What Is Confabulation?

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Confabulation is a type of memory error in which gaps in memory are unconsciously filled with fabricated, misinterpreted, or distorted information. In these instances, the individual may confuse imaginings with real memories. While there is no conscious or intentional attempt to deceive, the person is quite confident of the truth of these memories, even when confronted with contradictory evidence.

Causes

Confabulation is often the result of brain disease or damage. Some of the conditions that are linked to confabulation include memory disorders, brain injuries, and certain psychiatric conditions. There are several associated psychological and neurological conditions:

  • Wernicke-Korsakoff's syndrome is a neurological disorder often caused by chronic alcoholism that results in severe thiamine deficiency.
  • Alzheimer's disease is a form of dementia that is associated with memory loss, loss of cognitive abilities, language problems, and other issues.
  • Traumatic brain injury is damage to certain regions of the brain and has been linked to the emergence of confabulated memories. Some studies have shown that people with damage to the inferior medial frontal lobe are more likely to confabulate than people with either no injury or injury to other areas of the brain.
  • Schizophrenia is a mental disorder that is marked by difficulty with understanding reality and abnormal behavior. Confabulation is sometimes seen in individuals with schizophrenia, often in patients who are experiencing delusions.

Explanations

What explains confabulation? There are a number of different theories, but some research suggests that two factors play an important role in certain instances of this memory disruption.

  • Overlearning may result in some types of information being at the forefront of a person's mind. Since this information tends to loom large in a person's memory, it also tends to crowd out other details. When gaps in memory take place, the overlearned information may dominate and force out more specific facts and memories. This can lead to memory distortions and other inaccuracies.
  • Poor encoding may result in information not being fully stored in long-term memory in the first place. For example, a person might become distracted during an event and not really be paying attention to the details. Since the information is not fully encoded into memory, the person is more susceptible to forgetting and other memory problems.

Signs and Symptoms

There are several common characteristics of confabulation.

  • A lack of awareness that a memory is false or distorted. When errors are pointed out, the patient is unconcerned about the apparent unreality of his or her account.
  • No attempt to deceive or lie. There is no hidden motivation for the patient to misremember the information.
  • The story is usually drawn from the patient's memory. The basis for the misremembered information usually is founded in past or current experiences and thoughts of the patient.
  • The story can be either very probable or very improbable. The story might be completely coherent and plausible, whereas other stories may be highly incoherent and unrealistic.

Types

Confabulations are categorized into two different types: provoked and spontaneous.

  • Provoked confabulations occur when a patient creates an untrue story in response to a specific question. This type of confabulation is the most common and often occurs in patients with dementia or amnesia.
  • Spontaneous confabulations occur when a patient tells a fabricated story without any obvious motivation or provocation. This type of confabulation tends to be less common.

Examples

It is important to note that confabulation is not the same as lying. Lying involves presenting information with the intent to fool or manipulate others; those who confabulate are not doing so with the purpose of deceiving.

While confabulation involves presenting false information, the people who are doing so believe that what they are remembering is true.

For example, a person experiencing symptoms of dementia may be able to clearly describe the last time she met with her doctor, even if the scenarios she depicts never actually happened. A person with memory problems might not be able to remember exactly how she met a person. When asked, however, she might confabulate a story to explain the occasion on which she first met the individual.

Another example of confabulation can occur when a person who has gaps in his memory is asked to remember and describe details of a past event. Instead of simply replying that he does not know, his mind will fill in the missing details with confabulated memories of the event.

Confabulated memories can sometimes be quite elaborate and detailed. Schizophrenic patients who are experiencing delusions, for example, may confabulate memories that become increasingly fantastical and intricate the more they are questioned about them.

In other cases, such memories can be very small and mundane. For example, a patient may not be able to remember exactly how he got a small bruise on his arm but may fabricate or misremember a story to explain how the injury occurred.

Treatments

Research suggests that confabulation may be difficult to treat. The recommended approach to treatment may depend upon the underlying cause associated with the problem if it is possible to identify the source.

In patients with dementia, for example, arguing with the patient over the validity of their memories would serve little purpose. Rather than try to refute these memories, it is often simply better to offer acceptance and support.

In other instances, confabulation can be addressed with psychotherapeutic and cognitive-behavioral treatments. These approaches usually focus on helping patients become more aware of their memory inaccuracies. Cognitive approaches that encourage patients to question what they do and do not remember can sometimes be helpful. Patients are encouraged to simply respond that they do not know something or that they are not sure rather than confabulating a response.

One study found support for a neuropsychological treatment for confabulations. The treatment involved engaging participants in a memory task and then showing them their incorrect responses. When showing participants their errors, they were also given specific instructions to pay closer attention to the material and to think about their answers before responding. The results indicated that this approach was effective at reducing confabulations and that the effects generalized to other areas post-treatment.

A Word From Verywell

Family members and friends of people who are prone to confabulation may become frustrated or distressed because at times it may seem like their loved one is lying. Understanding that confabulation is not an attempt to deceive can sometimes make it easier to cope.

While confabulation can be confusing or frustrating, it may also help people with memory disruptions cope with their current reality. Gaps in memory can be difficult and even frightening for people who experience them, so confabulated memories are one way that the mind might try to make sense of the world. If you are concerned that a loved one may be showing signs of confabulation, consider talking to a mental health professional to learn more about how you can deal with this situation.

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Article Sources

  • Attali, E, & Dalla Barba, G. Confabulation in healthy aging is related to poor encoding and retrieval of over-learned information. Aging, Neuropsychology, and Cognition. 2013;20(3):339-355. DOI: 10.1080/13825585.2012.711462

  • Trivino, M, Rodenas, E, Lupianez, J, & Arnedo, M. Effectiveness of a neuropsychological treatment for confabulations after brain injury: A clinical trial with theoretical implications. PLoS One. 2017;12(3):e0173166. DOI: 10.1371/journal.pone.0173166