Editor:

We read with interest the article by Dike et al.,¹ on pathological lying, as well as the excellent commentary provided by Professor Grubin.² We feel that, while the concept of pathological lying serves as a great debate within academia, Dr. Dike and his colleagues missed the opportunity to advocate for the removal of the pejoratively and medically unproductive adjective “pathological,” which has been colloquially ingrained in psychiatric literature. The adjective dates back to the “moral viewpoint” of psychiatric disorders rather than the “disease viewpoint,” and its removal would be a necessary first step toward jettisoning our negative and countertransferential emotion about liars, thus facilitating the search for medical interventions for the sufferers.

Just like any other universal behavioral concept, lying cuts across cultures and may be part of normal development and individuation.³ Consequently, we do not believe there are pathological lies or pathological liars, in part because of the difficulty in determining what is pathological. Do we go with the numbers, as seems to be suggested by Dr. Dike and his colleagues¹ or do we go with the incredulity of the lies? Of what significance is “not being found out”? Does it mean that if you are a smooth liar who compulsively seduces women, but are rarely exposed, you can never be classified as a pathological liar? Where do we place politicians who consistently promise voters things they cannot deliver? What about the advertisers who hide significant information about their products in the “fine print”?

With regard to Professor Grubin's commentary,² we would like to point out that it is not uncertain whether the concept of lying involves demonstrable physiological abnormality. Apart from the studies mentioned by Dike et al.¹ about the link between pathological lying and central nervous system disorders^1,4 and right hemithalamic dysfunction,^1,5 there is a very recent landmark study by Yang et al.,⁶ who found that liars have increased prefrontal white matter volumes and reduced gray/white matter ratios compared with normal control subjects. This difference remains the same when compared with an antisocial control group and means that, with further research, more could be uncovered about the pathophysiology of lying. The revelations could lead to more studies in the area of psychotherapeutic and psychopharmacologic intervention.

Removing the adjective means we can evaluate people in a more objective manner. We will then be able to categorize those who are found to lie repeatedly, as to whether they perceive their repeated lying as ego‐syntonic or dystonic and whether they want treatment or not. This would be akin to a serial adulterer or someone who excessively eats, smokes, or drinks, but does not want medical intervention. If it is ego‐dystonic and the individual wants treatment, we can then determine whether the repeated lying is primary or secondary. Of course, if it is secondary, intervention could be directed toward the cause. However, if it is primary, we can then determine whether it is primarily compulsive or impulsive. If compulsive, would behavior therapy or selective serotonin reuptake inhibitors (SSRIs) help? If impulsive, considering the trends of current research linking lies to prefrontal lobe abnormality, would anticonvulsants have any role? Would those two groups benefit from a support group such as “Pathological Liars Anonymous,” which, in line with our views, should be more appropriately named “Impulsive‐Compulsive Liars Anonymous”? These are the exciting challenges we could face, if we can do away with the sensational adjective “pathological” and replace it with nonjudgmental nomenclature.

• American Academy of Psychiatry and the Law