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Objective: Pathological lying, originally called “pseudologia phantastica,” has an established history within clinical practice and literature, although it has not been recognized as a psychological disorder within major nosological systems. With the movement in psychological sciences toward theory-driven, empirically supported diagnoses, the current study sought to empirically test whether pathological lying aligned with nosological definitions and could be defined as a diagnostic entity. Methods: A total of 807 people were recruited (January to October of 2019) from various mental health forums, social media, and a university. Of those recruited, 623 completed the study. Participants responded to a lie frequency prompt, questionnaires about lying behavior, the Lying in Everyday Situations Scale, the Distress Questionnaire-5, and demographic questions. Results: Of the participants, 13% indicated that they self-identified or that others had identified them as pathological liars (telling numerous lies each day for longer than 6 months). People who identified as pathological liars reported greater distress, impaired functioning, and more danger than people not considered pathological liars. Pathological lying seemed to be compulsive, with lies growing from an initial lie, and done for no apparent reason. Conclusions: The evidence supports establishment of pathological lying as a distinct diagnostic entity. A definition of pathological lying, etiological considerations, and recommendations for future research and practice are presented.
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Pathological Lying: Theoretical and Empirical Support
for a Diagnostic Entity
Drew A. Curtis, Ph.D., and Christian L. Hart, Ph.D.
Objective: Pathological lying, originally called pseudologia
phantastica,has an established history within clinical prac-
tice and literature, although it has not been recognized as a
psychological disorder withinmajornosologicalsystems.
With the movement in psychological sciences toward
theory-driven, empirically supported diagnoses, the current
study sought to empirically test whether pathological lying
aligned with nosological denitions and could be dened as a
diagnostic entity.
Methods: A total of 807 people were recruited (January
to October of 2019) from various mental health forums, social
media, and a university. Of those recruited, 623 completed the
study. Participants responded to a lie frequency prompt, ques-
tionnaires about lying behavior, the Lying in Everyday Situations
Scale, the Distress Questionnaire-5, and demographic questions.
Results: Of the participants, 13% indicated that they self-
identied or that others had identied them as pathological
liars (telling numerous lies each day for longer than 6 months).
People who identied as pathological liars reported greater
distress, impaired functioning, and more danger than people
not considered pathological liars. Pathological lying seemed
to be compulsive, with lies growing from an initial lie, and
done for no apparent reason.
Conclusions: The evidence supports establishment of path-
ological lying as a distinct diagnostic entity. A denition
of pathological lying, etiological considerations, and re-
commendations for future research and practice are
PRCP in Advance (doi: 10.1176/appi.prcp.20190046)
The frequency with which people lie varies (1, 2). Consid-
erable research has focused on the normative aspects of
lying (1, 37). Deception has been dened by Vrij (3) as a
successful or unsuccessful deliberate attempt, without
forewarning, to create in another a belief which the com-
municator considers to be untrue.Some studies report that
people tell an average of two lies per day (4, 8, 9). Two recent
studies, however, discovered that a majority of people re-
ported telling no lies within the past 24 hours, whereas a
small subset reported telling numerous lies (1, 2). Although
extensive research has explored the normative aspects of
lying among the general population, and within psycho-
therapy (1013), the pathological dimensions of deception
have been neglected.
Pathological lying (PL) has been referenced in popular
culture, although some have suggested that psychiatrists
and psychologists know little about the phenomenon (14). PL,
originally termed pseudologia phantastica,was rst re-
corded in 1891 by psychiatrist Anton Delbrück in discussions
of several cases of people who told so many outrageous lies
that the behavior was considered pathological (15). Today,
there is little consensus for a denition of PL, but many
continue to use a denition proposed by Healy and Healy
more than a century ago (15). They dened PL as falsication
entirely disproportionate to any discernible end in view, may
be extensive and very complicated, manifesting over a period
of years or even a lifetime, in the absence of denite insanity,
feeblemindedness or epilepsy.
The DSM-5 denes a mental disorder as a syndrome that
causes signicant distress and impairs functioning (16). Similarly,
the ICD-10 denes a disorder as a set of symptoms or behaviour
associated in most cases with distress and with interference
with personal functions(17). From these denitions, models of
Pathological lying exists in a small percentage of people,
for whom it causes signicant distress, impaired func-
tioning, and danger.
Pathological lying, distinct from normative lying and pro-
lic lying, has a prevalence of 8%13%.
Evidence supports establishing pathological as a diagnos-
tic entity.
prcp in Advance 1
abnormality have been suggested, such as the four Fs:
frequency, function, feeling pain, and fatal (18). In com-
parison with contemporary models of psychopathology, the
denition of PL put forth more than a century ago does not
fully capture aspects of pathology (15). Therefore, to merge
the key elements of the previous denition with psychopa-
thology criteria from classication systems, we suggest that
PL should be dened as a persistent, pervasive, and often
compulsive pattern of excessive lying behavior that leads to
clinically signicant 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
PL has not been classied within the DSM-5 or the ICD-10
(16, 17). The DSM-5 mentions that deception is a symptom of
antisocial personality disorder and is used for external in-
centive (malingering) and to assume a sick role (factitious
disorder) (16). PL is one of 20 items used in the Hare Psy-
chopathy Checklist-Revised (PCL) (19). However, this item
does not serve to provide a diagnosis but to assess lying
behavior related to psychopathy.
Research investigating PL is scant. One study of 1,000
young offenders found excessive lying among 15% of males
and 26% of females (15). A recent imaging study found that
12 participants who endorsed the PL item from the PCL
showed an increase in prefrontal white matter and re-
duction in gray matter and white matter ratios compared
with normal control participants and antisocial control
participants (20). Research on PL has mostly involved case
studies. Delbrück discussed ve case studies, and Healy
and Healy identied 12 case studies (15). Across the subse-
quent 100 years, other PL case studies have been published
(2123). A comprehensive analysis of 72 case studies (24)
showed that PL was equally represented among men and
women of average to above average intelligence, typically
beginning in adolescence, with some people committing
crimes. Although evidenced in case studies, the distinc-
tiveness of PL has been debated (2527), with some arguing
that PL is a unique disorder (14, 15).
