Medical professionals differ greatly whether pathological lying is a true disease or a severe character weakness. When accompanied by such mental problems like antisocial personality disorder, bipolar disorder, Obsessive Compulsive Disorder (OCD), or Attention Deficit Hyperactivity Disorder (ADHD); pathological lying is generally treated as a disease with cognitive and drug therapy. Compulsive liars without underlying mental problems are often treated with counseling. Extreme cases stemming from brain damage, injury or severe mental illness may require treatments like aversion therapy or desensitization. A clear and broad treatment set for this condition has not been defined because psychologists and psychiatrists have not specifically defined all types of it as a treatable medical problem.
Treatments largely depend on the characteristics and health of the person and the extent of the lying. Some people lie frequently and may even develop detailed stories that involve bits and pieces of truth. When confronted, these people may eventually confess their lies but struggle to change their habit. For these patients, counseling is the most common treatment. A therapist tries to get the person to realize the consequences of his or her actions and understand the difference between truth and the lies.
Personality disorders such as OCD and ADHD may respond well to a combined treatment of psychiatric medication and cognitive behavioral therapy. Desensitization treatment, exposure therapy, and mood-stabilizing medications for addictive behavior may help people overcome lying as well as treat underlying personality conditions. In severe cases, healthcare professionals may prescribe antipsychotic medications or aversion therapy.
Many people who exhibit pathological lying also clearly exhibit symptoms of other treatable conditions. Accurately diagnosing underlying conditions is extremely important, both for treatment of the problem as well as preventing the development of additional problems. The last thing one would want to give a person with OCD is a stimulant, which would likely exacerbate the disorder.
Therapy and medication require compliance from the person being treated, and a pathological liar who has antisocial disorders may not wish to be treated. A person who suffers from this condition must on some deep level be committed to the work required in cognitive behavioral therapy, as well as be willing to take medications. The trouble with these methods is that a pathological liar can quite easily lie about taking medications, or about the effectiveness of medications. He or she could also lie about what is happening in their life, which may make the therapy ineffective.
Possible Relation to Brain Structure
A study on pathological lying published in the October 2005 British Journal of Psychiatry suggests that a pathological liar may have a slightly different brain than others. If this is true, it would make treatment very difficult, since its very difficult to effectively change a person's brain structure without harming them. Pathological liars have been shown to have 26% more white matter than people with other psychological disorders who don’t lie compulsively. Other studies have also linked the presence of white matter with the ability to lie, as those with autism, who generally cannot lie, tend to have lower amounts of white matter in their brains.
Additionally, research in child development shows that children tend to become much more credible liars when they are about 10 years old. Before then, they generally are not believable. This 10-year mark coincides with notable development of white matter in the prefrontal cortex. More white matter may simply mean more lying, and too much might translate to pathological lying.