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Pathological lying

Pathological lying, also known as pseudologia fantastica or mythomania, is a psychiatric condition characterized by a persistent, pervasive, and often compulsive pattern of excessive lying that leads to clinically significant impairment in social, occupational, or other important areas of functioning, marked distress, and potential risk to self or others, persisting for longer than six months.^[1]^[2] Unlike ordinary deception, which typically serves a clear external purpose such as gain or avoidance of punishment, pathological lying involves elaborate fabrications that are disproportionate to any discernible end, often beginning in adolescence with an average onset around age 16 and frequently tied to internal motivations like low self-esteem or wish fulfillment.^[1]^[3] Individuals with this condition may initially believe their lies or experience them as extensions of reality, though they can acknowledge the falsehoods when confronted with irrefutable evidence, distinguishing it from delusions.^[1] The term "pseudologia fantastica" was first coined in 1891 by Anton Delbrück to describe this behavior as a distinct clinical entity, though it has historically been viewed through various lenses, including as a symptom of hysteria or moral deficiency, rather than a standalone disorder.^[2] It is not formally recognized as an independent diagnosis in the DSM-5 or ICD-11, but it is commonly associated with cluster B personality disorders such as borderline or narcissistic personality disorder, as well as conditions like post-traumatic stress disorder (PTSD) stemming from childhood trauma or dysfunctional family environments.^[1] Neurobiologically, it may involve dysfunction in the prefrontal cortex and limbic system, which regulate impulse control and emotional processing, contributing to the compulsive nature of the lies.^[1] Prevalence estimates for pathological lying are limited; a 2020 study estimated a prevalence of 8% to 13% based on self-reports and identifications by others in an online sample of adults, with no significant gender difference.^[3] The condition often results in profound interpersonal damage, including eroded trust in relationships, social isolation, and heightened risk of legal or financial consequences due to escalating fabrications that build upon one another.^[3] Diagnosis typically requires comprehensive psychological evaluation, including collateral information from others, to differentiate it from adaptive lying or other deceptive behaviors, with treatment focusing on underlying issues through psychotherapy rather than direct confrontation of the lies.^[1]

Definition and History

Definition

Pathological lying is characterized as a persistent, pervasive, and often compulsive pattern of excessive lying that leads to clinically significant impairment in social, occupational, or other areas of functioning, causes distress, or presents a risk to the individual or others, with the behavior lasting more than six months and lacking a clear external motive or benefit.^[4] This form of lying is distinguished by its intrinsic motivation, where the act itself becomes self-perpetuating, often escalating without apparent external gain, and may involve elaborate fabrications that the individual struggles to control.^[5] Alternative terms for pathological lying include pseudologia fantastica, which refers to elaborate and fantastical lies that blend fact and fiction, and mythomania, a synonym emphasizing the compulsive and mythical quality of the deceptions.^[6] The concept was first described in medical literature in 1891 by German physician Anton Delbrück, who coined pseudologia fantastica to capture this phenomenon.^[7] Some sources distinguish pathological lying from other forms of compulsive lying by its more elaborate, self-sustaining fabrications and greater potential for long-term impairment, though the terms are sometimes used interchangeably in the literature.^[1]^[8] A key debate in the field centers on whether pathological lying constitutes a standalone diagnostic entity or functions primarily as a symptom of underlying conditions, such as personality disorders, with empirical support leaning toward recognition as a distinct pattern warranting further nosological consideration.^[9]^[5]

