Pseudologia Fantastica Fuels Trump’s Lies

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Pseudologia Fantastica Fuels Trump’s Lies

By Arthur Lazarus, MD, MBA (This article was originally published on

In the August 1, 2023 U.S. federal indictment of Donald J. Trump, prosecutors said that Trump knew his claims of having won the 2020 election were false but he “repeated and widely disseminated them anyway — to make his knowingly false claims appear legitimate, to create an intense national atmosphere of mistrust and anger, and to erode public faith in the administration of the election.” The indictment also outlined how the former president, in furtherance of his lies, took criminal steps to reverse the clear verdict voters had rendered for Biden in the election.

Central to the mounting criminal cases against Trump – from his alleged falsification of business records about a hush money payoff to an adult film actress, to illegally possessing classified documents after leaving the White House and concealing them from investigators, to Trump’s attempts to reverse his election loss to Biden in Georgia – is a rare psychiatric syndrome known as pseudologia fantastica, more commonly known as pathological lying.

The German psychiatrist Anton Delbrük was the first to describe pseudologia fantastica in 1891. Through an elaborate and exhaustive investigation of the lies told by five patients over a period of years, he came to the conclusion that the form of falsifying information in these cases deserved a special name. It was not ordinary lying, or delusion, or false memory; hence, he coined the term “pseudologia phantastica” to describe patients who tell complex tales where fantasies seem to coexist with lies. There are fewer than 30 case reports in the English literature.

One of the best definitions of pseudologia fantastica comes from a 1915 monograph “Pathological Lying, Accusation, and Swindling.” The key elements are:

·      lying is entirely disproportionate to any discernible goal or purpose

·      lying rarely, if ever, centers on a single event

·      lies manifest over a period of years, or even a lifetime.

·      the person cannot definitely be declared “insane”; however,

·      an ego motive is always present – the person lies about something they wish to possess or be

In Trump’s case, his lies were about retaining power and his position as Commander-in-Chief and president of the United States.

Make no mistake about it. Lies come in all sorts of shapes and sizes. There is a famous quote attributed to Mark Twain that there are three types of lies: lies, damn lies and statistics. The latter is often applied to the world of clinical research wherein marketing professionals attempt to spin the results of clinical trials in a favorable way to make claims unsubstantiated by statistical significance.

In announcing the most recent federal indictment, prosecutor Jack Smith said Trump’s actions were “an unprecedented assault on the seat of American democracy…fueled by lies.” The key to convicting Trump, therefore, will be to prove that Trump knew he was lying. However, Trump appeared to believe wholeheartedly that the election was stolen, a belief that he clings to today. In Trump’s mind, which is awash in pseudologia fantastica, a conspiracy against him would justify the actions he took to retain the presidency – the very actions deemed criminal in the indictment.

Trump’s lawyers are likely to argue that his First Amendment rights gave him broad latitude to speak publicly about the election. But this defense is anticipated and accounted for in the indictment, which even acknowledges Trump’s right to lie and make false claims about the election, which he did, including Trump’s right to pursue legal means to challenge the results, which he also did. Where the line was crossed, according to indictment, was Trump’s pursuit of “unlawful means of discounting legitimate votes and subverting the election results,” specifically by undermining the certification process and proceedings, as well as attempting to nullify the right to vote and to have one’s vote counted.

A better defense than invoking the First Amendment is to argue that Trump acted upon his pathological fantasies, similar to a not-guilty-by-reason-of-insanity defense, only not insane. Trump’s attorneys could argue that Trump’s pervasive fabrications are pathological yet real to him. Pathological lying could be used to justify the extraordinary means Trump used to remain in the White House. A forensic psychiatrist could argue that, in psychological terms, Trump lied for internal reward and gratification. And because Trump remains steadfast in his beliefs, under no circumstances are his lies an attempt to avoid the painful consequences of prosecution.

Trump’s legal team should point out that individuals with pseudologia fantastica rarely admit to psychological motives that have been postulated for lying (e.g., to improve self-esteem, as a form of wish-fulfillment, etc.), an indication that the phenomenon is unconsciously driven, which further differentiates it from other non-pathological forms of lying.

Moreover, because the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) does not consider pseudologia fantastica as a distinct psychiatric syndrome, Trump’s attorneys can use this defense with impunity while allowing Trump to save face: “Crazy? Not me!” His lawyers may be able to convince a jury that Trump’s stories, like those of other people with pseudologia fantastica, are not entirely improbable and are often built upon a matrix of truth. Perhaps Trump’s pathological lying will, in the minds of a jury, confirm what they already know to be true: Trump has a narcissistic personality disorder. Trump’s legal team simply needs to remind the jurors that pathological lying is characteristic of such individuals.

My experience with pseudologia fantastica stems largely from treating patients with factitious disorder (Munchausen syndrome), where pathological lying is also a characteristic feature: patients feign their own illnesses. Whether diagnosed with narcissistic personality disorder or Munchausen syndrome, psychotherapy is the treatment of choice. The aim of therapy is to uncover the origins of the lying in the context of the patient’s broader psychological make-up.

Trump’s remarkable inability to acknowledge his difficulty with telling the truth would make him a formidable patient. Lying might just sustain him for the remainder of his career.

Arthur Lazarus, MD, MBA, is an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.

Arthur Lazarus, MD, MBA

Certified Physician Executive & Healthcare Consultant

Pronouns (He, Him, Doctor [not Provider])

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