[Projective identification and denial of pregnancy--considerations of the reasons and background of unrecognized pregnancy also undiagnosed by a physician].
BACKGROUND
In denial of pregnancy, the pregnant woman does not consciously perceive the pregnancy and, in extreme cases, awareness occurs only during delivery. The attending physicians also often fail to recognize the pregnancy, even though the somatic complaints leading to consultation with a physician are typically pregnancy associated. This "iatrogenic participation" was described in the earliest historical publications. Different theories are presented in this paper to elaborate this phenomenon. Elementary deficiencies in perception or incompetence do not explain most cases.


METHODS
Twenty five women with denial of pregnancy, interviews PSYCHODYNAMIC EXPLANATIONS: Based on the deep-rooted subjective attitude of not being pregnant, the pregnant woman is able to include family, friends, and associates into the denial of pregnancy mindset. In a similar way, she is able to influence her doctor. The woman's autosuggestive wishful notions of not being pregnant receive suggestive confirmation by the physician's misdiagnosis and lead to a continuing denial of pregnancy.
In 1946, M. Klein introduced this term to describe a certain defense mechanism relating to fantasies and accompanying object relationships. The self initially successfully disposes of unwanted aspects, splits them off, and transfers them to another person, to finally reclaim them in a modified form. Certain elements of this psychoanalytical concept can characterize the interaction between physician and pregnant woman, which, in the case of denied pregnancies, does not lead to a diagnosis of pregnancy. Through projection, the pregnant woman is capable of manipulating the physician so that he perceives her, according to her wishes, as not being pregnant and misdiagnoses her correspondingly as "service in return". Opportunities for more mature handling of the denied content in terms of psychological development through accurate diagnosis of the pregnancy are indicated.
Klinik für Geburtsmedizin, Charité, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin.
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Kästner
D000293:Adolescent; D000328:Adult; D003951:Diagnostic Errors; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D007062:Identification, Psychological; D007231:Infant, Newborn; D010348:Patient Care Team; D010817:Physician-Patient Relations; D011247:Pregnancy / Q000523:psychology*; D011258:Pregnancy Tests / Q000523:psychology*; D011385:Projection; D011574:Psychoanalytic Theory; D012017:Referral and Consultation