Historical Development

The concept of pathological lying first emerged in medical literature in 1868, when Henry Wharton described it as "pseudomania," characterizing it as a morbid propensity for lying observed in psychiatric cases.^[10] This early recognition laid groundwork for later conceptualizations, though the term was used more broadly in legal and psychological contexts at the time. By 1891, German psychiatrist Anton Delbrück formalized the condition in his seminal work Die pathologische Lüge und die psychisch abnormen Lügner, coining "pseudologia fantastica" to describe patients who produced elaborate, fantastical falsehoods without clear external gain, often blending reality and invention in a compulsive manner.^[11] Delbrück's observations of five patients over several years emphasized the lies' internal psychological drivers, distinguishing them from ordinary deception.^[11] In the early 20th century, pathological lying gained traction within psychoanalytic frameworks, where it was interpreted as an expression of unconscious fantasy and repression, serving as a mechanism to fulfill unmet wishes or evade psychic pain.^[11] Figures like Karl Jaspers in his 1913 General Psychopathology integrated it into broader discussions of abnormal mental states, linking it to dissociative and delusional processes rather than mere moral failings.^[11] By 1951, British physician Richard Asher associated pseudologia fantastica with Munchausen syndrome in his landmark Lancet article, highlighting how pathological liars might fabricate illnesses to assume the sick role, thus expanding the condition's clinical implications beyond isolated mendacity.^[7] Mid-20th-century American psychiatry saw ongoing debates about pathological lying's status, with persistent confusion over whether it constituted a distinct syndrome, a symptom of other disorders, or a cultural artifact.^[12] A 2005 review by Dike, Baranoski, and Griffith underscored this ambiguity, noting that despite more than 100 years of descriptions since Delbrück, the phenomenon remained poorly defined and understood, often conflated with malingering or personality traits.^[12] Recent advancements have pushed for greater recognition; for instance, Curtis and Hart's 2020 empirical work proposed a definition of pathological lying as a persistent, pervasive, and often compulsive pattern of excessive lying behavior that leads to clinically significant impairment of functioning in social, occupational, or other areas; causes marked distress; poses a risk to the self or others; and occurs for longer than 6 months.^[8] Their 2022 American Psychological Association book further advocates for refined classification, synthesizing historical and modern research to support its potential as a standalone diagnostic entity.^[13] Notably, pathological lying lacks an entry in the DSM-5-TR (2022) or ICD-11, and as of 2025, ongoing scholarship continues to explore its nosological status without formal inclusion.^[8]

Clinical Features

Characteristics

Pathological lying, also known as pseudologia fantastica, manifests through persistent, compulsive fabrication of elaborate narratives that are often grandiose and disproportionate to any discernible external benefit.^[1] These lies typically portray the individual as a hero, victim, or figure of extraordinary accomplishment, escalating from minor distortions to fantastical stories woven seamlessly into their personal history.^[11] Unlike occasional deception, the behavior is habitual, occurring frequently—often multiple times daily—and persisting over years without episodic remission.^[10] Psychologically, pathological liars frequently exhibit an impaired distinction between fiction and reality, partially believing their own fabrications to the point where they may integrate them as genuine memories.^[1] The internal motivations remain opaque but often stem from unconscious needs for self-gratification, enhancement of fragile self-esteem, or evasion of harsh realities, rather than material or social gains.^[14] This compulsive quality is evident in the rapid, automatic production of lies, underscoring its involuntary nature.^[10] The consequences of pathological lying are profound, frequently resulting in social isolation, breakdowns in personal relationships, and legal entanglements due to eroded trust and credibility.^[11] Individuals often experience occupational instability, financial strain, and heightened risk of self-harm or harm to others, compounded by the compulsive persistence and associated distress that distinguish it from prosocial or strategic lying.^[10] Common examples include grandiose fabrications, such as inventing prestigious careers, celebrity connections, or heroic exploits, versus subtler distortions like exaggerating everyday hardships to elicit sympathy.^[1] These patterns may briefly overlap with traits in narcissistic or antisocial personality disorders but are defined by their compulsive persistence.^[14]

