Why patients lie about their mental health

Alistair Gardiner | November 18, 2021

When treating a patient with a mental health condition, the best clinicians gather as much information about their patient as possible. But what if the patient is lying?

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Depressed older woman

Surveys show that patients often lie to their doctors about their mental health, but clinicians can learn strategies to get patients to open up.

It turns out they often do. According to survey findings published in October by AdventHealth, one in five patients routinely lies or avoids conversations with their doctors relating to depression, anxiety, or suicidal thoughts.  

Why would a patient lie to their doctor, the person who is in a position to help with their cognitive, behavioral, and emotional well-being? What are the signs that your patient isn’t being open with you? And what can you do to ensure you're getting all the necessary information to provide the best possible care? Here’s what researchers have found.

When and why patients lie

Another recent survey of 500 Americans found that 23% of respondents regularly lied to their doctors about smoking habits, drinking habits, sexual behaviors, and more. Three-quarters of those respondents said they lie to avoid embarrassment and one-third said they lied to “avoid discrimination.” Nearly a quarter of respondents said they believed their doctors wouldn’t take them seriously if they told the truth, and one said they lied about their sexual activity because their mother was present in the room during the consultation. 

A study published in JAMA Network Open involved two national surveys of 4,510 Americans, and found that 60%-80% of respondents admitted withholding at least one type of important information from their primary care provider. Around 45% said they didn’t tell their physicians when they disagreed with a prescribed therapy; just under one-third said they concealed when they didn’t understand treatment instructions. Roughly one in five said they lied about their unhealthy diets or lack of exercise.

Respondents to the surveys said they lie out of fear of being judged or lectured. Some said they felt embarrassed. Other reasons for lying included not wanting to “waste the doctor’s time” and fears of being perceived as "difficult.” 

The significance of this is illustrated by the fact that respondents who reported worse health or had chronic conditions were statistically more likely to withhold information or lie to their physicians. In other words, patients who stood to benefit the most from telling the truth were the most likely to withhold it.

Researchers noted that physicians would benefit from gaining a better understanding of how to increase patients’ comfort and improve their clinician-patient relationships, writing “The clinician-patient relationship requires honest and open communication between both parties to maximize the therapeutic benefit and avoid potential harms.”

An article published in the Canadian Medical Association Journal (CMAJ), which cites the above survey, came to a similar conclusion: Doctors should question whether their own behavior is partly responsible for patients’ hesitance to open up.

The challenge for physicians 

Research indicates it may not be possible to tell when a patient is lying. 

A review published in Frontiers in Psychology in 2020 notes that the “psychological folklore” of nonverbal cues that are associated with lying (gaze avoidance, fidgeting, restless foot and leg movements, frequent body posture changes) are still commonly held gauges of honesty. However, decades of empirical research have found that none of these nonverbal signs are reliable indicators of the truth versus a lie.

In fact, various studies that examined people’s abilities to detect lies have found average scores at chance level (54%), and that those whose profession requires them to detect lies (police investigators, psychiatrists, those who work in recruitment) are no better than the average person.

But if there’s no way to tell if your patient is lying or withholding information, what can you do to ensure that their patients are being honest?

Tips for doctors

The trick isn’t really a trick at all: Establish a good relationship with your patient and create an environment where they feel comfortable being honest. 

According to Clark Madsen, MD, who was interviewed for an article published by FierceHealthcare in 2020, there are several habits you can adopt to encourage your patients to be open. These include:

  • Avoid lecturing your patients, even if they admit to an unhealthy habit. 

  • Don’t be judgmental; instead, make sure the patient knows that you’re on their side.

  • Deploy a silent pause, particularly when you think that you’re being lied to. According to Madsen, this gives the patient time to consider if their lie was a good idea and possibly correct themself.

  • Do not confront a patient, even if you suspect they’re being dishonest. Madsen notes that this can sometimes make patients double down on the lie.

  • Reassure patients by letting them know that you have their best interests at heart.

  • Ensure that patients are aware of the consequences of lying about their health.

As noted in the above CMAJ article, physicians should be as honest with the patient as they want the patient to be with them. The relationship is a two-way street, and it works best when everyone is on the same page.

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