The purpose of the current study was to explore a theo-
retical model of PL as a distinct psychopathology that meets
major nosological denitions, namely a disorder bearing the
features of frequency, function, feeling pain, and fatality. On
the basis of this hypothesis, we made six predictions: Our rst
prediction was about prevalence, frequency of behavior, and
duration of the condition. We predicted that patients with
PL would represent a smaller percentage of the population
reporting excessive lying, would report PL as lasting for a
longer time than would the general population, and would
report onset of the condition as occurring during adoles-
cence. Our second prediction was that patients with PL would
report impaired functioning in several areas. Our third
prediction was that patients with PL would report more
distress from their lying than would the general population.
Our fourth prediction was about fatality; we predicted that
patients with PL would be more likely to report that their lies
put themselves or others in danger. Our fth prediction was
that patients with PL would indicate that their lying was not
entirely under their control and that it provided relief from
anxiety. Our sixth prediction was that patients with PL would
report telling lies for no specic reason and that their lies
would tend to grow from an initial lie more so than those of
people without PL.
We recruited 807 people via Facebook, Reddit/samplesize,
Psych Forums, and a university in the southwestern United
States to participate in a study on lying behavior. A total of
635 participants completed information beyond the inclu-
sion criteria. Three participants were removed because of
reporting an unlikely number of lies told, and nine partici-
pants were excluded because they indicated they had lied in
response to some of the survey questions. Thus, 623 partic-
ipants were retained for the analyses.
SD=21.9767.57) with more female (N=374, 68%) partici-
pants than male. The majority of participants were Cau-
casian and/or European American (N=325, 59%), followed
by Hispanic and/or Latinx (N=135, 25%); multiracial (N=41,
8%); African American and/or Black (N=20, 4%); Asian,
Asian American, and/or Pacic Islander (N=19, 4%); and
Native American and/or Alaskan Native (N=8, 2%). The par-
ticipants ranged in education, from having no high school
diploma (N=6, 1%), a GED (N=4, 1%), a high school diploma
(N=210, 38%), a col lege degree (N=309, 56%), a masters degree
(N=21, 4%), and a doctoral degree (N=2, ,1%). A majority of
participants indicated that their annual income was under
$25,000 (N=456, 85%), with fewer reporting annual incomes
3%), and $75,000 or more (N=22, 4%). Although the complete
sample of 623 participantsdrew from a range of ages, ethnicity,
education, and income, participants were slightly younger,
more Hispanic, more educated, and had lower incomes than
the general population.
Participants were asked about whether they considered
themselves to be pathological liars and whether others
considered them to be pathological liars. Additionally, par-
ticipants were given a lie frequency assessment (1, 2) (Figure 1)
and other questionnaires. The Survey of Pathological Lying
behaviors (SPL) is a nine-item questionnaire about function-
ing, feeling pain, and fatal risks of lying behavior that uses a
Likert-type ratingscale (1=strongly disagree; 7=strongly agree)
(see the online supplement accompanying this article). In-
ternal consistency for the SPL was acceptable (Cronbachs
a=0.82). The Survey of Lying Behaviors is a seven-item survey,
reporting on the frequency, functioning, pain, and risks the
respondent perceives as related to lying behavior, and has a
Cronbachsaof 0.80. The Survey of OthersPathological prcp in Advance
Lying is an 11-item questionnaire, reporting on the frequency,
functioning, pain, and risks respondents perceive as related to
the lyingbehaviors of others (Cronbachsa=0.83).The Lying in
Everyday Situations (LiES) Scale (28) is a 14-item scale de-
signed to assess the propensity to lie. The LiES scale has
demonstrated high internal consistency, test-retest reliability,
and concurrent validity and displayed high internal consis-
tency reliability in the current study (Cronbachsa=0.88). The
Distress Questionnaire-5 (DQ5) is a ve-item screen, with
suggested sensitivity and specicity cutoff points, used to
measure general psychological distress among individuals
with various psychological disorders (29) (Cronbachsa=0.83).
A demographic questionnaire also was provided.
The institutional review board of Angelo State University
approved the study. Following written consent, we presented
the participants with a prompt and lie frequency assessment
(1) (Figure 1). We then asked three questions which we used
to identify assignment to the PL or non-PL condition. Par-
ticipants in the PL condition completed the SPL, LiES, DQ5,
and the demographic questionnaire. Participants in the
non-PL condition completed the Survey of Lying Behaviors,
LiES, DQ5, and the demographic questionnaire. Additionally,
participants in the non-PL condition completed the Survey of
OthersPathological Lying if they indicated that they knew
someone whom they believed was a pathological liar. All
participants were debriefed after participating in the study.
Identication of Pathological Lying
We assigned participants to the pathological lying condition if
they considered themselves pathological liars or if others
considered them pathological liars. Statistics for normally
distributed data are likely to be unreliable for handling lie
distributions, which have consistently been shown to be
positively skewed (1, 2). Thus, we conducted a negative bi-
nomial regression to examine the t of the frequency of lies
with self-identied PL, because it is a robust method for
handling overdispersed count data (30). The likelihood ratio
chi-square test indicated that the model was a signicant
improvement in t over a null model (p,0.001). Thus, the
self-identication of a PL and non-PL model was found to be a
better t and was retained.
Of the 623 participants, 83 (13%) indicated that they or
others considered themselves pathological liars (35 indicated
only self, 27 indicated only others, 12 indicated both, and nine
afrmed self or others). A chi-square analysis revealed a
statistically signicant difference between people in the PL
and non-PL conditions (x
=335.23, N=623, df=1, p,0.001). Of
the 589 participants who responded to the question that
asked about having been formally diagnosed by a mental
health professional with a psychological disorder, 49 (8%)
indicated they were pathological liars. Thus, our prediction
was conrmed that PL would occur within a relatively small
percentage of the sample (8%13%).