Diagnosis

Pathological lying is not recognized as a standalone diagnostic entity in the DSM-5 or ICD-11 classification systems. Instead, it is viewed as a symptom or behavioral feature embedded within broader personality disorders, particularly as part of the deceitfulness criterion in antisocial personality disorder, where repeated lying, use of aliases, or conning others for personal profit or pleasure is a key indicator. This symptomatic framing underscores its role in pervasive patterns of interpersonal exploitation rather than an isolated condition. Diagnosis primarily involves comprehensive clinical interviews conducted by mental health professionals, focusing on the chronic persistence of lying (typically spanning more than six months), resultant impairment in social, occupational, or other areas of functioning, and the absence of clear external motives or benefits for the deception. Collateral information from family, friends, or records is often essential to verify patterns, as direct observation of lies in session may be limited. A validated assessment tool, the Pathological Lying Inventory (PLI), developed and empirically tested in 2024, provides a structured 19-item self-report measure scored on a 7-point Likert scale, with subscales assessing excessive lying (frequency, pervasiveness, and compulsivity), associated psychological distress, and social dysfunction. The PLI demonstrates strong reliability (test-retest r = 0.83) and validity through correlations with lie chronicity, compulsivity, and functional impairment, offering clinicians a quantifiable aid to identify pathological patterns beyond casual or adaptive deception. Differential diagnosis requires careful distinction from related conditions to avoid misclassification. Unlike malingering, which entails intentional fabrication of symptoms or falsehoods motivated by external incentives such as financial gain or avoiding responsibilities, pathological lying lacks such deliberate external rewards and often appears pointless or self-sabotaging. It differs from confabulation, an unconscious distortion of memory to fill gaps, typically arising from neurological impairments like Korsakoff's syndrome, rather than a volitional behavioral trait. Pathological lying must also be differentiated from delusional disorders, where fabrications stem from fixed, false beliefs held with conviction despite contradictory evidence, whereas pathological liars may recognize their deceptions as untrue but persist compulsively. Key challenges in diagnosing pathological lying include the inherent unreliability of self-reporting, as individuals frequently deceive during evaluations, complicating efforts to establish a truthful baseline. Additionally, significant overlap exists with factitious disorders, such as Munchausen syndrome (factitious disorder imposed on self), where elaborate lies about illness or symptoms serve an internal psychological need for attention or care, blurring boundaries and requiring exclusion of motive-driven role assumption. These factors contribute to underdiagnosis, as the condition's subtlety and lack of dedicated diagnostic criteria in major manuals demand nuanced, longitudinal assessment to confirm its pathological nature.

Etiology

Neurobiological Factors

Pathological lying has been associated with dysfunction in key brain regions involved in executive function and moral decision-making. The prefrontal cortex, particularly the dorsolateral and orbitofrontal subregions, plays a critical role in impulse control, decision-making, and behavioral inhibition, and abnormalities here may facilitate habitual deception by impairing the ability to weigh consequences or suppress truthful responses.^[15] A seminal neuroimaging study from the University of Southern California in 2005 provided the first empirical evidence of structural brain differences in pathological liars, using magnetic resonance imaging on 12 individuals diagnosed with the condition compared to controls. The study revealed a 22-26% increase in prefrontal white matter volume and a 36-42% reduction in the prefrontal gray-to-white matter ratio among pathological liars, suggesting enhanced neural connectivity that might predispose individuals to frequent deception.^[15] Increased white matter was localized to the orbitofrontal and dorsolateral prefrontal regions, potentially reflecting developmental vulnerabilities in neural maturation.^[16] These structural changes may also explain behavioral patterns such as faster production of lies, as the surplus white matter could reduce the cognitive load required for deception by streamlining neural communication pathways between prefrontal areas.^[17] In typical individuals, lying demands greater executive resources than truth-telling, but in pathological liars, the altered prefrontal architecture appears to automate the process, making falsehoods as effortless as honesty.^[15] The role of neuroplasticity in pathological lying remains hypothetical but is supported by theories that chronic deception could reshape neural pathways over time. Repeated activation of prefrontal circuits during lying may lead to adaptive increases in white matter, as proposed in follow-up analyses of the 2005 data, where habitual lying is seen as potentially reinforcing its own neural substrate through experience-dependent plasticity.^[16] Pathological lying also shows interplay between genetic predispositions and environmental factors, with associations to central nervous system (CNS) abnormalities observed in approximately 40% of documented cases. These include epilepsy, abnormal electroencephalographic findings, head trauma, and CNS infections, which may disrupt prefrontal development or function and heighten vulnerability when combined with genetic risks for impulsivity or neurodevelopmental issues like ADHD.^[9]

