Can Mythomania Be Treated? How to Address Compulsive Lying

One of the first questions people ask when they recognise a mythomania pattern — in themselves or in someone close to them — is whether anything can actually change. The pattern often feels fixed. It has usually been present for a long time. Previous attempts to address it may have ended in disappointment. And compulsive lying, unlike many other psychological patterns, carries a layer of shame that makes seeking help feel particularly exposing. The answer, based on consistent clinical experience, is that mythomania does respond to the right kind of work.

Why Mythomania Requires Therapeutic Work to Change

The compulsive lying pattern is not a habit in the ordinary sense. It does not operate primarily through conscious decision-making. It precedes conscious thought: the lie arrives before the person has decided to lie, driven by an automatic response that has been calibrated over many years of experience.

This automatic quality is what makes willpower alone insufficient. A person with mythomania can sincerely intend to be honest, sincerely want to change, and still find themselves lying in the next conversation — not because their intention was not genuine but because the mechanism driving the lying does not operate at the level of intention. Effective work must operate at a deeper level: the conditioned response itself.

What the Pattern Is Actually Responding To

The mythomania pattern developed in response to something — typically a history of environments in which honesty felt unsafe, in which the truth produced rejection or punishment, or in which deception was modelled as the reliable strategy for managing difficult social situations. Understanding that the pattern served a function is part of what makes it possible to address it without simply condemning it.

This also explains why approaches that focus purely on the lying behaviour — confronting it, demanding it stop, imposing consequences — tend to be ineffective and often counterproductive. Effective treatment works with the mechanism itself: the anxiety, the shame, the self-worth foundations that the lying is protecting and responding to.

Therapeutic Approaches for Mythomania

Several therapeutic approaches have genuine clinical relevance for mythomania, each addressing different aspects of the pattern. In practice, effective therapy typically draws on more than one approach, adapted to the specific psychological drivers present in the individual.

Cognitive Behavioural Therapy

CBT is the most evidenced approach for mythomania treatment. It works at the level of the thought patterns that maintain the compulsive lying reflex: the automatic interpretations of situations as requiring deception, the anticipatory anxiety about how the truth will be received, the beliefs about the self that make honest self-disclosure feel unsafe. One of the most significant contributions CBT makes is the development of a tolerance for honesty — the gradual building, through repeated experience, of the capacity to tell the truth in situations that previously triggered the automatic lying response, and to find that the anticipated consequences do not materialise.

Acceptance and Commitment Therapy

ACT addresses a specific feature of the mythomania pattern that CBT sometimes addresses less directly: the compulsive quality of the lying reflex. Rather than working primarily to change the content of the thoughts that drive the lying, ACT develops the capacity to hold those thoughts differently — to notice the urge to lie, to observe it as an experience rather than a command, and to make a different choice about how to respond to it. For many people with mythomania, this capacity to create a gap between the impulse and the action is genuinely new.

Person-Centred Counselling

Person-centred counselling provides a relational experience that is itself corrective. The unconditional positive regard that characterises person-centred work — the consistent experience of being accepted as oneself, without performance or management of the therapist’s response — directly addresses the belief that honesty is unsafe. Many people with mythomania have never experienced a relationship in which they could be fully honest without negative consequences. The therapeutic relationship provides that experience, and over time it begins to update the nervous system’s operating model of what happens when you tell the truth.

What Changes — and What the Process Looks Like

People who have engaged seriously with therapeutic work for mythomania describe a characteristic set of changes. Understanding what these look like helps set realistic expectations that are neither falsely optimistic nor unnecessarily discouraging.

The Gap Between Impulse and Action

The first and often most significant change people report is the development of awareness — the capacity to notice the lying impulse before acting on it. In the early stages of successful therapy, people often describe becoming aware of the impulse but still acting on it; later, noticing it and sometimes pausing; later still, noticing it and making a different choice with increasing regularity. This progression — from automatic action to noticed action to deliberate choice — is the practical route through which the pattern changes.