FIGURE 1. Screen shot of lie frequency assessment
Talked to them
Talked to them in
writing or by phone or
over the Internet
4) Family members
5) Friends or other people you know socially
6) People you work with or know as business contacts
7) People you do not know but might see occasionally
(such as a store clerk)
8) Total strangers
Think about where you were and what you were doing during the past 24 hours, from this time yesterday until right
now. Listed below are the kinds of people you might have lied to and how you might have talked to them, either
face-to-face or some other way such as in writing or by phone or over the Internet. In each of the boxes below,
please write in the number of times you have lied in this t ype of situation. If you have not told any lies of a particular
type, write in “0.”
In the past 24 hours, how many times have you lied?
Please enter a number for each person
Continue ONLY when fi nished. You will be unable to return or change your answers.
Continue »
Source: Serota et al. (1).
prcp in Advance 3
We conducted a chi-square test of independence to com-
pare the frequency of formal psychiatric diagnoses among the
PL group and those in the non-PL group and found no sig-
nicant association (x
=4.42, N=553, df=2, p=0.11). Thus,
participants in the PL group were no more likely to have a
psychiatric diagnosis than those in the non-PL group.
We conducted an independent samples t-test to examine
whether there were differences in age between the PL group
and non-PL group and found no statistically signicant dif-
ferences (t=0.62, df=519, p=0.54). Chi-square tests of in-
dependence found no signicant association for sex (x
N=551, df=2, p=0.63), education (x
=0.89, N=552, df=5,
p=0.97), income (x
=2.77, N=540, df=3, p=0.43), or ethnicity
=12.05, N=548, df=6, p=0.06). To examine whether edu-
cation (inclusion of a college sample) resulted in the differ-
ences, we created an educationvariabletodifferentiate
between those with a college degree or higher and those with
a high school education or less. In addition, we used a mul-
tivariate analysis of variance (MANOVA) to compare educa-
tion across lying frequency, distress, functioning, and danger
and found no statistical signicance for the PL group (F=1.97,
df=7 and 58, p=0.07) or the non-PL group (F=0.49, df=7 and
424, p=0.84).
Frequency (Prediction 1)
To further test prediction 1, we used a chi-square test to
examine duration of engagement in PL, which demonstrated
statistical signicance (x
=59.18, N=78, df=24 p,0.001). A
majority of participants in the PL group reported engaging in
PL for 6 months or longer (N=68, 87%), with more than half
(N=42, 54%) indicating they had engaged in frequent lying for
more than 5 years (Table 1).
We conducted an independent samples t-test to examine
the difference in the number of lies told by participants in the
PL group compared with the non-PL group and found a
statistically signicant difference (t=7.52, df=588, p,0.001).
As predicted, participants in the PL group indicated telling
more lies within a 24-hour period (mean=9.99611.17, me-
dian=7, mode=1, N=82, maximum=66 lies, 95% condence
interval [CI]=7.512.44, skewness=2.27 [SE=0.27], and kur-
tosis=7.20, [SE=0.53]) than participants in the non-PL group
(mean=3.0966.86, median=1, mode=0, N=499, maximum=80
lies, 95% CI=2.493.70,skewness=6.79[SE=0.11],kurto-
sis=58.43 [SE=0.22]). We conducted a one-sample t-test on
the PL condition, and a test value of ve revealed a statistically
signicant difference (t=4.04, df=81, p,0.001). Conrming
our hypothesis, a majority of participants in the PL group
(N=49, 60%) reported telling ve or more lies within the past
24 hours. Furthermore, the PL group told more lies in per-
son (mean=6.3567.75) than over the phone or in writing
(mean=3.8865.82, t=2.85, df=76, p=0.006). We conducted a
MANOVA to determine to whom the participants in the PL
group reported telling lies and found statistical signicance
(F=13.71, df=5 and 76, p,0.001). Participants in the PL group
reported lying more to friends and social acquaintances than
to other people (Table 2).
We used an independent samples t-test to compare scores
on the LiES between the PL and non-PL groups and found a
statistically signicant difference (t=7.09, df=78, p,0.001).
Those in the PL group reported a greater propensity for
telling lies in their everyday lives (mean=50.80618.00) than
those in the non-PL group (mean=34.88612.59).
A frequencyanalysis revealedthat a majority of participants
in the PL group indicated onset of PL during adolescence
(1020 years) (N=48, 62%). A chi-square analysis showed a
statistically signicant difference between developmental
periods (x
=35.62, N=78, df=2, p,0.001), with most partic-
ipants reporting that the earliest age they were considered a
pathological liar was in adolescence (N=48).
Impaired Functioning (Prediction 2)
To assess impaired functioning, we conducted a MANOVA
with areas of functioning as the dependent variable and the
lying condition as the between groups variable. A statistical
signicance was shown (F=24.09, df=4 and 549, p,0.001).
Univariate tests indicated statistical signicance between the
PL and non-PL groupsimpairment in functioning in occu-
pation (F=15.32, df=1 and 552, p,0.001), social relationships
(F=83.88, df=1 and 552, p,0.001), nances (F=27.42, df=1
and 552, p,0.001), and legal contexts (F=29.04, df=1 and
552, p,0.001). Within the PL group, a repeated measures
MANOVA showed statistical signicance in areas of func-
tioning (F=16.16, df=3 and 72, p,0.001). Pairwise compari-
sons found the greatest impairment in social relationships
(p,0.001) (Table 3).
Feeling Pain (Prediction 3)
Participants in the PL group reported greater distress from
their lying (mean=3.0462.02) compared with those in the
non-PL group (mean=2.2161.65, t=3.44, df=94, p=0.00).
