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Dr John B
Dr John B, Psychologist
Category: Mental Health
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Experience:  PhD in Clinical Psychology, registered clinical psychologist.
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How do you help a pathological liar, who also has schitzoaffective

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How do you help a pathological liar, who also has schitzoaffective bi polar disorder? Is pathological lying a common co occurrence with schitzoaffective disorder?

Hi,

Pathological lying isn't usually considered a feature of Schizoaffective Disorder. You mention Bipolar Disorder (which is a different illness) and lying can be a feature of the manic state of BPD when people become disinhibited and grandiose. Lying can also be seen at times as part of Attention Deficit Hyperactivty Disorder or Obsessive Compulsive Disorder but not so often that it is considered a major feature of those illnesses. When lying occurs as part of another illness (like the ones I have mentioned) then the aim of treatment would be to treat the illness and expect the lying to reduce as the illness diminishes. For example, if lying were to occur beacuse a person with BPD was in a manic phase then you would treat the mania......and expect the lying to reduce when the mania resides.

There is no well known or well accepted specific treatment for pathological lying but there are two major therapies that could be used in attempt to change the behaviour. Psychodynamic Psychotherapy generally aims to help people to uncover subconsious conflicts or processes that are impacting upon present life and so a Psychodynamic therapist would look to possible repressed conflicts that might be contributing to the lying. Cognitive Behavioural Therapy (CBT) generally seeks to use emotion, cognition and behaviour to achieve change. For example, a CB therapist might try to use the way a person thinks and behaves to change how they feel. In the case of lying a CB therapist would look to work with any thoughts or beliefs that might be contributing to the behaviour of lying.

So, if you were seeking to help a person who is having difficuly with lying the first thing to do would be to encourage them to seek appropriate tretament for any disorder that might be causing the lying (for example, Bipolar Disorder). If the lying was not really being caused by a specific illness then the next thing to do would be to encourage them to consult with an experienced therapist (CBT or Psychodynamic) who treats pathological lying.

I'll pause here and wait for any repsonse you might have to what I have written so far.

Customer: replied 4 years ago.
She (my stepdaughter) has DSM-IV-TR 295.70 Schizoaffective Disorder sub type - Bipolar type. Her doc also diagnosed her as ADHD. What you said is helpful as I understand what you are saying. I am half way thru my Counseling Psychology Masters degree, for MFT and LPCC. She will lie about something, mostly to just say what ever the person she is talking to wants to hear with no thought or care that what she is saying is true or she will do what she says. I do not think it is part of her mania, as she is now in a depression mode. She has a Psychiatrist and counselor and they have caught her saying things just to sound good to them. It makes me angry and I know that is not the right response, as then she goes catatonic or starts psychosis. I think she is just afraid to be assertive about the truth and face what people will say. I want to help her so she can work and have friends in the real world. Should I point out the lies with out getting angry so she is aware of what she is doing. What is going on may be ADHD, but maybe not. One time she said she would do something before she left, ( I asked her to do it 30 seconds before she went out the door), then she went our the door saying she would do the action before she left. I told her she was lying to me. I cant believe she is that ADHD to forget that she said she would take action 30 seconds later.
Am I right in understanding that the lying is pervasive and doesn't appear to occur within the context of any specific illness state or episode? Is it your gut feeling that the lying is more a personality trait rather than a symptom of illness?
Customer: replied 4 years ago.
I have lived with her three years and she never before (diagnosis and meds) just agreed with everything someone said whether it was true on not. This started after she went on meds for her condition. I think her normal assertiveness has gone down with the latest increase in depression med. Also fear of saying something wrong and being held accountable causes her to automatically lie vs facing those issues. I do know fear is at the bottom of a lot of abnormal behavior. I have not yet taken psycho pharmacology, but I think the lying has to do with meds or her mental illness. Probably subconscious conflicts or processes needs to be addressed. Nor sure we can afford Psychodynamic Psychotherapy, but I understand your advice.

If you believe you have seen a significant change in behavior corresponding with the introduction of a medication (or even a change of dosage) then the first thing to assess is whether it is in fact medication related. The range of more subtle and unusual side effects to psychiatric medications is enormous and while I haven't previously heard of this a medication related side effect I wouldn't for one minute think that it wasn't possible.

It sounds like you have a good deal of insight into her situation and it would not be unusual for a person's confidence (and thus assertiveness) to diminish as a consequence of pharmacological treatment. Certain anti-depressants can actually induce suicdal ideation so it's no such a stretch to think confidence might be diminished by certain drug processes.

If the lying is fear based then I would suggest CBT might be a good approach to try. Fear is inherently a cognitive process (intense negative interpretations about potential future events) and as such would be amenable to the CB method.

Putting all this aside, my suggestion regarding how you handle her lies on an incident by incident basis is that you should handle it the way you would with anyone else. I understand that confronting her may cause her distress but I wouldn't expect this kind of confrontation to induce a psychotic episode unless she is in a very, very fragile psychological state. If she is...then she needs a review by a more senior Psychiatrist for an alternative treatment approach.

How would you handle this situation if psychiatrc illness wasn't part of the picture?

Customer: replied 4 years ago.
Thank you for your response, it has been very helpful in my understanding of what may be going on with her. However, she does break down easy in stressful situations and in response to the stress of me pointing out her lying. So I am not sure I can treat her like I would treat a normal person when I catch them lying frequently. However I will look into some kind of CBT approach (for her fears) , and I will get her Dad to discuss how to handle her response ( it does include a breakdown for an hour or so) on the next appointment he attends. My husband and I are trying to find time to go to NAMI, maybe we can get more guidance there. If there was no illness, lying could still be a habit or response to avoid the consequences of telling the truth, so I would look for fear as a root of even a normal person lying.

Very good idea trying to get in touch with NAMI, I often suggest people use their resources.

I'm a CBT therapist so I'll just make a quick point about working with potential fears;

You need to try to determine what her assumptions are about saying no to/disagreeing with someone. If the lying is occurring as part of a passive communication style then the assumption will likely be along the lines of 'potential rejection'. If the lying is a reaction to the expectation of rejection then what you could begin to do slowly is to reassure/convince her that you will not reject her regardless of whether she lies or not. No easy task!

Also, if it is the case that you have seen a change corresponding to a medication change then I really do strongly recommend that you have her reviewed.

If you have further questions or would like me too clarify or elaborate on any part of my answer please let me know and I will happily respond. If not....I wish you the best of luck!

Dr John B and other Mental Health Specialists are ready to help you
Hi,

I hope you've made some progress in forming a strategy for handling your step daughter. If I can be of further assistance, or if you ever have other questions, please don't hesitate to contact me directly.

Regards,

John

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