Psychological and Environmental Causes

Pathological lying often serves as a psychological coping mechanism for underlying issues such as low self-esteem and a fragile sense of self, where individuals fabricate stories to enhance their self-perception and gain a sense of autonomy or power.^[1] Psychoanalytic perspectives view these lies as unconscious wish fulfillment, functioning as an escape from harsh realities through elaborate fantasies that provide temporary relief from internal distress or shame.^[11] This process is typically defensive, aimed at repressing painful experiences rather than achieving tangible external benefits.^[1] Environmental factors play a significant role in the development of pathological lying, particularly through exposure to childhood trauma, neglect, abuse, or dysfunctional family dynamics that disrupt healthy emotional regulation and self-concept formation.^[1] Such chaotic home environments foster maladaptive coping strategies, where lying emerges as a way to navigate instability or seek validation in the absence of secure attachments.^[11] Stressful life events during adolescence can trigger or exacerbate this pattern, linking it to broader psychosocial vulnerabilities without direct reliance on neurobiological differences.^[5] Developmentally, pathological lying tends to manifest in late childhood or early adolescence, often around age 16 on average, coinciding with identity formation and increased social pressures.^[1] It frequently begins with seemingly innocuous lies for attention or sympathy, which compulsively escalate into pervasive patterns as the individual loses control over the deception.^[5] Motivational models emphasize intrinsic rewards driving pathological lying, such as the emotional gratification from storytelling, reduced anxiety, or a thrill derived from the act itself, in contrast to minimal extrinsic gains like material profit.^[11] These internal drivers reinforce the behavior, making it self-perpetuating and distinct from strategic or occasional dishonesty.^[5]

Associations with Other Disorders

Relation to Psychopathy

Pathological lying is explicitly incorporated into the assessment of psychopathy through the Psychopathy Checklist-Revised (PCL-R), a widely used diagnostic tool developed by Robert Hare. In the PCL-R, pathological lying is scored as item 4 within the interpersonal facet of Factor 1 (interpersonal/affective traits), where a score of 2 indicates pervasive deceitfulness without apparent reason or benefit, often intertwined with glibness/superficial charm (item 1), which also scores up to 2 for superficially engaging but insincere communication involving manipulation.^[18]^[19] Both pathological lying and psychopathy share core traits of frequent deception and manipulation, but in psychopathy, lying tends to be calculated and self-serving, aimed at gaining power, resources, or control over others, whereas pure pathological lying is often compulsive and lacks clear instrumental purpose, sometimes even harming the liar's interests. Psychopathic individuals exhibit deceit as part of a broader pattern of exploitative behavior, including lack of remorse and empathy, which amplifies the strategic nature of their lies.^[20]^[21] A key distinction lies in the motivation and outcomes: psychopathic lying is typically instrumental, facilitating exploitation or evasion of consequences, while pathological lying can be aimless, self-deceptive, or driven by internal psychological needs without external gain, and it does not invariably indicate psychopathy. For instance, many pathological liars experience distress or internal conflict from their behavior, unlike the remorseless detachment in psychopathy. This overlap with psychopathy extends briefly to associations with other personality disorders, such as antisocial or narcissistic traits, but psychopathy uniquely emphasizes the predatory use of deception.^[9]^[20] Recent research highlights the intersection in adolescents, where psychopathic tendencies exacerbate pathological lying patterns. A 2023 study by Curtis and colleagues found that adolescents exhibiting pathological lying reported an average of 9.6 lies per day, significantly higher than non-pathological peers, underscoring the compulsive yet frequent nature of deception in this presentation.^[22]

Links to Personality Disorders

Pathological lying exhibits significant overlap with antisocial personality disorder (ASPD), where deceitfulness is explicitly listed as a core diagnostic criterion in the DSM-5, encompassing repeated lying, use of aliases, or conning others for personal profit or pleasure.^[23] In individuals with ASPD, pathological lying often manifests as a strategic tool for manipulation and exploitation, distinguishing it from more impulsive forms of dishonesty seen in other conditions.^[24] In narcissistic personality disorder (NPD), pathological lying frequently serves to uphold a grandiose self-image or evade feelings of shame, with individuals fabricating achievements or narratives to garner admiration and attention.^[1] This behavior aligns with the antagonism domain in the DSM-5 alternative model for personality disorders, which includes traits like manipulativeness and deceitfulness that facilitate such deceptive practices in NPD.^[25] Beyond these, pathological lying associates with borderline personality disorder (BPD), where it can emerge impulsively during periods of intense stress or fear of abandonment, often as a defensive response rather than a calculated strategy.^[26] Similarly, in factitious disorder, lying centers on fabricating illnesses or symptoms to seek emotional care or attention, blurring lines with pseudologia fantastica through elaborate deceptions aimed at assuming the sick role.^[7] Comorbidity rates highlight the strong ties between pathological lying and cluster B personality disorders, with studies indicating frequent co-occurrence with BPD, NPD, or ASPD due to shared features like emotional dysregulation and interpersonal manipulation.^[1] While psychopathy represents one subset of these links, the broader connections underscore pathological lying's role as a transdiagnostic symptom across these disorders.^[10]

