suspected pseudocyesis an ultrasound is the best course of action, in order to demonstrate that the uterus is empty," Starkman says. "That's not always easy—women with it can seek out little things on the ultrasound they then interpret as being part of a baby. But when they accept it, things like abdominal swelling can go down markedly in just one day."
Starkman believes that it is essential for women going through pseudocyesis to receive support from family and friends. "It's a loss—they not only have to grieve due to not having a baby, but deal with continuing infertility and whatever other stressors in their life contributed to the development of the false pregnancy in the first place," she says. "They need support that recognizes this loss. They need to know that their doctor is there to help them conceive, if it is caused by a medical problem of this nature, and they can benefit from seeing a psychiatrist who can provide help as they process what happened."
Lujan herself found that there was a lot of misinformation surrounding the subject. She had joined a few online support groups while experiencing symptoms, but when she told some members about her ultrasound results they told her to ignore what her doctor had advised and to continue to believe she was pregnant instead.
"I was flabbergasted by this response from these women who I thought had my best interests at heart," she explains. "So after I felt healed from my own experience I decided I needed to make education a priority, to hopefully help some of the women active in this community who believe themselves to be pregnant for two or more years." She now runs a YouTube that provides awareness and support, as well as a closed Facebook group, both of which she updates regularly.
"Phantom pregnancy can happen to anyone without discrimination—I experienced this even as a medical professional," she says. "There is very little information about it, and many people have admitted to me that they think it is a myth, or didn't know it even existed in the first place." Some women with it can also face stigma from their peers due to this, who think they've just made it up. "The symptoms are very real. Medical practitioners need to be taught about it in the first place and try to understand it. I get messages every day from women who think they are pregnant without an actual fetus—but they are sent home with no answers, just a huge bill and more questions."