Synopsis of Psychiatry, Kaplan and Sadock, Sixth Edition, 1991 (Pages 487)

Lisa, a 20-year-old unmarried billing clerk, was referred for psychiatric evaluation by the criminal court judge. Lisa, who had previously been placed on probation by the juvenile court, was now being tried as an adult for yet another charge of theft. She had deposited cash payments made to the physician for whom she worked into her own account. Lisa was accompanied to the psychiatric interview by her mother, a well-dressed, upper-middle-class matron who provided additional (and often contradictory) information to that given by Lisa.

Lisa had been charged and convicted of theft twice previously, but those offenses reflected only the times she had been caught and her mother had not been able to successfully intervene. In fact, Lisa had been repeatedly apprehended for shoplifting and had, on several occasions, “borrowed” the credit cards of her friends and her mother, charging thousands of dollars for clothing, jewelry, food, and cosmetics. As a child and young adolescent, Lisa had frequently stolen money from her father’s wallet and her mother’s purse. Teachers at school had learned that if anything was missing, Lisa’s desk or locker was the first place to look. When Lisa was apprehended, her mother would make plausible excuses for Lisa and then pay for whatever loss she had caused. Everyone, including Lisa, agreed that she had no need to stealůher mother was indulgent and provided her with essentially anything she wanted.

Lisa continued, however, to steal and lie repeatedly. Lisa lied about everythingůhow much money her father earned, how many boyfriends were pursuing her, and how well she was doing at school. When caught stealing, she inevitably had a facile, reasonable excuse for why she had something that did not belong to her. To further complicate her story, Lisa also secretly engaged in bulimia and would, once or twice a week, binge and induce vomiting.

From a psychiatrist’s viewpoint, the information about Lisa’s family was very revealing. Her father was described as a successful surgeon whose compulsive gambling had led to repeated financial crises that had been kept secret from the children. He was also described by the mother as a “pathological liar” who skillfully covered his absences (to see his bookie) from the hospital and office with plausible excuses. His father (Lisa’s paternal grandfather) was an alcoholic, as was Lisa’s maternal grandfather.

The overriding dynamic in Lisa’s family was the attention provided to her older brother, a professional baseball player. Almost all family activities throughout her childhood had centered around this brother and his athletic accomplishments. Her father may not have been able to take time from his busy medical practice to attend Lisa’s piano recitals, but he never missed a Little League or high school baseball game. Lisa’s mother doted on the handsome young man, indulged him, and rescued him from his minor misdemeanors.

Lisa was referred for psychological testing that revealed mild dyslexia, in addition to the underlying depression and mixed impulse control disorder (kleptomania, bulimia, and compulsive lying) diagnosed by the psychiatrist. Once again, with the behind-the-scenes interventions of her mother, the judge ordered a brief period of probation and mandated psychiatric treatment. Lisa canceled the first appointment that was scheduled after the end of her probation and never returned for further treatment.

The lying that is frequently observed in persons with impulse control disorders appears to be more pervasive than just the need to cover up behaviors and avoid their consequences. Pathological (or compulsive) lying may itself be an impulse control problem, and thus its association with other difficulties in impulse control may reflect the underlying psychological or brain dysfunction problems common to several syndromes. The impulse control disorders are frequently associated with depression and a personal or family history of substance abuse. McElroy and colleagues (1992) and Stein and colleagues (1993) have suggested that a common neurophysiological abnormality in the impulse control disorders (including the more impulsive personality disorders such as antisocial and borderline personality disorders) is a deficiency in brain serotonin, one of the primary neurotransmitters. Serotonin is known to have inhibitory qualities, and treatment with a medication that increases serotonin at the neural synapse often serves to reduce impulsiveness (McElroy et al. 1992). Clinical research and clinical trials with Prozac or similar medications for treating pathological lying have not yet been reported but might theoretically be helpful.

In addition to neurophysiological substrates to impulsivity, there are also psychological/psychodynamic issues to consider. Goldwater (1994) described impulsive people as deficient in the constructive and preparatory use of fantasy to control their present and their future. They are also only vaguely aware of the past and, thus, live only in the present, for the moment. Goldwater’s view of impulsivity is instructive in reference to the lying behaviors of impulsive people. They do not learn from the past and are not aware that other people use the past for reference. Or, in other words, that the truthfulness of the liar’s words will be evaluated in terms of past experiences. Furthermore, the impulsive liar fails to take into account the various effects (including negative effects on the liar himself or herself) that a lie may produce. As a result, the impulsive person lies to gratify current feelings and thoughts without regard to either the past or the future.