By Brenda Goodman
(CNN) -- When Timothy Levine set out to write a book about deception in 2016, he wanted to include a chapter on one of its most extreme forms: pathological lying.
"I just couldn't find any good research base on this," said Levine, chair of the Department of Communication Studies at the University of Alabama at Birmingham.
Now, it seems it's the only thing anyone wants to talk to him about.
"Santos has brought more reporters to me in the last couple of weeks than probably in the last year," Levine said.
Santos, of course, is US Rep. George Santos, a Republican from Long Island who was recently elected to represent New York's third congressional district.
In the months since his election, key claims from Santos' biography -- including where he earned his college degree, his employment at Citigroup and Goldman Sachs, an animal rescue group he says he founded and his Jewish religious affiliation -- have withered under the scrutiny of reporters and fact-checkers. Now, he says, he doesn't have a college degree; he wasn't employed by Citigroup or Goldman Sachs; and the IRS has no record of his animal rescue group. He also says he never claimed to be Jewish, but rather he was "Jew-ish."
Santos defended himself in media interviews in December, saying that the discrepancies were the result of résumé padding and poor word choices but that he was not a criminal or a fraud.
It's not clear what is driving Santos' statements.
But the story has given professionals who study lying in its most extreme forms a rare moment to raise awareness about lying as a mental disorder -- one they say has been largely neglected by doctors and therapists.
"It is rare to find a public figure who lies so frequently in such verifiable ways," says Christian Hart, a psychologist who directs the Human Deception Laboratory at Texas Woman's University.
Psychiatrists have recognized pathological lying as a mental affliction since the late 1800s, yet experts say it has never been given serious attention, funding or real study. It doesn't have its own diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the bible of psychiatry. Instead, it is recognized as a feature of other diagnoses, like personality disorders.
As a result, there's no evidence-based way to treat it, even though many pathological liars say they want help to stop.
The standard approach to treating lying relies on techniques borrowed from cognitive behavioral therapy, which emphasizes understanding and changing thinking patterns. But no one is sure that this is the most effective way to help.
We don't know necessarily what's the most effective treatment," said Drew Curtis, an associate professor of psychology at Angelo State University in Texas who studies pathological lying.
Curtis had someone offer to drive across the country to see him for treatment, which he says he wasn't able to offer.
"So that's the heartbreaking side of it for me, as a clinician: people that are wanting to help and can't have the help," Curtis said.
Longtime collaborators Curtis and Hart recently published a study laying out evidence to support the inclusion of pathological lying as a standalone diagnosis in the DSM.
Over the years, Hart said, almost 20 people have proposed definitions of pathological lying, but there's very little overlap between them: "The only truly common feature is that these people lie a lot."
Most lying is normal
The first thing to know about pathological or compulsive lying is that it is rare, Levine says. His studies show that most people tell the truth most of the time.
"These really prolific liars are pretty unusual," said Levine, whose book about deception, "Duped," was published in 2019.
Which isn't to say that lying isn't common. Most people lie sometimes, even daily. In his studies, people lied up to twice a day, on average.
Levine himself regularly lies at the grocery store when workers ask whether he found everything he was looking for. Since the Covid-19 pandemic began, that answer is almost always no, but he says yes anyway.
One of his students worked in a retail clothing store and regularly lied to people who were trying on clothes. Another -- a receptionist -- lied to cover for a doctor who was always running late.
That's all pretty normal, Levine said. He believes that honesty is our default mode of communication simply because people have to be honest with each other to work effectively in big groups, something humans do uniquely well in the animal kingdom.
But sticking to the facts isn't easy for everyone.
Defining pathological lying
In their studies, Hart and Curtis have found that most people tell an average of about one lie a day. That's pretty normal. Then there are people who lie a lot: about 10 lies a day, on average.
Hart and Curtis call prolific or especially consequential liars -- someone like Bernie Madoff, who dupes and defrauds investors, for example -- "Big Liars," which is also the title of their recent book.
Big lying is pretty unusual. Pathological lying is even more rare than that.
Hart thinks he's only ever interacted with two people that met the classical case study description of pathological lying.
"It was dizzying," Hart says.
When people start to lie so much that they can't stop or that it begins to hurt them or people around them, that's when it becomes abnormal and may need treatment.
"It's more the clinical category of people who tell excessive amounts of lies that impairs their functioning, causes distress, and poses some risk to themselves or others," Curtis said, sharing the working definition of pathological lying that he and Hart hope will eventually be included in the DSM.
"What we found, examining all the cases, is that the lying appears to be somewhat compulsive," Hart said. "That is, they're lying in situations when a reasonable person probably wouldn't lie, and it seems like even to their own detriment in many cases.
"It tends to cause dysfunction in their lives," Hart said, including social, relationship and employment problems.
On some level, pathological liars know they're lying. When confronted with their lies, they'll typically admit to their dishonesty.
Lying can also be a feature of other disorders, but Hart says that when they assessed people who met the criteria for pathological lying, they found something interesting.
"It turned out that the majority of them don't have another psychological disorder. And so it seems like lying is their principal problem," he said, lending weight to the idea that it deserves to be its own diagnosis.
The American Psychiatric Association, or APA, publishes the DSM and regularly reviews proposals for new diagnoses. Curtis says he has been gathering evidence and is in the process of filling out the paperwork the APA requires to consider whether pathological lying should be a new diagnosis.
Some jobs seem to reward the ability to lie
As for whether certain professions seem to attract people who lie more than average, Hart says that's a complicated question.
It's not that people who lie a lot tend to gravitate to certain jobs. Rather, certain jobs -- like sales, for example -- probably reward the ability to lie smoothly, and so these professions may be more likely to have a higher concentration of people who lie more than average.
"The evidence we have suggests that politicians aren't by their nature any more dishonest than the typical person," Hart said. "However, when people go into politics, there's pretty good evidence that the most successful politicians are the ones that are more willing to bend the truth" and so they may be the ones more likely to be re-elected.
Only time will tell, how the situation may play out for Santos.
So far, he has resisted calls to step down, saying he intends to serve his term in Congress. This week, though, Santos announced he would step down from any committee assignments while the investigations are ongoing.
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