J Am Acad Psychiatry Law 33:3:350-353 (2005)
Copyright © 2005 by the American Academy of Psychiatry and the Law.

Commentary: Getting at the Truth about Pathological Lying
Don Grubin, MD

Dr. Grubin is Professor of Forensic Psychiatry, University of
Newcastle, and (Hon) Consultant Forensic Psychiatrist, Newcastle,
North Tyneside, Northumberland Mental Health Trust, Newcastle-upon-
Tyne, UK. Address correspondence to: Don Grubin, MD, Department of
Forensic Psychiatry, St. Nicholas Hospital, Gosforth, Newcastle-upon-
Tyne, UK NE3 3XT. E-mail: don.gru...@ncl.ac.uk

    Abstract

Lying is common, and in its many aspects forms a normal part of social
interchange. In this issue, Dike et al. review the literature on what
has been referred to as pathological lying, highlighting the lack of
information available about this phenomenon. In this commentary on
Dike et al., it is noted that if pathological lying exists, it is not
the lie, but the liar that is abnormal, with the abnormality relating
not to the nature of the lies told, but to the mental state associated
with the behavior. Before forensic opinions regarding pathological
lying can be given with confidence, we need more data to help
determine whether it is in fact a psychiatric entity, and if it is,
about the physical and psychological characteristics that underpin
it.

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The truth, the whole truth, and nothing but the truth. The words of
the oath are of interest, not only because of their tacit recognition
that people lie, but also because of their acknowledgment that "truth"
is multifaceted. Lies may be overt, as in the case of Judge Couwenberg
who, as described by Dike et al.,1 made "misrepresentations" and
"deliberately" provided false information, and as they indicate, Judge
Couwenberg is not without illustrious colleagues. However, lies may
also take the form of statements in which no actual untruths are
uttered but which disguise a much larger truth, as was well
illustrated by U.K. Cabinet Secretary Robert Armstrong, who in 1986
resurrected the phrase "being economical with the truth" in describing
his actions in court proceedings to ban a book about the Intelligence
Service. Lies may hide themselves within the truth, as demonstrated in
a recent survey of National Institutes of Health-funded scientists,
which reported that a third of respondents admitted to engaging in at
least 1 of 10 types of behavior defined as fabrication, falsification,
or plagiarism in their research.2

    Lying

From an early age we are taught not to lie, and lying carries with it
a host of negative moral overtones. Put simply, we are supposed to
tell the truth. Yet in his book on the topic,3 Ford identified over 50
words synonymous with lies and lying and quoted research indicating
that 90 percent of Americans admitted to being deceitful (with the
other 10% perhaps being dishonest about it). In their work, Depaulo
and colleagues4 found that American college students on average tell
two lies a day, and ordinary people in the community one a day. Given
the ubiquitous nature of lying, therefore, is it possible to identify
a pathological form of the behavior? To do so, it is necessary first
to be confident that we understand the phenomenology of lying itself.
It is not, however, entirely clear that we do.

Most definitions of lying refer to the deliberate communication of
information believed to be false and intended to deceive (although
terms such as "the whole truth" and being "economical with the truth"
suggest that the inclusion of false information is not necessary to
the concept of lying in its wider aspects). Thus, patients who
communicate false information in the context of a range of psychiatric
states, such as when they are confabulating, have delusional memory,
or are demented, are not lying because they are not deliberately
misleading us. But what of more borderline situations? Does the
compliant individual who makes a false confession under interrogatory
pressure from the police lie when he confesses?5 Or is the sex
offender lying when he minimizes, rationalizes, or otherwise justifies
the circumstances of an offense, something we more typically label as
"cognitive distortion" or "denial"? And what about Vietnam veterans
with symptoms of PTSD who appear to exaggerate the nature and extent
of their service in Vietnam?6