Participants in the PL group reported greater general psy-
chological distress (mean=15.7665.11) than the non-PL group
(mean=14.5064.63, t=2.15, df=539, p=0.03). By using DQ5
suggested cutoff points for sensitivity ($11) and specicity
($14), 9% (N=59) and 8% (N=50) of the overall sample were
identied as those in the PL group who experience psy-
chological distress, respectively.
Fatal Danger (Prediction 4)
We used an independent samples t-test to compare the PL
and non-PL groups on scores of whether their lying put them
or others in danger. A statistically signicant difference was
TABLE 1. Duration of engagement in pathological lying among
participants considered pathological liars (N=78)
Duration N %
3 months 10 13
6 months 8 10
1 year 4 5
15 years 14 18
.5 years 42 54
Data missing for ve of the 83 participants considered pathological liars. prcp in Advance
found (t=5.53, df=82, p,0.001). Participants in the PL group
reported that their lying had placed themselves or others in
danger (mean=2.7662.16) more so than participants in the
non-PL group (mean=1.3861.00).
Compulsivity (Prediction 5)
To assess compulsivity, we conducted a MANOVA on two
items (feeling out of control and for relief from anxiety) and
found statistical signicance (F=90.47, df=2 and 563,
p,0.001). Participants in the PL group indicated that their
lying was out of their control more (mean=3.2962.25) than
did individuals in the non-PL group (mean=1.3860.93,
lying (mean=3.5162.23) compared with the non-PL group
(mean=1.9561.55, p,0.001).
Motivation and Growth of Lies (Prediction 6)
We conducted an independent samples t-test to examine
whether the participants in the PL group were more likely
than those of the other group to report that they told lies for
no reason. A signicant difference was found (t=6.13, df=92,
p,0.001). Participants in the PL group told lies for no rea-
son (mean= 3.7362.30) more than participants in the non-PL
group (mean=2.0961.64). Additionally, we used an inde-
pendent samples t-test to examine group differences in the
belief that their lies grew. The results showed a statistically
signicant difference (t=6.46, df=91, p,0.001), with those in
the PL group indicating their lies grew from an initial lie
(mean=3.8162.22) more so than did those in the non-PL
group (mean=2.1561.15).
Pathological Liars Versus Prolic Liars
Prolic liars were identied from the non-PL sample in a
manner similar to Serota and Levines (2) by using an index of
dispersion (D) to decide whether the data t a distribution.
We used a negative binomial regression because of over-
dispersed data (30). To achieve a dispersion closest to 1, we
divided the sample into two groups: those who told zero to
two lies (mean=0.6660.77, D=0.89) and those who told three
or more lies (prolic liars) (mean=7.51610.09, p,0.001).
Thus, prolic liars were coded into a new condition variable.
An independent samples t-test found no signicant dif-
ference in number of lies told between the PL group and the
prolic lying group (p=0.09). However, a signicant differ-
ence was seen on the LiES (t=6.12, df=224, p,0.001). Par-
ticipants in the PL group reported greater propensity for
telling lies (mean=50.80618.00) compared with participants
in the prolic lying group (mean=38.32612.03).
We used a MANOVA to analyze areas of functioning
between participants assessed as pathological liars and those
assessed as prolic liars and found a statistical signicance
(F=8.86, df=4 and 230, p,0.001). Univariate tests indicated
statistical signicance for lower functioning among PL par-
ticipants in occupation (F=4.40, df=1 and 233, p=0.037), social
relationships (F=28.44, df=1 and 233, p,0.001), nances (F=7.43,
df=1 and 233, p=0.007), and legal contexts (F=12.51, df=1 and 233,
p,0.001). An independent samples t-test found a signicant
difference between the PL group (mean=3.0462.02) and those
classied as prolicliars(mean=2.4961.63) with regard to lying
causing distress (t=2.08, df=127, p=0.039). Lying was also reported
to be more dangerous by the PL group (mean=2.7662.16) than by
the prolic liar group (mean=1.5861.19,t=4.49, df=100, p,0.001).
Perceptions of Pathological Liars
Of the participants who did not indicate being a pathological
liar, 162 indicated that they knew someone they considered a
pathological liar. Participants estimated that these individ-
uals had told an average of approximately 10 lies within
the last 24 hours, with ve lies as the most frequent response
(mean=9.96615.47 lies told, median=5, mode=5, N=127,
maximum=130 lies, 95% CI=7.2412.68, skewness=5.53 [SE=0.22],
kurtosis=37.13 [SE=0.43]). A majority of participants reported
either that the person did not have a formal diagnosis (N=67,
42%) or that they did not know whether the person had
a formal diagnosis (N=73,46%. Most of these participants
TABLE 3. Pairwise comparisons of impairment in areas of
functioning among participants considered pathological liars
Function M SD p
Occupation 2.01 1.46
Social relationships
3.52 2.09 ,0.001
2.32 1.83 0.02
Legal contexts 1.88 1.57
Data missing for ve of the 83 participants considered pathological liars.
p,0.001 for all other areas of functioning.
p,0.05 compared with legal contexts.
TABLE 2. Lies told by participants considered pathological liars
(N=75), by relationship
Relationship M SD
Family member (face-to-face) 1.40 2.59
Family member (writing or
phone or internet)
1.11 2.48
Friends or other people you
know socially (face-to-face)
2.07 2.71
Friends or other people you
know socially (writing,
phone, or Internet)
1.53 2.32
People you work with or know
as business contacts (face-
1.37 3.12
People you work with or know
as business contacts
(writing, phone, or Internet)
0.59 1.53
People you do not know but
might see occasionally
0.83 1.92
People you do not know but
might see occasionally
(writing, phone, or Internet)
0.28 0.91
Total strangers (face-to-face) 0.76 2.48
Total strangers (writing,
phone, or Internet)
0.37 1.08
Data missing for eight of the 83 participants considered pathological liars.
