Vitaly Gariev | Pexels
A 28-year-old man arrived at a Boston emergency department with right lower abdominal pain that looked so much like appendicitis that doctors asked psychiatry to see him quickly before surgery. On the way to the CT scanner, he told staff that his pregnant fiancée had been killed in a car accident.
The scan showed no appendicitis, and surgery was canceled. Then psychiatrists began piecing together his history, and much of what he had told them fell apart too.
Psychiatrists at Beth Israel Deaconess Medical Center described the case in Case Reports in Psychiatry as an example of pseudologia fantastica, a little-understood pattern of elaborate, persistent storytelling. Now a 2026 systematic review of 55 published cases offers one of the broadest looks yet at who presents this way and what it costs them.
A Fiancée, a Professorship and a Football Career Unraveled
The man had established care at the hospital a month earlier, during a long admission for complicated gallbladder surgery. He had told staff he was a tenured mathematics and physics professor at a prestigious university and an engineering consultant. He said he had played Division I college football and been drafted by the NFL.
In the emergency department, he asked to be admitted for electroconvulsive therapy, saying he had been depressed and suicidal since his fiancée died eight months earlier. But his records showed he had described getting engaged only a month before. He could not recall the date of her death. Asked about his research, he offered only a vague answer about Einstein's formulas.
He told psychiatrists that both parents, his siblings, and his cousins had died in his early childhood. Yet his medical record listed his father as an emergency contact. When doctors reached him, the father said his son had graduated with poor grades from a university without a Division I football program. He described years of severe opioid use disorder, homelessness, and unemployment, and said his son had sought pain medication at hospitals in the city and out of state using similar stories.
When gently confronted, the patient seemed untroubled and offered more details. Pressed further, he said he thought he needed a dramatic reason to be taken seriously. Then he asked, "Can I just be depressed and suicidal?"
A Diagnosis Psychiatry Has Never Formally Defined
German physician Anton Delbrück coined the term pseudologia fantastica in 1891. It describes people who tell dramatic, detailed stories, often casting themselves as a hero or victim, with no clear benefit that explains the scale of the lies.
According to the Boston authors, these patients sit somewhere between conscious deception and delusion. They may seem to half-believe their stories without losing touch with reality. When confronted, this patient could let go of his tale, which helped rule out a delusional disorder.
The pattern is not a standalone diagnosis in the DSM-5, psychiatry's main diagnostic manual. It overlaps with factitious disorder, in which people fake illness without an outside reward, and with malingering, in which they fake it for gain. In this case, the team diagnosed pseudologia fantastica along with a substance use disorder and likely narcissistic personality disorder.
55 Cases Show Who Tells These Stories
The new review, published online in May 2026 in the Annals of Medicine and Surgery by researchers at BronxCare Health System, pooled 55 cases from 34 articles published between 1914 and January 2024. Patients ranged from 14 to 68 years old, with an average age of about 35. About 73% were men.
The most common motives were self-aggrandizement in 38% of cases, attention-seeking in 36%, and taking on a sick role in 29%. Health-related lies appeared in 67% of cases, and made-up work or education histories in 44%.
The toll was heavy. About 69% of cases involved unstable family or romantic relationships, 47% involved unemployment or reduced ability to work, and 44% involved legal trouble. Nearly 31% involved substance use, and more than 1 in 5 involved suicidal thoughts or behavior. A related European Psychiatry abstract from the same group reported cluster B personality disorders, a group that includes narcissistic and borderline personality disorders, in about 25% of cases, followed by depressive and trauma-related disorders at about 16% each.
The review has clear limits. Because it relies on published case reports, it reflects cases unusual enough to be written up, and it cannot say how common the pattern is in the general population. The authors also note the small sample, the English-only search, and the lack of standard diagnostic criteria.
Treating the Person, Not the Story
The Boston psychiatrists caution against dismissing these patients as liars. Repeated deception can breed resentment in clinicians, they write, and the label itself can become a way of expressing that resentment, causing doctors to miss real psychiatric illness that needs treatment.
There are no clinical trials on treatment. Older case reports suggest that showing interest in the person rather than the stories may work better than confrontation, which in some reports increased the storytelling.
Despite the fabrications, the patient kept reporting serious suicidal thoughts. The team admitted him to a dual-diagnosis unit for opioid detoxification and further care, treating his distress as real even when his stories were not.
Anyone worried that a loved one's persistent false stories reflect a mental health problem can encourage an evaluation by a qualified mental health professional. Anyone having thoughts of suicide can call or text the 988 Suicide and Crisis Lifeline at any time.
Read more
Key Questions Answered
What is pseudologia fantastica?
It is a pattern of chronic, elaborate storytelling, often casting the teller as a hero or victim, that goes beyond any clear benefit. It is not a standalone diagnosis in the DSM-5.
What happened in the Boston case?
A 28-year-old man described a dead pregnant fiancée, a professorship, and an NFL draft. His father and medical records contradicted the stories, and he was admitted for opioid detoxification and psychiatric care.
Who is most often affected?
In the 2026 review of 55 published cases, about 73% were men, and the average age was about 35.
How is it different from factitious disorder?
Factitious disorder centers on faking illness, while pseudologia fantastica stories often range across many themes, including work, family and achievements. The two can overlap.
Can it be treated?
No clinical trials exist. Case reports suggest a supportive, nonpunitive approach along with treatment of any accompanying psychiatric or substance use disorders.