This shift does not happen all at once, and it does not happen uniformly across all situations. People typically find that lower-stakes situations become manageable before higher-stakes ones. The first signs of genuine change are often modest: a small truth told in a situation that previously would have produced an automatic fabrication. These moments are significant not because of their size but because they establish that choice is possible.

Changes in Self-Worth and Shame

The changes in self-worth and shame that underlie the mythomania pattern take longer to shift than the surface behaviour, but they are the more durable changes when they occur. As the person builds a different experience of themselves in the therapeutic relationship — an experience of being accepted without performance — the internal belief that they are not acceptable as they actually are begins to soften. This softening is gradual and rarely linear, but it is often described by people who have been through it as the most meaningful change of all: not just lying less, but needing to lie less.

When the Person With Mythomania Does Not Want Help

A significant practical challenge is that the person displaying the pattern frequently does not initially seek help of their own accord. The pattern may be felt as simply part of how the person is, rather than as a problem requiring attention. Or the shame associated with acknowledging the extent of the lying may make seeking help feel too exposing.

For People Around Someone With Mythomania

For the people who care for someone with mythomania and want to support change, the most important thing to understand is that external pressure — confrontation, ultimatums, expressions of anger or despair about the lying — is rarely effective and often counterproductive. It may intensify the lying by intensifying the anxiety that the lying manages. What is more likely to create the conditions for the person to seek help is a consistent, non-punishing honesty about impact: what happens in the relationship when this occurs, rather than a character judgement.

Individual counselling for the people in relationship with someone with mythomania is valuable in its own right — not as a strategy to fix the other person but as support for processing the confusion and harm that the pattern causes. It also helps the person around the mythomania develop a clearer and more sustainable position about what they can accept and what they need to protect their own wellbeing.

When to Encourage Professional Help

The point at which professional help becomes clearly indicated is when the mythomania pattern is causing consistent harm to the person’s relationships, professional life, or sense of self, and when the person’s own attempts to change it have not produced sustainable results. Suggesting professional support is most effective when it is done at a moment of relative calm rather than in the aftermath of a discovery, and when it is offered as support rather than as a response to an incident.

What About Medication?

A question that people sometimes ask when seeking mythomania treatment is whether medication has a role. The short answer is: occasionally, in specific circumstances, but not as a primary or standalone treatment. Mythomania is a psychological pattern rather than a condition driven primarily by neurochemistry, and medication does not address the anxiety, shame, and self-worth roots that generate the compulsive lying. There is no medication that specifically treats mythomania.

Where medication may be relevant is when significant co-occurring conditions are present — particularly anxiety disorders, depression, or ADHD — that are themselves contributing to the difficulties the person experiences in changing the pattern. In these cases, appropriate medication for the co-occurring condition may create conditions in which therapeutic work becomes more accessible. This is a decision that should be made by a GP or psychiatrist based on a full assessment.

The Role of a GP Assessment

If you are uncertain about whether co-occurring conditions might be relevant, the appropriate first step is a GP consultation rather than self-diagnosis. A GP can assess whether a referral for further evaluation is warranted, and can coordinate the medical and therapeutic aspects of care. Individual counselling can proceed alongside this process and does not require a GP referral at Hope Therapy — but knowing whether other conditions are in play helps ensure that the therapeutic work is appropriately focused.

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THE AUTHOR

Ian Stockbridge

• MBACP (Senior Accredited)

Founder & Clinical Director — Hope Therapy & Counselling Services

MBACP (Senior Accredited) · SNCPS (Acc) · BSc (Hons) CBT · PGCert Clinical Supervision

Founder of Hope Therapy, published author, clinical supervisor, and co-presenter of The Talk Room Podcast. Practising therapist with 25+ years of senior leadership experience.

Before Ian Stockbridge was a therapist, he was a leader. For more than 25 years he worked in senior management and directorial roles across commercial organisations — at times managing teams of more than 200 people. He was effective at it. But the longer he did it, the harder something became to ignore. The people around him were struggling. Capable, committed, often high-achieving people carrying invisible weight that had nowhere to go. Stress accumulated quietly across months and years. Anxiety managed behind professionalism. Relationships and mental health dealt with in the margins of a working life that left little room for either.

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• 25+ Years Leadership
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