Denial of pregnancy as a reproductive dysfunction: A proposal for international classification systems

Objective: To propose a new Diagnostic and Statistical Manual (DSM) and International Classification of Diseases (ICD) category concerning reproductive dysfunctions not caused by organic disorder. Methods: Forensic (n=93) and obstetrical cases (n=78) of denied and concealed pregnancies are compared and discussed. Results: Denied pregnancies occur with a ratio of 1:475 births. An overwhelming phenomenological agreement is demonstrated between obstetrical and forensic cases. The findings were similar for denial and concealment of pregnancy, probably representing two different types of reproductive dysfunction that can be classified psychosocially together under the heading "negated pregnancy". Conclusions: Analogous to the phenomenology of "sexual dysfunctions", "reproductive dysfunctions" could be distinguished by the extraordinariness of both reproductive experience and behavior (as part of human sexuality) and psycho-physiological changes, which characterize the reproductive course of events and cause obvious suffering and interpersonal complications. It is therefore suggested to include these entities as categories in their own right under the appropriate existing headings in DSM and ICD. (c) 2006 Published by Elsevier Inc.