Pseudologia fantastica (PF), also known as pathologic lying, compulsive lying, or mythomania, is a rare psychiatric syndrome involving enduring falsifications with extraordinarily colorful and detailed narratives. There is a limited amount of literature on PF, and it remains a challenge for clinicians to diagnose and manage. We present a case of PF with a focus on clinical features and management strategies. The literature on PF is reviewed using the PubMed database. Management strategies reported in previous case reports were successfully adapted for this patient. This report describes the clinical presentation of an individual with PF who experienced a range of psychiatric presentations and had a favorable response to psychotropic medication. Management of such patients should include collaborative effort from treatment teams to provide supportive listening and focus on building rapport with patients. Recognition of PF does not preclude other psychiatric conditions, and any coexisting psychiatric conditions should be treated following current guidelines.

Feigning and fabrication by a patient can evoke anger and distress in staff and generate diagnosis and management challenges. When faced with difficulties that can lead to moral injury among health care providers, and even risk compromised patient care, clinical teams must balance empathy with appropriate boundaries. This case report examines an individual with a history of polysubstance use and acute-on-chronic pain whose persistent patterns of fabrication-spanning exaggerated military service, terminal illness, family trauma, and academic accomplishments-posed substantial risk-assessment and treatment-planning challenges across multiple clinical presentations. Insights from three expert discussants with distinct specializations in psychodynamic formulation, distress management, and forensic psychiatry are provided. Through their analyses, the complex interplay among chronic pain, inadequate distress tolerance, personality pathology, and health care utilization are evaluated in conjunction with evidence-based approaches to differential diagnosis and management. This article presents practical recommendations for preserving therapeutic engagement while protecting appropriate boundaries and, ultimately, working toward optimized care delivery for such challenging, vulnerable patients.

Munchausen syndrome, also called factitious disorder imposed on self, is a psychiatric disorder in which a person assumes the role of a sick patient without the intention of external gain (time off from work, medications). Physical symptoms are intentionally produced with the purpose of gaining the appearance of a "sick patient." These patients are often a medical mystery to healthcare workers as their laboratory, and radiographic results can be inconsistent with the history and physical exam. Furthermore, standard therapeutic interventions may not be effective in persons with Munchausen syndrome, causing increased confusion for the care team.[1][2][3][4][5]

Pseudologia fantastica (PF), commonly known as pathological lying or mythomania, is a psychiatric phenomenon characterized by persistent, pervasive, and often compulsive lying. PF involves the intricate crafting of highly exaggerated narratives across various domains of life, including personal background, accomplishments, and interpersonal connections. Individuals afflicted with PF earnestly subscribe to these fabricated accounts, often perceiving them as genuine truths. Unlike conventional lying, which typically involves 3 key components—consciousness of falsehood, intentional act of conveying misinformation, and a predetermined motive—PF diverges in its presentation and is characterized by a sincere belief in the veracity of the fabricated narratives, rather than a deliberate and calculated attempt to deceive for specific gain or purpose.  PF manifests as an excessive distortion of reality grounded in factual elements, involving prolonged and extensive fabrication of events over extended durations, often spanning years, and lacking predefined objectives. Characterized by the construction of ostensibly credible falsehoods intricately woven into a framework of reality, PF is distinguished by its consistency over time and absence of overt personal gain motives, instead marked by a propensity for exaggeration and a notable lack of control over the fabrication process. The fabrications characteristic of PF stands in contrast to fixed delusions in that individuals afflicted with PF can acknowledge the falsehood of their statements upon confrontation with factual evidence. This differs from false fixed beliefs, known as delusions, wherein individuals persist in their erroneous convictions even when presented with incontrovertible evidence contradicting their beliefs, demonstrating an inability to recognize the falsehood of their assertions.   Since PF was conceptualized in the late 1800s, it has not been recognized as an independent disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), the condition is considered to be a feature of cluster B personality disorders, including narcissistic, antisocial, and histrionic types, or posttraumatic stress disorder (PTSD). PF has been theorized to stem from low self-esteem. PF is most related to factitious disorder, which was a standalone diagnosis in the DSM-IV and is classified under "Somatic Symptom and Related Disorders" in DSM-5, characterized by producing physical or psychological signs or symptoms without external gain or clear reasoning behind them. "Pseudologue" is a term used to refer to an individual who engages in PF, meaning someone who habitually fabricates elaborate and exaggerated stories. The term is derived from the condition itself, where pseudo in Greek means "false or deceptive," and logue is derived from the Greek word logos, meaning "speech or discourse." Therefore, a "pseudologue" is essentially someone who engages in the behavior characteristic of PF. PF has significant forensic implications, particularly in examining a pseudologue's competency to stand trial, as they may deliver false testimony under oath. Currently, PF is not recognized as an official mental illness per the DSM-5. Having one symptom without a recognized disorder may pose a question in mitigation.  With the existing limited data on PF, efforts to comprehend its prevalence, identify associated risk factors, and assess its impact on individuals and society are imperative. Through clinical recognition and the implementation of suitable management strategies, the adverse repercussions of pathological lying can be alleviated, potentially leading to improved outcomes for those affected by this condition.

