Pathological Lying: Psychotherapists’ Experiences and Ability to Diagnose

Pathological lying has been discussed in the research literature for more than a century, mostly in case studies. Recent research has supported pathological lying as a diagnostic entity, although it remains absent from nosological systems. The current study aimed to survey practitioners about their experiences working with clients who engage in pathological lying and to examine practitioners’ abilities to diagnose pathological lying.

Psychotherapists (N=295) were recruited and asked to report about their experiences with patients who engaged in pathological lying. Participants were also presented with four clinical vignettes and a definition of pathological lying and were asked to determine whether the individuals portrayed in the vignettes met that definition.

Most practitioners reported clinical experience with patients exhibiting pathological lying, although such patients made up a small proportion of their caseloads. Clinicians described these patients as lying with great frequency and indicated that lying caused marked distress and impaired functioning in social, occupational, financial, and legal domains. The behavior typically had begun during adolescence and had continued for ≥5 years. Respondents reported usually offering a diagnosis other than pathological lying, such as a personality disorder. By using a published definition of pathological lying, respondents (N=156) were able to reliably identify cases of pathological lying portrayed in clinical vignettes and were able to consistently discriminate between pathological lying and both related and unrelated disorders.

The participants largely endorsed the proposition of including pathological lying in nosological systems such as the DSM and ICD, which could allow for accurate diagnosis and effective treatments.