Pathological Lying: Symptom or Disease?
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http://www.psychiatrictimes.com/display/article/10168/1162950#
Psychiatric Times. Vol. 25 No. 7
Pathological Lying: Symptom or Disease?
By Charles C Dike, MD, MPH, MRCPsych | June 1, 2008
Dr Dike is division medical director at Whiting Forensic Services at
the Connecticut Valley Hospital in Middletown, and assistant clinical
professor in the division of law and psychiatry of the department of
psychiatry at Yale University School of Medicine in New Haven, Conn.
He reports that he has no conflicts of interest concerning the subject
matter of this article.
Pathological lying (PL) is a controversial topic. There is, as yet, no
consensus in the psychiatric community on its definition, although
there is general agreement on its core elements. PL is characterized
by a long history (maybe lifelong) of frequent and repeated lying for
which no apparent psychological motive or external benefit can be
discerned. While ordinary lies are goal-directed and are told to
obtain external benefit or to avoid punishment, pathological lies
often appear purposeless. In some cases, they might be self-
incriminating or damaging, which makes the behavior even more
incomprehensible. Despite its relative obscurity, PL has been
recognized and written about in the psychiatric literature for more
than a century. The German physician, Anton Delbruck,1 is credited
with being the first to describe the concept of PL. He observed that
some of his patients told lies that were so abnormal and out of
proportion that they deserved a special category. He sub-sequently
described the lies as "pseu- dologia phantastica."
Case Vignette
Mr A was desperate. He was about to lose yet another job, not because
he was at risk for being fired, but because his lying behavior had
finally boxed him into a corner. He had lied repeatedly to his
colleagues, telling them that he had an incurable disease and was
receiving palliative treatment. Initially, his coworkers treated him
with sensitivity and concern, but as the weeks wore on, the scrutiny
of his colleagues became increasingly pointed. He had to tell more and
more outrageous lies to cover his tracks and justify having a terminal
illness. Finally, when the heat became too unbearable, he suddenly
stopped going to work. On the face of it, it would seem Mr A told
these lies to gain the sympathy of his colleagues, but the
consequences of his lying, in terms of emotional distress and
potential loss of job, far outweighed any perceived gain. Mr A had
lost several other jobs in the past because of his lying, and he was
becoming frustrated. Family members reported that he often told
blatant lies, and even when confronted, and proved wrong, he still
swore they were true. Mr A finally sought psychiatric help after
concluding that he could not stop himself from lying.
This scenario, or similar stories, is not uncommon in clinical
practice. Letters I have received from mental health professionals,
attorneys, and individuals around the world describe similar
characteristics in people they know—excessive lying, easily verifiable
to be untrue, mostly unhelpful to the liar in any apparent way, and
even possibly harmful to the liar, yet told repeatedly over time. Even
prominent and successful individuals are not immune to this behavior—
for example, the well-known California case of Judge Patrick
Couwenberg, who was removed from office not only for lying in his
official capacity but also for lying under oath to a commission
investigating his behavior.2 A psychiatric expert witness diagnosed
pseudologia phantastica and suggested that the judge needed treatment.
Why such a successful individual would repeatedly tell lies that could
damage his credibility and put him in trouble with the law or other
administrative bodies is baffling. Was his lying behavior completely
within his control, or was there something different about his pattern
of lies?
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