Pseudologia fantastica (PF), also known as mythomania or pathologic lying, is a well-known yet controversial phenomenon in psychiatry. There is no firm conceptualization of PF, nor are there any widely accepted diagnostic criteria for PF. The condition may be related to low self-esteem, and it shows some overlap with narcissistic personality disorder and other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cluster B personality disorders. Given the mysteriousness and rarity of PF, there is a dearth of information to guide diagnosis and even more limited information about effective treatments. Here, we discuss a case in which an adult male patient exhibited protracted symptoms that were consistent with PF, which consisted of elaborate falsifications pertaining to a history of military service that had duped even close family members. We describe the patient's presentation and the careful process of confrontation and acquisition of collateral information used to reach the diagnosis, along with the patient's efforts to avoid accepting the truth by constructing a series of even more elaborate stories. Finally, we underscore the importance of maintaining a therapeutic alliance in caring for patients with PF through frequent displays of uniform positive regard, and we describe the approach to treatment used during the patient's hospital stay.

The phenomenon of unqualified persons dishonestly holding themselves out as registered health practitioners has a lengthy and colourful history. Many notorious examples of such conduct have been exposed only after significant periods of successful deception by the perpetrators. However, there is a very limited scholarly literature on the phenomenon. A number of explanations have been proffered for such examples of deceptive conduct, including the commercial, the pathological and even the socially and sexually opportunist. Pseudologia fantastica is a term coined by Delbrück in 1891 for compulsive lying and has been mooted as an explanation for at least some impersonators of health practitioners. It may be that in many scenarios the explanation lies more closely in personality disorders, especially those featuring grandiosity, including Antisocial Personality Disorder and Narcissistic Personality Disorder. This article instances a variety of current and historical examples of impostor health practitioners. It provides 12 recent Australian and New Zealand case studies across the broad spectrum of general medical practice, gynaecology and obstetrics, psychiatry, psychology, paramedics, orthodontics, and general dentistry. It identifies that it is persons coming from overseas who disproportionately have utilised the opportunity to engage in premeditatedly fabricating and misrepresenting their qualifications. Such conduct endangers the wellbeing of patients, undermines the health regulatory system and can have both criminal and disciplinary consequences. In spite of a general tightening of checking of asserted qualifications, persons determined to fake their credentials and to create fictional professional lives continue to make their way through the regulatory net. This article seeks to understand better the phenomenon of impostor health practitioners, to consider how the criminal and disciplinary law should respond to their conduct, and to emphasise the importance of regulatory processes that will reduce the prospects of success for persons minded to engage in such dangerous misrepresentations.