Epidemiology

Prevalence and Demographics

Pathological lying is estimated to affect approximately 5–8% of the general population, though empirical studies suggest a range of 8%–13% based on self-identification and distress criteria in surveyed samples.^[27]^[5] In clinical practice, psychotherapists report observing it in fewer than 10% of their caseloads, indicating potential underrepresentation due to diagnostic challenges.^[10] The condition typically emerges in late childhood or adolescence, with 62% of affected individuals reporting onset between ages 10 and 20, and it often persists chronically into adulthood without intervention, with most cases lasting over five years.^[5]^[10] Gender distribution shows no significant disparity, with men and women equally represented in case studies and surveys.^[10] Demographic analyses reveal no notable differences across age, education, income, or ethnicity, though research samples are predominantly Caucasian (around 59–81%).^[5]^[10] Recent validation of the Pathological Lying Inventory in 2024 underscores underdiagnosis, attributing it to the lack of standardized diagnostic tools and societal stigma that discourages disclosure and recognition.^[27]

Risk Factors

Pathological lying is associated with various familial and environmental risk factors, particularly those involving unstable home environments and histories of abuse or neglect. Individuals who experience childhood trauma, such as emotional neglect or physical abuse, may develop pathological lying as a maladaptive coping mechanism to navigate feelings of shame or unmet needs.^[1] Neurodevelopmental factors also elevate the risk, with a notable proportion of cases linked to central nervous system (CNS) issues. A majority of individuals with pseudologia fantastica exhibit some form of CNS dysfunction, including conditions like epilepsy, head trauma, or abnormal EEG findings, which may impair impulse control and executive functioning.^[1] Early childhood trauma further compounds these risks by influencing neurodevelopmental pathways.^[1] Psychological risk factors include low self-esteem, which contributes to pervasive deceit as a means of self-protection or enhancement.^[11] Comorbid substance use disorders frequently co-occur, exacerbating the tendency toward dishonesty as individuals seek to conceal or cope with addiction-related shame.^[1] Recent empirical findings highlight the predictive role of lying frequency in adolescence for later pathological patterns. Studies indicate that adolescents exhibiting pathological lying tendencies report an average of about 10 lies per day, often accompanied by functional impairments and early onset during this developmental stage.^[8] This frequency, persisting beyond typical experimentation, correlates with heightened risk for chronic deceit in adulthood.^[28]

Treatment and Management

Therapeutic Approaches

Therapeutic approaches to pathological lying primarily involve psychotherapy aimed at addressing the underlying patterns and motivations for lying, with a focus on building skills for honesty and emotional regulation. Cognitive-behavioral therapy (CBT) is widely recommended as it helps individuals identify and challenge dysfunctional thought patterns, such as those driven by attention-seeking or avoidance, while developing alternative honest responses through techniques like habit reversal training.^[29]^[1] Dialectical behavior therapy (DBT), which integrates CBT with mindfulness practices, targets emotional dysregulation and impulsivity often associated with lying, improving interpersonal effectiveness and distress tolerance.^[29] Additional methods include motivational interviewing, which fosters intrinsic motivation to change by exploring ambivalence and denial without confrontation, thereby building trust and commitment to honesty. Group therapy provides social accountability, as peers can gently confront lies, encouraging self-awareness of the relational impacts and reinforcing honest interactions in a supportive setting.^[1]^[30] Evidence for these interventions, though limited by the lack of pathological lying as a standalone diagnosis, indicates potential efficacy; a 2023 article indicates strong evidence that some psychotherapies, such as CBT and DBT, lead to significant improvements in managing pathological lying, while a 2022 book on pathological lying provides guidance for clinicians on effective treatment strategies tailored to individual needs.^[29]^[13] Adjunctive pharmacological options, such as selective serotonin reuptake inhibitors (SSRIs) for comorbid anxiety or depression, may support therapy but do not directly treat pathological lying itself. Patient resistance, often stemming from fear of consequences, can complicate engagement but is best addressed through non-confrontational strategies.^[1]^[10]