prcp in Advance 5
reported that the earliest stage of development when the
person was perceived as a pathological liar was adolescence
(N=83, 52%) or that they did not know (N=42, 26%). A ma-
jority of these participants also reported that the person they
knew had been telling numerous lies for .6 months (N=121,
76%) or that they did not know (N=35, 22%). A MANOVA
revealed a statistically signicant difference in areas of func-
tioning (F=590.35, df=4 and 154, p,0.001). Participants in-
dicated that the persons lying had resulted in impaired
functioning more in social relationships (mean=5.9362.14)
than in occupation (mean=3.9362.14), nances (mean=3.846
2.24), or legal contexts (mean=3.2762.15). An independent
samples t-test was used to compare distress between the PL
group (mean=3.0462.01) and participants in the non-PLgroup
who reported knowing someone they considered a patho-
logicalliar (mean=4.2462.00), ndinga statisticallysignicant
difference (t=4.32, df=223, p,0.001). An independent sam-
ples t-test also showed a statistically signicant difference in
danger between those in the PL group (mean=2.7662.16) and
those the participantsconsidered pathological liars (mean=
5.6461.49, t=10.59, df=115, p,0.001).
The historical discussion of PL has been robust. Documented
case studies have supplied ample evidence of patients with PL
behavior in clinical practice. Yet, nosological systems have
not classied PL as a distinct entity. Attending to the credence
of theory-driven, empirical approaches to psychopathology
(3133), the current study provides evidence for PL as a
disorder and aligns with the requirements set forth by the
American Psychiatric Association for the addition of a new
diagnostic category (34). By applying denitions and criteria
from psychopathology models, a distinguishable group of
people emerges who lie excessively for extended periods and
experience impaired functioning, signicant distress, and
increased danger.
Our ndings showed that the participants classied as
pathological liars reported telling about 10 lies per day on
average, and most reported telling one lie per day. This av-
erage is greater than the number of lies told by a normative
sample, in the current study, and in previous research (14, 7,
8). Additionally, those in the PL group indicated a greater
propensity to tell lies, and the excessive lying had persisted
for longer than 6 months, a duration similar to that of other
DSM-5 disorders (16). Estimates of PL in the current sample
ranged from 8%13%. This range represented those who
reported no psychological disorder (8%), those who currently
met the DQ5 specicity criteria for distress (8%), and those
who self-identied (13%) as pathological liars.
Our results indicate a distinction between prolic and
pathological liars, with the latter endorsing greater distress,
impaired functioning, risk of harm, and propensity to lie. The
area of greatest impairment in functioning for those in the PL
group was in social relationships. This nding was not sur-
prising, because deception often damages trust, especially
when used to conceal a transgression (35, 36). Our results
provide a strong argument that a denition of PL should hinge
not solely on the frequency of the lying behavior, but on the
indices of psychopathology.
Participants in the PL group reported experiencing more
distress from telling lies. Classic research indicates that lying
can reduce distress when behavior is discrepant from beliefs,
acting as a distress-relieving mechanism (37, 38). However,
lying can cause distress because it requires a justication for
its use (4, 39). For pathological liars, the distress may result
from telling lies for no apparent reason, with lies growing
from an initial lie, and from concern about discovered de-
ceptions and relational conict. Additionally, the PL condi-
tion indicated greater psychological distress, suggestive of a
distinct mental disorder.
The fatal criterion was met because PL was more likely to
put oneself or others in danger. An example of lying that may
pose a threat to ones safety is if one conceals suicidal ideation
during psychotherapy (40).
In addition to the pathological distinctions, we found that
those in the PL group indicated that telling lies reduced their
anxiety and that their lying was out of their control. Fur-
thermore, PL behavior involves telling lies without a specic
reason, with lies growing from an initial lie. Thus, PL contains
elements of compulsiveness. The subsequent growth of lies,
however, tends to cause more distress.
The current study had some limitations. Participants were
recruited from forums that may attract people interested in
psychological disorders, which may have increased the PL
sample, resulting in a slightly larger prevalence than what
may be expected in the general population. However, this
method of recruitment was necessary to reach the target
sample, because PL is not an ofcial classication within the
DSM-5. Although PL is not a formal diagnostic entity, it has
been widely discussed by mental health professionals and
people who maintain difculty with lying behaviors. Addi-
tionally, our sample included an age range of 1860, with an
average age of about 22 and many having advanced education.
Although we found no statistical difference in a comparison of
education levels, use of this sample may have underestimated
some of the negative life consequences of PL compared with
individuals who are older or less educated. Another potential
concern was the self-report. We used this method because PL
has not been established as a diagnostic entity. Additionally,
self-reporters are most likely to seek out treatment. When
asking people to report on their lying behaviors, there may be
concern that the self-reports are lies. However, evidence
suggests that self-reports of lying behavior are valid and re-
liable (1, 2, 41). Halevy and colleagues found that self-reported
frequency of lying behaviors was not signicantly correlated to
variableresponse inconsistencyor true responseinconsistency
scales of the multidimensional personality questionnaire-brief
form, with no signicant differences found between subjects
who were categorized as valid and invalid respondents (41). prcp in Advance
Finally, although many of the participants indicated they had
never been formally diagnosed with a psychological disorder,
the current study did not specically compare PL to various
other psychological disorders. Future studies may examine
assessment proles of people with PL behavior to deter-
mine convergent and discriminant validity related to other
Future Directions
If PL is recognized as a diagnostic entity, researchers would
be positioned to examine additional features, etiology, and
effectiveand efcacious treatments. Research may also benet
from exploring cliniciansexperiences in treating individuals
having PL. Future analyses at the biological level may lead to a
deeper understanding of PL. Recognizing PL would equip
practitioners to diagnose and treat the condition, thus allowing
people to seek treatment. Because PL is not a formally rec-
ognized disorder, no systematic studies on the effectiveness
of psychotherapy in treating PL have been conducted (27).
The utility of implementing cognitive-behavioral therapy and
pharmacotherapeutic options for treating PL is worth con-
sideration (27).
