Dimitrakopoulos S, Sakadaki E, Ploumpidis D
Community Mental Health Centre of Byron-Kessariani, 1st Psychiatric Department, National and Kapodistrian University of Athens, Athens, Greece.
Psychiatriki. 2014 Jul-Sep;25(3):192-9.
While lying is a diachronic integral part of human interaction, pseudologia fantastica represents probably its psychopathological dimension. There are relatively few reported cases on psychological mechanisms of pathological lying and also on criteria concerning psychopathological development on a ground of lying. A review of literature on possible psychological mechanisms of pseudologia fantastica is presented. Psychopathological qualities are rather controversial, especially whether pathological lying is a conscious act or not. DSM IV-TR recognizes pseudologia fantastica in association with factitious disorder but not as a clinical entity. Diagnostic issues are raised regarding lying, deception, pseudology and its shared dimension. Cases of shared pseudology are rarely reported in literature. Related shared psychopathological phenomena such as pseudologia à deux, folie à deux and mass hysteria are equally examined and compared under the prism of 'mental infection'. Cases of pseudologia fantastica are poorly understood or underecognized and clinicians usually pay minor attention in its psychopathological significance. It remains doubtful, whether pathological lying should be considered as an autonomous clinical entity. The need for research both on phenomenology and pathophysiology is emphasized. In addition to reviewing literature, we also report a case of pseudology à deux in a couple, a female and a male patient. Presented psychopathological manifestations, personality characteristics, psychological and social factors concerning both patients are considered, aiming to determine a sufficient phenomenological analysis. The diagnoses of pseudologia fantastica and folie à deux are discussed and documented. A second axis diagnosis of personality disorder and other diagnostic issues are also considered. A favorable issue of this case, within a follow up of one year, is due to the therapeutic and social potential of a community psychiatry's setting, offering an individual follow up to both partners and a family approach including the ex husband of the female patient and her two minor children. The presented case focuses on a notably rare and controversial form of pathological lying, pseudologia fantastica à deux, and possible underlying mechanisms.
虽然说谎是人际互动中一个长期存在的组成部分，但虚构症可能代表了其精神病理学层面。关于病理性说谎的心理机制以及基于说谎的精神病理发展标准的报道案例相对较少。本文对虚构症可能的心理机制相关文献进行了综述。精神病理学特征颇具争议，尤其是病理性说谎是否为有意识的行为。《精神疾病诊断与统计手册》第四版修订版（DSM IV - TR）将虚构症与做作性障碍相关联，但未将其视为一个临床实体。文中提出了关于说谎、欺骗、虚构及其共同维度的诊断问题。文献中很少报道共同虚构的案例。诸如感应性虚构、感应性精神病和群体癔症等相关的共同精神病理现象也在“精神感染”的视角下进行了同等的审视和比较。虚构症的案例鲜为人知或未得到充分认识，临床医生通常对其精神病理学意义关注较少。病理性说谎是否应被视为一个独立的临床实体仍存疑问。强调了对现象学和病理生理学进行研究的必要性。除了综述文献外，我们还报告了一对男女患者的感应性虚构案例。文中考虑了两位患者呈现出的精神病理表现、人格特征、心理和社会因素，旨在进行充分的现象学分析。对虚构症和感应性精神病的诊断进行了讨论并记录在案。还考虑了人格障碍的第二轴诊断及其他诊断问题。在一年的随访中，该案例的一个有利之处在于社区精神病学环境具有治疗和社会潜力，为夫妻双方提供了个体随访，并采用了家庭治疗方法，其中包括女性患者的前夫及其两个未成年子女。所呈现的案例聚焦于一种极为罕见且颇具争议的病理性说谎形式，即感应性虚构症，以及可能的潜在机制。