Challenges in Treatment

Treating pathological lying presents significant obstacles due to its association with underlying personality disorders and the absence of a distinct diagnostic category in major classification systems like the DSM-5, which complicates identification and intervention planning.^[1] Clinicians often encounter resistance from patients who may not perceive their behavior as problematic until severe interpersonal or legal consequences arise, leading to inconsistent engagement in therapy.^[30] This lack of intrinsic motivation exacerbates the challenge, as individuals frequently enter treatment reactively rather than proactively, resulting in lower commitment to change.^[1] Patient-related factors further hinder progress, including persistent denial and the continuation of deceptive behaviors even within the therapeutic context. For instance, surveys of psychotherapists indicate that 86% of those treating individuals with pathological lying report patients engaging in deception during sessions, with an average of 11 lies per day observed, which undermines trust-building efforts essential for effective therapy.^[10] Many patients exhibit limited insight into the harmful impacts of their lying, such as damaged relationships or professional setbacks, and may rationalize fabrications as protective mechanisms, making it difficult to foster genuine self-reflection.^[30] From a clinical standpoint, detection remains a primary barrier, with therapists identifying pathological lying in fewer than 10% of their caseloads, often only after collateral information or prolonged observation reveals inconsistencies. Recent advancements, such as the 2024 validation of the Pathological Lying Inventory (PLI), a 19-item self-report tool assessing excessive lying, distress, and social dysfunction, can enhance detection and inform tailored treatment planning.^[10]^[31] High dropout rates compound this issue; in psychotherapies for associated personality disorders, attrition can reach 20-58%.^[32] These rates are frequently exacerbated by confrontational approaches, which can provoke defensive escalation of lying rather than resolution.^[1] Therapists must navigate these dynamics carefully, as aggressive challenging can strain the alliance and increase premature termination. Systemic gaps also impede comprehensive care, including the dearth of standardized treatment protocols tailored to pathological lying, leaving clinicians to adapt general strategies like cognitive behavioral therapy without empirical validation for this specific behavior.^[10] Ethical dilemmas arise in balancing the need to address deceptions—potentially through verification with external sources—against preserving a nonjudgmental rapport, as overly inquisitorial tactics risk alienating patients and violating confidentiality principles.^[1] Outcomes reflect these multifaceted challenges, with partial improvements in social functioning and distress reduction reported in case-based applications of adapted therapies, though relapse is common without sustained support to reinforce honest communication patterns.^[30] Limited research precludes precise success metrics, but the emphasis on multidisciplinary management highlights the potential for better results when underlying comorbidities, such as anxiety or substance use, are concurrently addressed.^[1]

