Pseudologia fantastica: a systematic review of sociodemographic features and psychiatric comorbidities

Background: Pseudologia fantastica (PF), or pathological lying, involves elaborate fabrications without clear external gain. Despite its clinical significance, PF lacks recognition in the DSM-5, posing diagnostic and legal challenges. Materials and methods: A systematic search of PubMed, PsycINFO, and Scopus identified studies on PF demographics, motives, comorbidities, and outcomes. After applying inclusion and exclusion criteria, 34 articles comprising 55 cases were analyzed. Results: PF predominantly affected men (72.7%), presenting in the third to fourth decades. Major motives included self-aggrandizement (38.2%), attention-seeking (36.4%), and sick-role assumption (29.1%). Common themes were health-related lies (67.3%) and occupational or educational fabrications (43.6%). Cluster B personality disorders (25.5%), depressive disorders (16.4%), and trauma-related disorders (16.4%) were frequent comorbidities. Suicidality (27.3%) and substance use (30.9%) were notable. Conclusion: PF significantly impacts social, occupational, and legal functioning. Early recognition and clinician–legal awareness are essential for appropriate management.