In addition to supporting recognition of PL as a diagnostic
entity, the current research adds to deception literature by
establishing parameters that distinguish pathological lying
from normative lying. The current study showed that cate-
gorical distinctions can be made between normative, prolic,
and pathological lying. Thus, this study will assist researchers
investigating the range of lying patterns.
In sum, the current evidence and theory built on existing case
studies support establishment of PL as a diagnostic entity. The
ndings support PL as meeting criteria for a mental disor-
der, with evidence of a unique, valid, and reliable group of
symptoms. We have provided theoretical criteria, etiological
markers, and a denition of PL, which should guide clinicians
in identifying PL. There are individuals who clearly recognize
and report concerns about their own excessive, persistent,
and problematic lying behavior. Currently, there is no di-
agnostic label for these individuals and no specic treatment.
Features of PL are distinct and found beyond the forensic
population. Denition of a diagnosis of PL would pose low
risk of harm and would allow practitioners to formally
identify PL and to provide treatment for people looking for
relief from its symptoms.
Department of Psychology and Sociology, Angelo State University, San
Angelo, Texas (Curtis); Department of Psychology and Philosophy, Texas
Womans University, Denton (Hart).
Send correspondence Dr. Curtis (
The authors report no nancial relationships with commercial interests.
Received December 29, 2019; revisions received March 9 and April 18,
2020; accepted May 12, 2020; published online June 22, 2020.
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... Although deceit is a potential symptom of antisocial personality disorder, pathological lying has not been discussed as a symptom (11). Furthermore, antisocial personality disorder generally involves a defiance of authority and lack of remorse, whereas people who endorse engaging in pathological lying show distress about their behavior (12). The DSM-IV-TR (13) indicates that individuals with factitious disorder may engage in pathological lying about aspects of their history or symptoms. ...
... Dike and colleagues (15) proposed the notion of primary and secondary pathological lying, with the former as an independent diagnostic entity and the latter involving conditions associated with pathological lying. Dike and other scholars (4,12,16,17) have argued that pathological lying is a separate diagnostic entity. These debates and the historical lack of empirical support for a pathological lying diagnosis may have contributed to the condition's exclusion from major nosological systems, such as the DSM-5 and ICD-10 (11,18). ...
... This definition is consistent with the suggestion from Dike (14) that pathological lying is a broad superordinate category. Additionally, with this definition, the risks involved in this behavior are related to danger to self or others because of the patient's lies (12). A recent study (19) found that people who interacted with those showing pathological lying behavior gave examples of harm to the individual, such as loss of jobs, imprisonment, loss of income, and divorce and other relationship problems. ...
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Objective: 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. Methods: 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. Results: 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. Conclusions: 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.
... Although the label of "pathological liar" is not yet a psychiatric diagnosis (Curtis & Hart, 2020), this term is understood by clinicians to entail several maladaptive characteristics. These include chronically lying without clear purposes or goals. ...
... In addition, pathological lying is persistent, pervasive, and compulsive. Regarding their maladaptive impacts, such lies undermine functioning socially (e.g., destroy trust in relationships when discovered), occupationally, and in other areas of life (Cole, 2001;Curtis & Hart, 2020). ...
... Although the label of "pathological liar" is not yet a psychiatric diagnosis (Curtis & Hart, 2020), this term is understood by clinicians to entail several maladaptive characteristics. These include chronically lying without clear purposes or goals. ...
... In addition, pathological lying is persistent, pervasive, and compulsive. Regarding their maladaptive impacts, such lies undermine functioning socially (e.g., destroy trust in relationships when discovered), occupationally, and in other areas of life (Cole, 2001;Curtis & Hart, 2020). ...
The introductory chapter to Creativity and Morality outlines the relationship between the constructs, summarizing the AMORAL model of dark creativity (Kapoor & Kaufman, in press). Specifically, the Antecedents, Mechanisms (individual), Operants (environmental), Realization, Aftereffects, and Legacy of the creative action are theorized and described within the context of general and dark creativity. We present real-life and simulated examples to illustrate the application of the theory across multiple domains, from law enforcement to interpersonal relationships, from the initial idea to the impact of the eventual action. The AMORAL model will help introduce the main concepts that will be addressed in subsequent chapters.
... Recent studies suggest a more nuanced relationship where more advanced theory-ofmind abilities lead to profiles of occasional, other-oriented lying in early adolescence [6]. Most adults lie at low rates, less often across later adulthood, and fewer tell lies prolifically or pathologically [7,8]. ...
... Indeed, the combination of social-environmental influences with individuals' own characteristics and skills, interacting across situations, over time, shape trajectories of lie-telling across the lifespan. This can lead to different profiles of behavior and understanding those dynamics may help us to understand why, for most, lying is an occasional, even infrequent, behavior with honest communication being prevalent in day-to-day interactions, and for others, it is a prolific, problematic behavior [7,8]. On the whole, empirical research has only started to examine divergent lie-telling trajectories and gaps in our knowledge remain. ...
Lying is a behavior that, in theory, is discouraged and punished, except when it isn’t. Perhaps as a result, many individuals lie at low levels somewhat regularly. While research has well documented the cognitive skills that support children’s early lying, it does not explain how children learn when to lie versus tell a truth. The current paper reviews the impact of social-environmental influences on the development of children’s lie-telling knowledge, understanding and behavior, including the roles of parents, siblings, teachers and others. It is argued that holistic examinations of cognitive, social, environmental, cultural and child factors, interacting over time, is required to understand divergent trajectories of lying and truth-telling across development, particularly at the extremes.
... Deception research extends across numerous disciplines. Some of the diverse research areas include understanding the basic aspects of human communication, detection, forensics, intimate relationships, parental relationships, childhood deception, healthcare, psychopathology, intelligence, law, government, and ethics (Bok, 1978;Curtis & Hart, 2020;Granhag & Strömwall, 2004;Heyman et al., 2009;Levine, 2014;2020;Talwar & Lee, 2002;Vrij, 2008). Much of this literature has revolved around the ability to detect deception (see Granhag et al., 2015;Levine, 2020;Vrij, 2008). ...
