Tokophobia: A dread of pregnancy
A 43-year-old married housewife of high socioeconomic status presented to the psychiatry out-patient department with a 2 years history of morbid dread of pregnancy. This started 2 years after marriage when she contacted a gynecologist for menstrual irregularity. She asked the physician about the complications of pregnancy. On hearing the dreaded complications like having a deformed fetus, change in body figure, eclampsia, caesarean, and even death, she developed excessive fear of pregnancy. When also informed that no contraceptive method is fully protective, she started avoiding sexual contact with husband. On stopping all sexual activity, she gradually developed sad mood, hopelessness, helplessness, worthlessness, difficulty in falling asleep, weeping spells, loss of appetite and suicidal ideation. She also started having less interaction with husband, parents, and other relatives. Even after being counseled by relatives and two obstetricians, she could not get rid of the fear of pregnancy. There was no past or family history of mood disorder, schizophrenia, epilepsy, or drug dependence. Her vitals, routine investigations, and physical examination were normal.\nOn mental state examination, she was a tidy, cooperative lady of pyknic build. There were no disturbances in orientation or memory. Her mood was sad with reduced psychomotor activity and monotonous low volume speech. There were ideas of hopelessness and worthlessness and also, feeling of guilt and suicidal ideation. There was no formal thought disorder. Insight and judgment were intact.\nShe was diagnosed as a case of tokophobia with major depressive disorder. She was started on fluoxetine, 20 mg once daily and clonazepam 0.5 mg at night and counseling (including psycho education) weekly for about 2 weeks but there was no improvement. The dose of fluoxetine was increased to 40 mg daily and over the next 4 weeks, there was reduction in her morbid fear of pregnancy along with symptoms of depression. She started having normal sexual activity. At follow-up after 3 months while still on medication, there was no recurrence of symptoms.