Sincere Lies Interest Me: Pseudologia Fantastica in Clinical Practice

• DOI: https://doi.org/10.22533/at.ed.1594812429089

• Palavras-chave: fantastic pseudology; mythomania; pathological lying

• Keywords: fantastic pseudology; mythomania; pathological lying

• Abstract:

  INTRODUCTION: Fantastic Pseudology—also known as mythomania—was first described and conceptualized by Delbrueck in 1981. Although there is no well-established definition, certain characteristics stand out, such as the lack of a clear objective in the narrative, the narrator's portrayal as a victim or hero in a quest for admiration, and the inclusion of fanciful, detailed, and fantastic stories. It is sometimes difficult to differentiate mythomania from simulation or factitious disorders, but in the case of pseudologists, the stories are disproportionate to any obvious external rewards and cover a wide range of themes—far beyond illness or physical symptoms.
  OBJECTIVE: Fantastic Pseudology is a nosological entity that is rarely reported in the literature and is not included in classification systems such as the DSM-V and ICD-10. The aim of this report is to describe a case of Fantastic Pseudology in order to aid in its recognition and, consequently, its diagnosis. CASE REPORT: T.O.S., a 21-year-old female, was admitted to a psychiatric hospital with visual and auditory hallucinations characterized by hearing children crying and seeing her deceased grandfather, who gave her commands to attempt suicide. There were reports of several suicide attempts and difficulties in managing anger (e.g., breaking objects, going on rampages). The patient's narrative was fanciful, with the story becoming more elaborate with each new interviewer, always adding more details. She spent a significant part of her hospitalization sleeping under the bed because, according to her, "she was saving room for her grandfather, great-grandmother, and son." Her history included sexual abuse at the age of 13 and an abortion at the same time, as well as a conflicting family environment. Her past medical history included poorly characterized seizures, raising the suspicion of pseudo-seizures. Less than a month after discharge, she presented to the emergency room with hemiplegia and right-sided ptosis. An MRI of the skull was performed, revealing no abnormalities. The physical examination was inconsistent with neurological involvement, but Hoover's sign was present, as well as a posture of la belle indifférence. She was discharged and referred to a psychiatrist in our department, but she did not return for follow-up, and we were unable to continue monitoring the case. CONCLUSION: Mythomania is a rare condition, but one that can cause significant harm to the patient and those around them. It must be distinguished from factitious or simulation disorders to understand that, rather than being a "liar," the pseudologist uses fantastic narratives as a primitive defense mechanism, blending reality with self-aggrandizing fantasies, often as a way to cope with feelings of helplessness, depression, and suicidal thoughts.