Full-text available
Deception is an extensively researched cross-disciplinary subject with limited assessments. Literature has revealed a difference in attitudes toward deception based on the perspective that one holds (liar or dupe). The Others' Deception Attitude Measure (ODAM) was developed to assess attitudes that people hold toward others who are deceptive. The purpose of the current study was to assess the psychometric properties of the ODAM. We recruited 149 participants who completed the ODAM and several other measures. Our results provide initial reliability and validity for the 17-item ODAM.
... 3). In fact, it is through knowledge of the positively skewed lie distribution that commonplace lying can be understood and differentiated from prolific lying and pathological lying (Curtis & Hart, 2020;Serota et al., 2010;Serota & Levine, 2015). ...
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In the psychological research literature, deception is often discussed as a ubiquitous phenomenon. However, recent research has revealed that the mean of two lies per day is highly misleading due to a skewed distribution, with most people telling zero lies on any given day. We sought to explore how the presentation of statistics on lie frequency affects understandings of lie frequency, veracity judgments, behavioral intentions, beliefs about others’ propensity to lie, suspicion, and attitudes. In Study 1, 176 participants were randomly exposed to two explanations of deception research findings that either described lying as ubiquitous or not. Results revealed that the differing explanations of lie frequency did not produce significance differences on the dependent measures. In Study 2, 114 participants were randomly assigned to watch a video of a researcher discussing one of three deception literature prompts. Results indicated that a more nuanced presentation of the skewed distribution of lie frequency led participants to believe that lying is less ubiquitous, but had no effect on veracity judgments, behavioral intention, beliefs about others’ propensity to lie, suspicion, and attitudes. Implications and considerations for reporting lie frequency are discussed.
... Recently, suggested the use of the four Fs as a theoretical approach for understanding pathological lying. Subsequently, Curtis and Hart (2020) utilized the model to discern if pathological lying warrants the inclusion in nosologies as a diagnostic entity, finding empirical support of pathological lying. Of the 623 participants they recruited, 8-13% of people reported excessive lying for greater than six months, leading to impaired functioning in social relationships, feeling pain (or distress), and their lying putting themselves or others more at risk (fatal). ...
Full-text available
Mental health education is very important and often threatened by various myths and misconceptions. Movies and shows tend to perpetuate various myths about mental health. Curtis and Kelley developed a model that advances understanding about psychopathology, referred to as the four Fs: frequency, function, feeling pain, and fatal. The four Fs help educate people about abnormality as criteria of behavior rather than stigmatizing people as ‘crazy’, which is often portrayed in film. Further, the model maps onto major nosologies and has implications for research with psychopathology. The model is discussed along with its benefits and applications.
Research reveals associations between creativity and both moral and immoral behavior, which are not well understood. Deception, ubiquitous among humans and morally ambiguous, provides a fertile context for understanding how creativity and morality interrelate. In the present chapter, a recent cognitive account of deception, Activation-Decision-Construction-Action Theory (ADCAT), illuminates theoretically the nexus between creativity and morality vis-à-vis deception. According to ADCAT, most acts of deception involve activation of the truth, deciding whether and then how to lie, constructing a lie that achieves liars' goals, and then acting the lie out as intended. ADCAT postulates that both moral and immoral lies share the same underlying cognitive mechanisms. It also explains why most lies, including those of young children and narcissists, are not creative, but can be in unusual circumstances. This framework is also applied to account for a variety of related research findings.
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Objective: Scientific tests confirm that certain personality features predict frequent lying. However, lying as a multidimensional construct still lacks a validated measure of dispositional deception to understand this heterogeneous behavioural pattern. Method: The ATRAMIC test was created in order to conceptualize and offer an objective and operational measure of lying as a dispositional trait. We wanted to know what factors from ATRAMIC (the variables of "Propensity to Lie", Personality, Attitudinal and the Sincerity and Social Desirability scales), of the EPQ-R and the IPDE-77, could predict the number of lies per day, in 475 adults of the general population aged 18 to 65 years (Mage = 36.97 years; SD = 13.39). Results: 52.65% of the participants reported that they lied one to three times a day. The ATRAMIC factors correlated more with neuroticism and psychoticism than with EPQ-R extraversion, suggesting different behavioural correlates associated with lying. Logistic regression shows that the variables that best predict the tendency to lie are "Recognition and Acceptance of Lying", "Paranoid Mistrust", "Empathy" and "Neuroticism". As the scores on these variables increase, the more likely it is that the individual will report lying daily. The variable "Acknowledgment and Acceptance of Lying" doubles the probability of lying daily. Conclusions: It is presented as a "dispositional trait" that underlies "the basic personality traits” that define liars. Keywords: predisposition to lie; personality; recognition and acceptance of lying; dispositional trait; frequency of lying.
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Deception in therapy has been documented anecdotally through various narratives of therapists. The investigation of its occurrence within therapy has largely been overlooked. We explored the reported frequency of deception within psychotherapy, the types of deception used within therapy, the likelihood of people lying to a therapist compared to other groups of people, and client perceptions of the types of deception that therapists use. Ninety‐one participants were provided with a series of deception examples, asked questions about the use of these types of deception within therapy, and asked generally about their use of deception in therapy. We found that a majority of the participants had been deceptive in therapy, and a majority were willing to be deceptive in future therapeutic contexts. Participants were more likely to use white lies than other forms of deception in therapy. Lastly, participants were less likely to lie to therapists compared to strangers and acquaintances. Implications for research and practice are discussed.