In the realm of more overt and straightforward lies, people tell
untruths in a range of ways and for a variety of reasons. Lies may be
big, like Judge Couwenberg’s, or small, as in the minor fibs we tell
to smooth normal social intercourse ("yes, of course that dress/suit
looks good on you"). Some are intended to achieve specific aims—to
avoid getting into trouble for being somewhere one was not supposed to
be or doing something one was not supposed to do, to sell a product
(or oneself), or to impress—while others seem without purpose,
designed simply to deceive. Lies can be altruistic (a 1989 study of
American doctors found that over 80% would lie if it were in the
interest of their patients7), or expedient. Lies may be obvious, or
they may be subtle. And of course, some people lie more than others.
Kashy and DePaulo8 suggest that those who tell more lies are more
manipulative, more concerned with self-presentation, and more
sociable, but less socialized.8

    Pathological Lying

Thus, lies are of different degrees and are told for various purposes
and with differing frequencies. What, then, amounts to "pathological"
lying, and what distinguishes the pathological liar from the person
who just lies a lot? Dike and colleagues1 suggest that the diagnosis
is made when the lying is persistent, pervasive, disproportionate, and
not motivated primarily by reward or other external factors. They also
suggest, however, that a key characteristic of pathological lying may
be its compulsive nature, with pathological liars "unable to control
their lying," although another term they use is "impulsive." In
addition, they refer to other accounts that speculate on whether the
pathological liar may be unaware that he is lying, although they point
to evidence showing that, when challenged, the pathological liar
admits to at least a partial recognition of his or her lies (which
assumes, of course, that pathological liars can be accurately
identified so this can be tested in the absence of a clear definition
or operational criteria).

Clearly, to be a pathological liar, an individual must lie on more
than a few occasions, but how frequent does the behavior have to be?
Is the scale of the lie really important, or does this just make the
pathological liar easier to spot? And why is it relevant that the lies
seem pointless? From a psychiatric point of view, lying is simply a
type of behavior, albeit a complex one, that demands an appreciation
of the abstract concept of truth. What makes a behavior
psychiatrically abnormal is not its degree or its purpose, but the
extent to which the individual has power over it. The fact that a
behavior may cause the individual more harm than good and that there
does not seem to be a rational reason for it may be indicators of
psychiatric morbidity, but neither is necessary or sufficient to
establish a disorder. What these indicators suggest, however, is an
apparent lack of control. For pathological lying to exist, therefore,
the individual must lie despite himself, just as someone with an
anxiety disorder cannot help feeling anxious.

If this formulation is right, then there are no pathological lies,
only pathological liars. And whether or not this is primary or
secondary to another condition, it suggests a disorder that is either
compulsive in nature or something akin to an impulse control disorder.
Although if it is true that some or all pathological liars are in fact
unaware of their lies, something more fundamentally organic seems
likely. Without evidence of compulsivity, excessive impulsivity, or
brain dysfunction, habitual lying, no matter how grand, is not a
symptom, syndrome, or diagnosis, but just plain lying.

    Identifying Pathological Liars

According to the Blue Fairy in Pinocchio, "Lies are easily recognized.
There are two types of them. Those with short legs, and those with
long noses."9 Was she right? And if so, are the lies of pathological
liars short legged or long nosed in nature?

First, the Blue Fairy was wrong in believing that lies are easily
recognized, except that the long-nosed ones of Pinocchio could be
easily spotted. Even if one focuses only on overt lies rather than the
much more complicated "whole truth and nothing but the truth" type of
lie, a number of studies have demonstrated that people are poor lie
detectors, being able to identify lies in experimental studies at
about chance rates, and sometimes below chance.10 Experienced
detectives, Secret Service personnel, and CIA agents are better than
average at detecting lies, but they still achieve accuracy rates of
only about 70 percent.11,12 What the research also shows is that, in
general, people are more likely to judge statements as truthful than
untruthful (a so-called truth bias) and that attending to content
rather than "body language" or voice cues is likely to be a more
productive strategy in correctly recognizing a lie.

There are two implications of this research. First, it is unlikely
that the pathological liar will be readily recognized from interview
material alone. Not only is good documentary evidence required with
which to check the individual’s self-report, but a high level of
suspicion is necessary in the first place if that evidence is going to
be sought and attended to closely. It is worth remembering that even
in the apparently more transparent arena of physical complaints,
doctors are easily fooled by simulating patients, and in fact pick up
fewer than a quarter of feigned complaints.13 Second, because of this
difficulty in detecting liars, let alone pathological liars, it is
unlikely that we will ever know the true prevalence of the condition.

