Deception: A Clinical Perspective

Note to Reader: This is not a blog about diagnosing. It is a discussion of clinical framing and an exploration of deception from a clinical perspective rather than as a personality trait or label. If you or someone you know is struggling with mental health concerns, please seek out a qualified mental health clinician for appropriate assessment and treatment.

First of all, I think this topic is important to talk about because many of us have experienced deception and may not have realized it until the person or situation revealed itself.

So, let’s talk.

Let’s talk about deception—and not in the way you may be thinking about it.

Most of the time, we use the word deception colloquially. We hear it and immediately think of lying, dishonesty, or someone intentionally trying to fool another person.

What’s interesting is that in the DSM-5, the diagnostic manual clinicians use to assess and diagnose mental health conditions, deception appears in a much more specific clinical context. In fact, deceitfulness is one of the diagnostic criteria associated with Antisocial Personality Disorder (ASPD).And this is where the clinical history becomes particularly interesting.

Antisocial Personality Disorder is an adult diagnosis, but the DSM-5 requires evidence of Conduct Disorder before the age of 15 as part of the diagnostic criteria. Conduct Disorder is a childhood or adolescent diagnosis characterized by a persistent pattern of violating the rights of others and major age-appropriate social norms or rules. Deceitfulness or theft is one of the criterion areas included in its diagnostic criteria.

The DSM-5 describes deceitfulness in ASPD as a pattern that may include repeated lying, the use of aliases, or conning others for personal profit or pleasure.

But here’s where I want to slow down.

Deception is not synonymous with Antisocial Personality Disorder.

A person can engage in deception without meeting criteria for ASPD, just as a person can lie without having a personality disorder.

That distinction matters because clinical language can easily become diluted when it enters everyday conversation.

We may call someone “deceptive,” “manipulative,” or even a “narcissist” based on a single interaction or a pattern that feels troubling to us. But a clinical diagnosis requires something much more specific: an established pattern of behavior, a defined set of criteria, and appropriate clinical assessment.

Deception is a behavior. It is not, by itself, a diagnosis.

And that brings us to a much broader question.

What does deception actually look like in relationships?

Clinically, deception is more complex than simply telling a lie.

It can involve the intentional manipulation, distortion, concealment, or withholding of information in a way that influences another person's understanding of reality.

Not all deception looks like an obvious lie.

Sometimes deception is what is said.

Sometimes it is what is deliberately left unsaid.

Sometimes it is how information is presented.

And sometimes it is the creation of a particular impression while technically never saying something that is untrue.

This is where deception becomes particularly relevant when we talk about relationships.

We often evaluate relationships based on what a person does. But we also need to consider whether we can accurately understand what is happening within the relationship in the first place.

Because informed decisions require access to information.

When information is intentionally manipulated, concealed, or distorted, our ability to evaluate a relationship—and determine what level of access is healthy—can be compromised.

And this brings deception directly into the conversation about boundaries and the Contact Continuum™.

Boundaries regulate behavior. Low contact regulates access. But deception can interfere with our ability to determine what access is appropriate in the first place.

Think about that for a moment.

If you are making decisions about a relationship based on incomplete, distorted, or intentionally manipulated information, you may believe you are making an informed decision when you are not.

That doesn't mean every omission is deceptive.

Privacy is not deception.

People are allowed to have information that they do not share with others. We do not have unlimited access to another person's thoughts, history, relationships, finances, or private experiences simply because we are in a relationship with them.

The clinical question becomes more nuanced:

When does withholding information serve privacy, and when does it serve deception?

When does an omission simply reflect a person's right to maintain privacy—and when is information intentionally withheld because revealing it would change another person's decision, perception, or behavior?

That distinction matters.

Because deception is not simply about whether someone told a lie.

It can also be about what another person is being led to believe.

And when deception begins to interfere with a person's ability to accurately understand a relationship, it can also interfere with their ability to make healthy decisions about contact.

So perhaps the more important questions are not simply:

Did they lie?

but:

What was being concealed?

Why was it being concealed?

What was the other person being led to believe?

And ultimately:

How did that deception affect their ability to make an informed decision about access to the relationship?

That is where deception becomes more than a word we use to describe dishonesty.

It becomes something worth examining clinically.

Continue the Conversation

We’ve established that deception is more than simply telling a lie—and that understanding it clinically requires us to look beyond the behavior itself.

But recognizing deception is not always straightforward.

Sometimes the deception is obvious. Other times, it is much more subtle. Information may be withheld, carefully selected, strategically presented, or concealed altogether. The person may never tell an outright lie, yet the result can still be that someone else develops a distorted understanding of the situation.

And that brings us to an important question:

Can someone deceive you without actually lying to you?

What happens when deception takes the form of omission, concealment, selective disclosure, or carefully managed information?

Where does privacy end and deception begin?

And perhaps most importantly, how do we recognize the difference?

That is where we’re going next.

In the next blog, we’ll take a closer look at the subtle forms of deception—and why sometimes what a person doesn’t tell you can be just as important as what they do.

About Christen J. Yassin, MSW, LCSW, LCSW-C

Christen J. Yassin is a licensed clinical social worker, author, and creator of The Contact Continuum™, a framework for understanding contact, evaluating access, and creating healthier connection in relationships.

With nearly two decades of clinical experience, Christen brings a clinical perspective to complex relational dynamics, boundaries, emotional safety, and the decisions people make about contact with others.

She is the author of The Contact Continuum: A Guide to No Contact, Low Contact, and Everything In Between, forthcoming.