Madelon Baranoski, PhD ；Ezra E. H. Griffith, MD ；Yale University School of Medicine New Haven, CT

　　We thank Adetunji et al. for their insightful commentary and appreciate their contribution to the discussion of this fascinating phenomenon.

　　Their proposition that the word "pathological" should be dropped with regard to lying is well taken. We concede that putting pathological in front of lying is problematic, but even more troubling is lumping all liars together in one group as if they were homogenous. Further, removing pathological does not help in solving our dilemma. We were trying to describe a unique phenomenon,1 a subgroup of lying that has been repeatedly described in the literature over the years with the terminology "pathological lying." Our goal was to sharpen the definition while keeping the terminology.

　　In the letter, the authors referred to the recent study by Yang et al.2 In fact, Yang et al. complicate things even more by referring without justification to different subgroups of liars as pathological liars. Their use of pathological lying is not the same as ours, and their work is not helpful in clarifying the interesting question of Adetunji et al.

　　Adetunji et al. suggested that pathological should not be used to describe lying behavior that may be secondary to cerebral abnormalities, as may be the case with pathological lying, to reduce stigmatization and encourage help-seeking. We appreciate the merits of this viewpoint. However, if brain pathology were responsible for the lying behavior, would it not be more appropriate to refer to the phenomenon as pathological lying? That will then be consistent with the "disease viewpoint" of psychiatric disorders described by the authors.

　　In our article,1 we defined pathological lying as "falsification entirely disproportionate to any discernable end in view, may be extensive and very complicated, and may manifest over a period of years or even a lifetime." Pathological lying is not defined by the magnitude of the lies per se, but by the chronicity, frequency, and apparent lack of benefit derived from the lies. Hence, the different examples of liars described by Adetunji et al. are not pathological liars by our definition. The benefit of lying in each case is obvious.

　　Adetunji and colleagues state that they do not believe there are pathological lies or pathological liars "because of the difficulty in determining what is pathological." This is analogous to saying Schizophrenia did not exist before the development of the DSM criteria for its diagnosis.

　　We are pleased by the recent interest in the subject of pathological lying and continue to advocate more discussion and systematic studies of the phenomenon. We maintain, however, that what is most important is not so much what name the phenomenon is called, but the development of uniform criteria for identifying it, the etiology of the phenomenon, and available treatment options.

　　References

　　Dike CC, Baranoski M, Griffith EEH: Pathological lying revisited: J Am Acad Psychiatry Law 33:342–9, 2005

　　Yang Y, Raine A, Lencz T, et al: Prefrontal white matter in pathological liars. Br J Psychiatry 187:320–5, 2005

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《美国精神病学与法律学报》2006年3月第34卷第1期