Although the true prevalence of pathological liars may remain well
hidden, a good operational definition would mean that when we have a
putative one in our grasp, we could better understand the
phenomenology, enabling us in future to distinguish pathological liars
from ordinary ones, or from other presentations. For example, I am not
as confident as Dike and his colleagues1 that the lying that takes
place in Factitious Disorder is necessarily distinct from that of the
pathological liar or that the goal of lying (in the case of Factitious
Disorder to assume the role of a sick person) is an important
distinguishing characteristic. Similarly, complexities introduced by
coexisting personality disorder could be more readily teased out. From
the account given by Dike and colleagues, how sure can we be that
Judge Couwenberg does not have a narcissistic personality disorder,
and if he does, whether it matters?

Confidence in identifying an individual as a pathological liar would
also allow the condition itself to be better understood. In
particular, we as yet do not know whether something different is
happening physiologically or psychologically when the pathological
liar is telling a lie compared with when ordinary folk lie. Based on a
review of the literature, King and Ford14 claim that 40 percent of
cases of pseudologia fantastica have a history of brain abnormality
and that there is also evidence of verbal-performance discrepancies on
IQ testing. If there is an underlying organic basis to the condition,
does the corresponding psychological deficit affect cognition (for
example, problems in processing information related to abstract
concepts like "truth"), emotion (perhaps a lack of negative emotions
such as the guilt normally associated with lying), interpersonal
functioning (for instance, linked to antisocial or even psychopathic
traits like ruthlessness and manipulation), or behavioral control? Or
might the explanation be more purely psychological, related to self-
identity and self-worth?

A useful starting point in investigating the pathological liar would
be to attempt to resolve the question of the extent to which the
pathological liar recognizes that he or she is lying. Given the
inherent difficulty in relying on self-report in these individuals, a
productive approach might be to use polygraphy to examine the
pathological liar’s physiological responses to lying. Although
polygraphy is not 100 percent accurate in identifying either liars or
truth-tellers, its accuracy rate is believed to fall within the range
of 81 to 91 percent,15 sufficient for a study of this nature. The key
aspect of the polygraph examination is not, as some believe, that
subjects should feel anxious when telling a lie, but rather that they
recognize they are lying and that the aim of the examination is not to
be caught doing so. If pathological liars regularly "beat" the
polygraph, then this would suggest either that they do not perceive
themselves to be lying, or that they are particularly good at using
countermeasures.

    Conclusion

We know very little about pathological liars. We may think we can
recognize one when we see one, but without a better understanding of
the phenomenology of the condition we cannot even say with certainty
that it exists as a pathological entity. Questions involving their
responsibility for the lies they tell or their fitness to plead can
therefore at present be answered only speculatively and based on
opinion, which will be heavily influenced by examiners�?psychiatric
biases (that is, whether they come from a psychodynamic,
psychological, or biological tradition), their moral views on the
nature of lying, and the extent to which they are willing to stray
beyond the limited evidence available.

In respect to whether the lies of the pathological liar are short
legged or long nosed according to the Blue Fairy—short legged based on
the Italian proverb that says that lies have short legs because they
do not take you very far and long nosed, perhaps, because they are
directly in your face—the answer seems clear. Based on the careers of
some of the potential pathological liars referred to by Dike and his
colleagues,1 it appears that the lies of these individuals have long
legs that have taken them very far indeed, despite, and possibly
because of, their prominence.

    References

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This article has been cited by other articles:

C. Bass and P. W Halligan
Illness related deception: social or psychiatric problem?
J R Soc Med, February 1, 2007; 100(2): 81 - 84.

B. Adetunji, B. Basil, K. Budur, and O. Oladinni
[In Process Citation]
J Am Acad Psychiatry Law, January 1, 2006; 34(1): 131 - 132.

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