When Do Habitual Lies Indicate a Developing Personality Disorder?
Part two of our series on lying
Photo courtesy of Len4foto/Shutterstock.com
Whether triggered by their genetic makeup or a childhood experience, certain teens are prone to developing personality disorders. These young people lack the full array of emotional tools for interacting with others and functioning normally in society. To make up for these missing tools, teens may turn to what Dr. Kenan Penaskovic, M.D., a psychiatrist on the teaching faculty at UNC School of Medicine in Chapel Hill, calls “maladaptive coping mechanisms.” One such coping mechanism is lying.
While lying alone is not definitive of an underlying personality disorder, it can – in combination with other symptoms – suggest one. If you look at the symptoms of personality disorders listed in the “Diagnostic and Statistical Manual of Mental Disorders,” referred to as DSM-5 and known as the standard classification of mental disorders used by mental health professionals in the U.S., you may see familiar behavior.
“Most teens have some of these traits,” Penaskovic says.
So how can you know when your teen’s lies suggest a disorder?
The “Lifestyle Liar”
A typical teen may lie once or twice because he is ashamed of a grade, or wants to prevent a parent from knowing he was out late at a party. Habitual lying, however, is not typical.
“Lifestyle lying is not a sign of health,” says Carl Pickhardt, a psychologist and published author who has written extensively on adolescence. “It’s a fugitive behavior, and is usually indicative of an erosion of self-esteem. Lying and hiding will always create distance between you and your child, which can eventually get lonely and scary, and cause a teen to seek support in other places.”
Recognizing that lying has become a problem with your teen can be a vital step toward keeping him safe and helping him prepare for an emotionally healthy adult life. If you can catch the lying before it becomes a habit, you are more likely to prevent further problems.
Once lying has become an emotional tool, it’s harder to “fix,” Penaskovic says. But with hard work and therapy, a teen can learn coping skills. Again, the earlier a child learns to curtail his lying, the better. Pickhardt says parents should “always be in the business of evaluating data you get from your kid.”
You can look for several warning signs:
1. Look at the frequency of your child’s lying. A single lie, while it may be serious, is probably not suggestive of an underlying mental health issue. Lying is a problem when it becomes a pattern. “Lying is enormously seductive,” Pickhardt says. “If a teen finds they can successfully manipulate a parent, then it becomes part of their repertoire in the relationship.” And if a parent still does not address the issue, the teen will go on to use lying in other less-forgiving relationships.
2. Look at the purpose of the lie. “What caliber of lie are we talking about?” asks Lorie Ritschel, an assistant professor of psychology at UNC School of Medicine and co-owner of The TAP Clinic in Durham. If your child is lying about eating the last cookie, then the lie should be promptly addressed but is most likely just a “developmentally appropriate mistake,” she says. However, if your child is lying for “no reason, or for any reason at all,” then the behavior is more of a red flag. Get a sense of the seriousness of the lie by talking with your teen and evaluating his level of remorse. If he says, “I’m sorry, I was too embarrassed to tell you,” that is different from a teen who continues to deny the lie.
“There is a problem if [teens have] no remorse, no control over their behavior, or can’t seem to stop themselves from lying,” Ritschel says.
3. Look at co-morbid issues. Even habitual lying might be just that — a bad habit that can be overcome with rules, consequences and attention. If the lying is accompanied by other symptoms, warns Ritschel, such as anxiety, irritability, low self-esteem, destructive behavior, theft, or unhealthy eating or sleeping, it could indicate an underlying mental health issue.
4. Look at the effects of the lying, suggests Frank Addonizio, chief clinical officer at Holly Hill Hospital in Raleigh. Is your teen’s lying affecting your relationship with him or his relationships with his friends? Is it affecting his schoolwork or other regular daily activities?
5. Once you have identified lying as a problem for your teen, you need to figure out what the lies are hiding. According to Ritschel, specific issues may include drug use, sexual promiscuity, shoplifting, personally damaging behavior like cutting, and suicidal thoughts and attempts. The lies could also hide less concrete mental health concerns such as anxiety, depression or difficulties with impulse control.
The Connection Between Lying and Personality Disorders
Personality disorders are defined as “ingrained patterns of behavior that deviate markedly from the norms of generally accepted behavior,” Addonizio says. The DSM-5 identifies three “clusters” of personality disorders. Lying is associated most closely with Cluster B disorders, which include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder. Of these, only antisocial personality disorder specifically lists lying as a symptom, but lying may be an indicator when other behaviors exist; for example, people with various Cluster B disorders may use lying as a tool to hide low self-esteem.
Therapists will not typically diagnose personality disorders in teens, Ritschel says. “Depression in kids is clearly different than in adults, and we are nowhere near as far down the road studying mental illness in kids,” she explains. “There’s just not enough data.”