Pseudologia fantastica, a psychological phenomenon that has been described in the literature for at least a century, is an understudied and poorly understood entity. Sometimes referred to as pathological lying, pseudologia fantastica involves disproportionate fabrication that may be present for many years or a lifetime. In a forensic context, it can significantly complicate the evaluation of capacity to stand trial and, in certain jurisdictions, criminal responsibility. We review the current literature regarding pseudologia fantastica and present a case to highlight the clinical and forensic challenges it may create. We specifically discuss the complications that pseudologia fantastica may have on the assessment of a defendant's rational ability to consult with an attorney, a required element of capacity to stand trial. In addition, we discuss the implications of pseudologia fantastica in the evaluation of criminal responsibility.

Psychiatrists commonly encounter deception in the emergency department. This article presents the case of a patient who presents to the emergency department with an unusual and elaborate web of deceptions along multiple themes including feigning medical illness, multiple losses, and grandiose academic and athletic achievements. We review the clinical characteristics of pseudologia fantastica and discuss how this patient's constellation of malingering, factitious disorder, and personality disorder suggests this diagnosis.

While lying is a diachronic integral part of human interaction, pseudologia fantastica represents probably its psychopathological dimension. There are relatively few reported cases on psychological mechanisms of pathological lying and also on criteria concerning psychopathological development on a ground of lying. A review of literature on possible psychological mechanisms of pseudologia fantastica is presented. Psychopathological qualities are rather controversial, especially whether pathological lying is a conscious act or not. DSM IV-TR recognizes pseudologia fantastica in association with factitious disorder but not as a clinical entity. Diagnostic issues are raised regarding lying, deception, pseudology and its shared dimension. Cases of shared pseudology are rarely reported in literature. Related shared psychopathological phenomena such as pseudologia à deux, folie à deux and mass hysteria are equally examined and compared under the prism of 'mental infection'. Cases of pseudologia fantastica are poorly understood or underecognized and clinicians usually pay minor attention in its psychopathological significance. It remains doubtful, whether pathological lying should be considered as an autonomous clinical entity. The need for research both on phenomenology and pathophysiology is emphasized. In addition to reviewing literature, we also report a case of pseudology à deux in a couple, a female and a male patient. Presented psychopathological manifestations, personality characteristics, psychological and social factors concerning both patients are considered, aiming to determine a sufficient phenomenological analysis. The diagnoses of pseudologia fantastica and folie à deux are discussed and documented. A second axis diagnosis of personality disorder and other diagnostic issues are also considered. A favorable issue of this case, within a follow up of one year, is due to the therapeutic and social potential of a community psychiatry's setting, offering an individual follow up to both partners and a family approach including the ex husband of the female patient and her two minor children. The presented case focuses on a notably rare and controversial form of pathological lying, pseudologia fantastica à deux, and possible underlying mechanisms.

Pseudologia fantastica, also known as mythomania, or pathological lying, is a psychiatric phenomenon that is a mixture of fact and fiction involving fantasized events and self aggrandizing personal roles. It has been recognized in the field for over a century. In this case report we discuss three different cases, two of them presented in the acute inpatient setting and one outpatient setting. All three presented with the common theme of extensive and 'pathological lying' in a manner that was notably very destructive to them and posing significant challenges to the treatment team. In an attempt to shed light into some of the clinical and legal/forensic challenges it creates when faced in the clinical settings, we also raise the need for a better definition and classification of this symptom in the DSM.

Munchausen's syndrome is classified as a chronic factitious disorder with predominant physical signs and symptoms. Several symptoms are specific to this disorder, such as travelling and pseudologia fantastica. Others symptoms, such as multiple physical complaints with no organic substrate, are shared with somatoform disorders. We report a case showing how difficult it is to diagnose a Munchausen syndrome. We discuss also the opportunity to classify such a syndrome as a factitious disorder. Indeed, several authors suggest classifying Munchausen syndrome as a subtype of somatoform disorders, as those two disorders share a lot of characteristics.