Notable Examples

Historical Cases

One of the earliest clinical descriptions of pathological lying emerged from the work of German psychiatrist Anton Delbrück in 1891, who coined the term pseudologia fantastica to characterize a series of five patients exhibiting persistent, elaborate fabrications. These individuals wove fantastical narratives, such as false claims of aristocratic lineage or heroic exploits, blending elements of truth with invention to elicit admiration or sympathy from others, rather than for tangible external benefits. Delbrück noted that the lies were not mere delusions or ordinary deceptions but compulsive stories that the patients appeared to believe at some level, often leading to social isolation or institutional commitment when inconsistencies surfaced.^[33]^[8] In the early 20th century, American psychiatrists William Healy and Mary Tenney Healy provided further insights through their 1915 forensic study of pathological lying, documenting over a dozen cases among adolescents and adults that illustrated its progression from habitual deceit to more severe outcomes. For instance, several patients escalated their fabrications into swindling schemes or false accusations of crime, resulting in legal entanglements or long-term institutionalization, as the lies became increasingly uncontrollable and detached from reality. These pre-DSM-era cases underscored the diagnostic challenges of the time, where pathological lying was viewed as a borderline mental condition intertwined with moral or developmental deficiencies, often without clear distinction from emerging concepts like hysteria or moral insanity.^[34]^[35] A prominent historical illustration is the case of Anna Anderson, who beginning in the 1920s claimed to be Grand Duchess Anastasia Romanov, the presumed-dead daughter of Tsar Nicholas II, maintaining this identity through decades of legal battles, media scrutiny, and personal relationships until her death in 1984. Anderson's detailed accounts of escaping the 1918 Bolshevik execution, complete with fabricated memories of royal life and family details, persisted despite mounting evidence, including 1994 DNA analysis confirming her as Polish factory worker Franziska Schanzkowska; this elaborate imposture exemplifies how pathological lying can sustain a false persona over a lifetime, often fueled by a need for identity and status.^[36]^[37] Similarly, Belle Gunness, a Norwegian immigrant in early 1900s Indiana, exemplifies escalation to criminality through fabricated backstories; she placed deceptive newspaper advertisements portraying herself as a wealthy widow seeking marriage, luring over 40 victims to her farm where she murdered them for financial gain, her lies enabling a pattern of manipulation that ended with her presumed death in a 1908 arson fire. Gunness's deceptions involved inventing tragic personal histories and false promises of security, highlighting how calculated deceit could intersect with antisocial behavior in the absence of formal psychiatric intervention.^[38] These historical cases offer key clinical lessons, demonstrating how pathological lying frequently intensified into criminal acts, institutionalization, or profound social disruption, particularly in the pre-DSM period when it was diagnosed through behavioral observation rather than standardized criteria. However, retrospective analysis suggests that many such "liars" likely suffered from co-occurring untreated mental illnesses, including undiagnosed personality disorders or trauma responses, complicating modern interpretations without contemporary diagnostic frameworks.^[12]^[9]

Modern Instances

One prominent modern example involves George Santos, a Republican politician elected to the U.S. House of Representatives in 2022, whose campaign was built on extensive fabrications about his personal and professional background. Santos falsely claimed to have graduated from Baruch College and New York University, worked at Goldman Sachs and Citigroup, played volleyball at college, and had Jewish heritage with grandparents who survived the Holocaust, among other inconsistencies regarding his finances, employment, and identity.^[39] These deceptions were uncovered through journalistic investigations and social media scrutiny, leading to a House Ethics Committee report in 2023 that found substantial evidence of federal law violations, including wire fraud and money laundering. Consequently, Santos became only the sixth member of Congress in history to be expelled, on December 1, 2023, and later pleaded guilty to fraud charges in 2024, receiving a sentence of 87 months (over seven years) in prison on April 25, 2025. He began serving the sentence in July 2025, but on October 17, 2025, President Donald Trump commuted his sentence, resulting in his immediate release.^[40]^[41] Another notable case is that of Frank Abagnale, a former con artist whose activities in the 1960s and 1970s involved impersonating professionals such as a Pan Am pilot, doctor, and lawyer to cash forged checks worth millions. Abagnale's fabrications extended to creating elaborate false identities and backstories to facilitate his schemes, which he detailed in his 1980 autobiography.^[42] After serving prison time, he reformed and has since worked as a fraud prevention consultant for the FBI and corporations, with his story gaining widespread cultural prominence through the 2002 film Catch Me If You Can.^[43] While some elements of his recounted exploits have faced scrutiny for potential exaggeration, the case exemplifies persistent identity deception with long-term societal repercussions.^[42] The Santos scandal, in particular, fueled 2023–2025 media discussions on pathological lying, with outlets like CNN examining how such chronic deception might warrant formal recognition as a mental health condition, given its rarity and lack of prior clinical focus.^[44] Social media platforms played a key role in exposing these instances, as users and journalists crowdsourced verifications of claims in real time, amplifying public awareness and ethical debates around deception in politics and public life.^[45] These high-profile examples reveal ongoing diagnostic challenges, as pathological lying remains unclassified as a distinct disorder in the DSM-5 but frequently co-occurs with narcissistic personality disorder, where grandiosity drives elaborate falsehoods, or factitious disorder, involving fabricated narratives for attention or sympathy.^[46]^[7] Such comorbidities complicate identification and intervention, highlighting the need for integrated psychological assessments in cases of compulsive deceit.^[47]

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An infrequently described clinical feature sometimes associated with borderline personality disorder is pseudologia fantastica, or pathological lying.
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who now advises businesses, banks, department stores and the FBI on fraud prevention and cybercrime — ...
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