A Pilot Without A Plane: A Case Of Pseudologia Fantastica
Pseudologia fantastica (PF), also known as pathological lying, was first described by Delbruck in 1891. PF involves a pseudologue using enduring deceptions that are not entirely improbable and result in no clear gain. Importantly, when confronted, the pseudologue acknowledges falsehoods distinguishing it from delusion.
Psychiatry was consulted to assess a 37 year-old male, initially presenting with left-sided chest pain, SOB, diaphoresis, and dizziness. Work-up was unremarkable and there was concern for deception. The patient, a California-based, private jet pilot, experienced the symptoms during a flight from Chicago to Kalamazoo. He is quick to share his many successes including playing football and earning an MBA from Stanford, programming for Google, owning restaurants and being financially stable enough to retire young. He does not seek any medication or further medical evaluation. He stated his job would send a private jet to pick him up. Despite his position he has no insurance card, uniform, or aviation ID. Internet search does not corroborate his history and yields a remote history of legal charges. EMR review reveals a consistent history given at previous encounters. His company and the hotel he was to stay at have no record of him. When confronted, he acknowledges his history and its falsehoods.
This case illustrates the nebulous nature of PF and highlights the importance of a better understanding of this phenomenon that does not fit clearly into factitious disorder or malingering, yet remains relevant given the implications of untruths in legal, medical, and social contexts.