The DSM-5 recommends that a personality disorder be diagnosed in a teen only if symptoms have been present for at least a year, with the exception of antisocial personality disorder — the only disorder that explicitly lists lying as a symptom — which cannot be diagnosed at all for patients under age 18. That said, antisocial personality disorder does require the existence of symptoms of “conduct disorder” in childhood and adolescence, and — as Ritschel explains — conduct disorder includes “deceitfulness” as a symptom.
Despite the lack of more explicit links in the DSM-5, lying has been associated with several disorders, from borderline personality disorder and narcissistic personality disorder, to attention deficit hyperactivity disorder and obsessive-compulsive disorder. Ritschel notes that teens with a tendency toward personality disorders may use lying as a coping mechanism, and that they may lie out of shame, impulsivity (ignoring consequences), lack of emotional regulation or, with narcissistic personality disorder, to bolster a false sense of self.
Pickhardt firmly believes in aggressively addressing lying before it becomes a habit.
“There is no such thing as a small first lie,” he says. “One successful lie will only lead to a second, bigger one.”
He suggests confronting the teen, letting her know how it feels to be lied to, then providing a symbolic consequence, such as a chore that is unrelated to the lie. Finally, he says, tell your teen you trust her.
“You can’t afford to say they have to earn your trust back; then the teen will believe you won’t believe them — whether they tell the truth or not. They would have no motivation to tell the truth.”
If you are past the first-lie stage and are seeing a pattern, Penaskovic recommends working with your child to come up with a strategy to address the lying. If the two of you are not able to get the lying under control, reach out to a therapist, as teens may be more willing to deal with a professional.
Therapist or not, once lying has become a problem, there are several challenges. First, Penaskovic says, the behavior has become a tool for comfort and “to make a change and get any benefits from therapy, the teen must see it as a problem.” Second, there is no quick fix. “A few weeks or even a few months is not going to address the problem,” he says.
Ritschel agrees. She specializes in dialectical behavior therapy, often referred to as DBT, which is the gold standard for borderline personality disorder. It targets emotional dysregulation and impulsive behavior like self-harm, suicidal thoughts and maladaptive coping behavior.
“The treatment is intense and long-term,” she says, requiring approximately six months — and sometimes longer — to complete. “Some people don’t get past the starting gate. You have to be willing to do the full treatment program — and if kids look and feel like they’re ordered, we won’t take them. We’ve had success because we’ve got families [who are] really committed to this.”
A comprehensive DBT program includes individual therapy, along with regular group skills-training sessions. Ritschel says the group therapy sessions “look like a class,” and while some teens shy away from the idea, she says that most end up really appreciating it.
“A lot of kids are really looking for specific skills to cope,” she says.
Individual psychotherapy and group therapies are often the preferred approach in treating teens with pre-personality disorder issues. Medication can sometimes be an important aspect of treatment, but Addonizio says, “Drug treatment is not the first line of defense for adolescents, though medication can help if symptoms of anxiety are debilitating.”
Even Ritschel, who has devoted her career to behavioral therapy, says some kids “absolutely” need medications. “If we can treat without drugs, that’s great,” she says. “But if the kid is having a major depressive episode and not getting any sleep, and their concentration is terrible, they may not be able to make the best use of therapy. In those situations, I recommend a consultation with a pediatric psychiatrist, because a low-level medication might give them a foundation.”
She adds that the psychiatrists she works with are very careful with young patients, and would never leave a child or teen on medication without regular checkups.
Ritschel notes that some teens become anxious to stop taking the medications when they start feeling better, and parents often side with their child. She warns teens and parents in this situation against taking too hasty of an approach. “When the teen is more functional, then you can talk with the psychiatrist about coming off the medication,” she says.
Ritschel also warns that self-tapering without medical guidance can be dangerous. “Just tell your psychiatrist you’d like to get your teen off the drug,” she says. “They are often willing to have that conversation when the time is right.”
It can be hard to acknowledge that your teen has a mental health issue. “As far as we’ve come,” Penaskovic says, “our society is still learning to understand and embrace mental disorder, and we need to overcome not only patient stigma, but family [stigma] as well. What we should be promoting is that everyone needs help.”
He emphasizes the importance of addressing your child’s issues as early as possible. “If you catch it early, there could be some modification, but these issues will not disappear,” he says. “You need to help your teen develop coping skills.”
Pickhardt agrees, adding: “Now is later. You are the custodian of your child’s future. How they are with you right now will absolutely affect their later relationships.”
Caitlin Wheeler is a Parenting Media Association award-winning freelance writer who lives in Durham.