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Deception researchers have developed various scales that measure the use of lying in specific contexts, but there are limited tools that measure the use of lies more broadly across the various contexts of day-today life. We developed a questionnaire that assesses the use of various forms of lying, including protecting others, image enhancement, saving face, avoiding punishment, vindictiveness, privacy, entertainment, avoiding confrontation, instrumental gain, and maintaining and facilitating relationships. The results of a factor analysis brought our original 45-item scale down to a two-dimensional, 14-item scale that we have titled the Lying in Everyday Situations (LiES) scale. In three studies, the concurrent validity of the scale was assessed with several domain-specific lying scales, two Machiavellianism scales, a social desirability scale, and reports of actual lie frequency over a 24-hour period. The scale was also assessed for interitem consistency (Cronbach's α) and test-retest reliability. We found that the LiES scale was a reliable and valid measure of lying. The LiES scale may be a useful tool for assessing the general tendency to lie across various contexts.
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Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the “problem of comorbidity” by explicitly modeling patterns of co‐occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
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Objective: The K6 and K10 are well-validated screening measures for psychological distress and are widely used. However, the accuracy of these scales in identifying common mental disorders may be suboptimal. This study aimed to develop a brief scale of psychological distress - the Distress Questionnaire-5 (DQ5) - and validate its diagnostic accuracy in identifying common mental disorders, relative to the K6 and K10. Study design and setting: The DQ5 was developed from a pool of 347 items reflecting a range of mental health symptoms. Validation of the DQ5 was conducted concurrently, based on DSM-5 criteria for seven common mental disorders. A population-based sample of Australian adults (n = 3,175) was recruited online, with data weighted to reflect population estimates of disorder prevalence, age and gender. Results: At specified cut points, the DQ5 was significantly more accurate in identifying individuals who met criteria for each of the disorders examined relative to the K6, with the exception of major depression where there was no significant difference in sensitivity or specificity. Conclusion: The DQ5 is a promising tool for identifying psychological distress in the community, with potential for use in a range of clinical settings.
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Objectives: The primary aim of this study was to investigate one facet of a survey of client lying in psychotherapy, that which focused on the nature, motivation, and extent of client dishonesty related to psychotherapy and the therapeutic relationship. Method: A total of 547 adult psychotherapy patients reported via an online survey, incorporating both quantitative and qualitative methodologies, what topics they were dishonest about in therapy, and the extent of and reasons for their dishonesty. Results: Ninety-three percent of respondents reported having lied to their therapist, and 72.6% reported lying about at least one therapy-related topic. Common therapy-related lies included clients’ pretending to like their therapist’s comments, dissembling about why they were late or missed sessions, and pretending to find therapy effective. Most extreme in their extent of dishonesty were lies regarding romantic or sexual feelings about one’s therapist, and not admitting to wanting to end therapy. Typical motives for therapy-related lies included, “I wanted to be polite,” “I wanted to avoid upsetting my therapist,” and “this topic was uncomfortable for me.” Conclusions: Clients reported concealing and lying about therapy-relevant material at higher rates than previous research has indicated. These results suggest the need for greater therapist attention to issues of client trust and safety.
The 4th version of Clinical Practice Guidelines for Hepatocellular Carcinoma was revised by the Japan Society of Hepatology, according to the methodology of evidence‐based medicine and partly to the Grading of Recommendations Assessment, Development and Evaluation system, which was published in October 2017 in Japanese. New or revised recommendations were described, herein, with a special reference to the surveillance, diagnostic and treatment algorithms.
Objective: To identify psychotherapy clients' motives for concealing suicidal ideation from their therapist, and their perceptions of how their therapists could better elicit honest disclosure. Method: A sample of 66 psychotherapy clients who reported concealing suicidal ideation from their therapist provided short essay responses explaining their motives for doing so and what their therapist could do to help them be more honest. Content analysis was used to identify major motives and themes in these responses. Results: Seventy percent of suicidal ideation concealers cited fear of unwanted practical impacts outside therapy as the reason they did not disclose. Chief among these unwanted impacts was involuntary hospitalization, a perceived outcome of disclosing even mild suicidal thoughts. Less concrete motives for concealment, such as shame or embarrassment, were significant but secondary concerns. Nearly half of suicide-concealing clients said they would be more honest only if the threat of hospitalization was somehow reduced or controlled. Conclusion: Fostering disclosure of suicidal ideation in therapy may require renewed attention to providing transparent, comprehensive, and easy-to-understand psychoeducation about the triggers for hospitalization and other interventions. Clients make risk-benefit calculations about whether to disclose suicidal ideation, but may operate with exaggerated or inaccurate ideas about the consequences of disclosure.
Traditionally, psychopathology has been conceptualized in terms of polythetic categories derived from committee deliberations and enshrined in authoritative psychiatric nosologies—most notably the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association [APA], 2013). As the limitations of this form of classification have become evident, empirical data have been increasingly relied upon to investigate the structure of psychopathology. These efforts have borne fruit in terms of an increasingly consistent set of psychopathological constructs closely connected with similar personality constructs. However, the work of validating these constructs using convergent sources of data is an ongoing enterprise. This special section collects several new efforts to use structural approaches to study the validity of this empirically based organizational scheme for psychopathology. Inasmuch as a structural approach reflects the natural organization of psychopathology, it has great potential to facilitate comprehensive organization of information on the correlates of psychopathology, providing evidence for the convergent and discriminant validity of an empirical approach to classification. Here, we highlight several themes that emerge from this burgeoning literature.
The paper outlines the difference between the so-called normal (common) lying and pathological lying. Pathological lying is an intriguing topic, still lacking any strong professional consensus, clear etiology, treatment options and prognoses. The paper explores some possible psychological mechanisms of pathological lying, reviews biological factors in pathological lying, and considers forensic significance of normal and pathological lying. The relationship between pathological lying and mental disorders is also discussed. The authors suggest that lying should be considered as a heterogenic and multidimensional behavioral pattern. The paper highlights how important it is to assess the patient's control over lying, the function of lying, insight into and awareness of lying, as well as the effect of lying on everyday functioning.