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Ask Dr. Z Your Own Question

Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4746
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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What treatments are available for someone who lies about everything

Resolved Question:

What treatments are available for someone who lies about everything and sometimes believes them. Never is responsible for the outcome of his actions(not completing tasks, lies and stealing from family)? I forgot about impulse control, like getting married to someone hardly knew after another failed relationship.
This would be about my 21 year old son who in past was diagnosed ADHD. Meds helped with some issues but not all. I have Adult ADHD but I seemed to have grown out of most of it or learned how to control myself.
We do not have much money or other resources and have no idea what exactly insurance will cover.
Submitted: 9 months ago.
Category: Mental Health
Expert:  Dr. Z replied 9 months ago.

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

I am so sorry that your son has been exhibiting these symptoms/behaviors, I can understand why it would distress you

Dr. Z :

I would like to ask a couple questions to get some more information if possible, so that I can better assist you

Dr. Z :

How long has your son been having these issues of lying, not taking responsibility, and impulsivitiy?

Dr. Z :

So most likely your son is exhibiting behavioral symptoms that are typically associated with a personality disorder called Narcissistic Personality Disorder (NPD), where the person lies, manipulates, can be charming, impulsive, fails to take responsibility and in fact will blame others for their faults, and always seeks praise. Here is a good link explaining NPD in more detail for you

Dr. Z :

Now I cannot be certain if he has this disorder completely or only traits of this disorder, as both are possible, but he definitely should be evaluated by a therapist.

Dr. Z :

The best and most evidence based treatment for this disorder is called Cognitive Behavioral Therapy (CBT). CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Dr. Z :

But I do have to say that even with CBT treatment, it has to be intensive for around 1-2 sessions per week and usually they last for 1-3 years. And even then the success rate is not that high. Many therapists use CBT and can help your son and many therapists work on a sliding scale, so they can provide low cost therapy dependent on your income, so that can be an option

Dr. Z :

I would be more than welcome to try to find you a qualified CBT therapist that provides sliding scale fees in your area, I would just need a zip code

Dr. Z :

I see that you are offline right now, but when you get back online I would be very interested in continuing this discussion with you and talking about anything further you would like to share regarding your concern, so if you respond in the chat box I will be able to get back to you as soon as possible.

Customer: He has been telling s
Dr. Z :

I see that you are typing, but I also wanted to recommend these books of NPD as well that I forgot to mention before

Customer: oops, he has been telling stories since age 3. He has always been very active starting around 2yrs. We had to be very creative keeping him indoors( locks placed high, zip tie dinning chairs to table). When outside playing he would be in sight then disappear. Then when ready for kindergarten, did not retain activities down to what was for lunch, then we got advised to put him back in pre-k. Then at age of 6 that's when things got really bad for him. Teachers did not believe him when he kept having to go to restroom all the time, they refused to let him go causing him to have accidents where then the other kids made fun of him. Then he started having anger issues. At age of 8 he was put on Ritalin, it kicked in the very next day not 2 was.! Too late teachers had labeled him the bad child. I started noticing his grades went from not good to really bad, asked principle for testing her response was " he is not far enough behind to warrant testing!" He has never had friends for long, never invited to anything his whole life. In middle school he was tested after we moved and got a shock. 7th grader at maybe 4th grade level math, reading n comp, handwriting no thank you! School modified his lessons which caused more torture for him. High school..... Let's say was not any better. He lost his favorite grandparents 6 months of each other and then he would takeoff in auto for days or weeks.
Dr. Z :

Wow I am so sorry to hear about this for your son, since this behavior started at such a young age then most likely he does not have NPD at all., but it most likely is a developmental disorder. I will wait for you to stop typing to explain what I think is the issue.

Customer: Sorry so long. I love him so much and can relate to being the outsider most of my life. He doesn't seek praise all the time. He wants friends and follows their leads, most of time he lives in the right now moment n does not think of afterwards. He also has very bad hygiene and his room/ auto is a mess.
Dr. Z :

I understand that you care about your son a lot and most likely because his symptoms occurred at such a young age, he most likely has a developmental disorder that has gone undiagnosed. I would like to ask some questions to try to narrow it down

Dr. Z :

Does your son have poor eye contact when he talks to others?

Dr. Z :

Does he have a difficult time reading other's emotions?

