Pseudologia Fantastica: An Elaborate Tale of Combat-related PTSD

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.