Dr. Z :

When communicating with him, is it usually one-sided as he talks a lot and does not allow for pauses in the conversation to occur?

Dr. Z :

Also does he have poor coordination at all?

Customer: No he will look everyone in the eye and he has not met a stranger EVER!
Dr. Z :

So his social interaction with others is good

Customer: Not always. He can read happy, sad, anger. He just can not tell if someone is honest or trustworthy with friendship. Yes, I have to always cut him off so I can finish my sentence.
Dr. Z :

And what about his coordination? Is he considered clumsy or is very well coordinated?

Customer: No he can walk climb anything!
Dr. Z :

Does he have any fixations on routines at all?

Customer: no he could careless about those.
Dr. Z :

Well with the ADHD diagnosis, and this behavior of telling stories, running off doing his own thing, and more starting at a young age, I would say that this a Conduct Disorder that has most likely gravitated to a possible personality disorder. He does not meet the criteria for a developmental disorder and Conduct Disorders occur 25 percent of the time with ADHD, 50 percent in males with ADHD, as males are more frequently hyper.

Dr. Z :

Still you asked for the best treatment and that is Cognitive Behavioral Therapy (CBT) still and for this though, it had a good prognostic factor because it is strongly related to the ADHD and can be treated very successfully

Dr. Z :

May I ask what medications is he currently on and what has he tried in the past?

Customer: Concerta in place of Ritalin. Depacote to help sleep at night. Vyvanse and Adderall did not work.
Customer: No meds since age of 17-18.
Dr. Z :

Well the medications may help with his ADHD symptoms, but the CBT should be more concentrated for his lying and not taking responsibility for his actions

Customer: So, Conduct disorder same as ODD?
Dr. Z :

They are very similar, but ODD would be if he only was acting out against authority figures, but because he was acting out towards peers as well as authority figures it is more indicative of a conduct disorder. Now he is not there yet, but this conduct disorder could translate to a severe personality disorder called Antisocial Personality Disorder (ASPD) if he does not seek the treatment right now. He shows some traits of this disorder, but not the full disorder by any means, so the sooner he is in CBT therapy the better the outlook because right now he has a good prognostic shot of managing these symptoms

Customer: Can this conversation be sent to my email? I would like my husband to read this.
Dr. Z :

Well actually i do not have access to your email, the administrators keep that information to protect your confidentiality, but when you finish rating me, this chat will be sent as a link to your email, if it has not already, so you can always use it for future reference. In addition, this chat will be saved in your JA account under My Questions so you can always go back to it when you need to

Customer: Where can I find someone willing to treat him?
Dr. Z :

Well what is your zip code, i can look for some therapists in your area if you like

Customer: Would this explain as to why he can not stay employed?
Customer: 76120
Dr. Z :

Yes it definitely does explain why employment is hard for him, but also that can be the ADHD too. This is the criteria for Antisocial Personality Disorder, and like I said he does not meet the criteria for the whole disorder, but he could in the future which is why treatment is wise now.

Dr. Z :

Give me a few minutes to compile a list of therapists for you

Dr. Z :

So I believe these therapists are good to help your son as they specialize with behavioral issues and Antisocial traits like your son exhibits.

Dr. Z :

Is there anything else I can do for you or son tonight?

Customer: Nope. He is worried that he will become a "zombie".
Dr. Z :

Like with the medication?

Customer: Concerta or any meds for ADHD.
Dr. Z :

That is understandable, many psychiatrists can prescribe lower doses so that he does not feel like a "Zombie" or he can try a non-stimulant ADHD medication called Strattera that should not make him feel like a "zombie" either.

Dr. Z :

The CBT should help him a lot and can help him to a point where the medication may not be necessary or at the minimum doses to reduce the level of side effects too

Dr. Z :

I would also like to recommend these treatment books as well for your son too

Dr. Z :

These should help and reduce the need for medication, so that can put your son's mind at ease

Customer: Tried that one too. Did not work.
Dr. Z :

Well then try a lower dose of the Concerta, that should help. Also some psychiatrists will prescribe Wellbutrin or Tricyclic antidepressants as well

Dr. Z :

So there are other options, but the CBT is important for the other behavioral symptoms that he has exhibited.

Customer: Thank you and good morning! Lol
Dr. Z :

Haha, yes it is late for you, but I wanted to make sure to help you with everything. Is there anything else you need that I can assist you with?

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4746
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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