Confabulated memories can sometimes be confused with intentional lying or malingering. Malingering involves deceiving others to gain something. While confabulation involves lying, the two are not the same. People who are confabulated are not aware that their memory is wrong, and they are not lying to manipulate or deceive other people.
Types of Confabulation
When someone’s mind confabulates, it is attempting to cover up for a memory that has been lost. This happens without the person being aware of it. Confabulations are categorized into two types: provoked and spontaneous:
Provoked confabulation occurs when someone creates an untrue story in response to a specific question. This type of confabulation is the most common and frequently occurs in people with dementia or amnesia. Spontaneous confabulation is less common. It occurs when someone tells a fabricated story without any obvious motivation or provocation.
Confabulation is often associated with memory disorders, brain injury or disease, and psychiatric conditions. However, it has also been observed in healthy people with no history of a neurological disorder, mental health condition, or brain damage.
Signs and Symptoms of Confabulation
Confabulation often points to an underlying issue with a person’s memory—for example, a neuropsychiatric condition, brain injury, or substance use disorder. There are several common characteristics of confabulation, including:
A lack of awareness that a memory is false or distorted. When errors are pointed out, the person is unconcerned about the apparent unreality of their account.No attempt to deceive or lie. There is no hidden motivation for the person to misremember the information.The story is usually drawn from the person’s memory. The basis for the misremembered information usually is founded in past or current experiences and thoughts of the person.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.
Examples of Confabulated Memories
Confabulation is not the same as lying. When someone tells a lie, they present information that is untrue with the conscious intent to fool or manipulate others. A person who confabulates, on the other hand, is not doing so with the purpose of deceiving and is not actually aware that what they are remembering is not the truth. For example, a person with dementia may be able to clearly describe the last time they met with their doctor, even if the scenario they depict never actually happened. A person with memory problems might not be able to remember exactly how they met someone. When asked directly, they might confabulate a story to explain the occasion on which they first met the individual. Another example of confabulation is when a person with gaps in their memory is asked to remember and describe the details of a past event. Rather than responding that they do not know, the person’s mind fills in missing details with confabulated memories of the event. For example, a person with schizophrenia who is experiencing delusions may confabulate memories that become increasingly fantastical and intricate the more they are questioned about them. In other cases, a person’s memories can be quite mundane. For example, a person might not be able to remember exactly how they got a small bruise on their arm but may fabricate or misremember a story to explain how the injury occurred.
Identifying Confabulated Memories
Confabulation can sometimes be challenging to recognize. It can also make diagnosing mental health and memory conditions more difficult. To determine if someone is confabulated, a doctor or mental health professional may:
Ask questions: During an interview process, a clinician will ask questions about a person’s experiences, symptoms, or medical history. If inconsistencies or obvious examples are noted, the individual may then be referred to a neurologist for further evaluation.Family reports: Family and friends may also be able to provide information about confabulation since it can be very difficult for professionals to recognize. In many cases, only people living with the individual or spending a great deal of time with them may notice examples of confabulation.Verifying with multiple sources: If confabulation is suspected, a mental health professional might ask further questions and verify the information using several sources to help determine if the information is factual.
Causes of Confabulation
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 psychological and neurological conditions associated with confabulation, including:
Wernicke-Korsakoff’s syndrome, a neurological disorder associated with severe thiamine deficiency that is usually caused by chronic alcoholism Alzheimer’s disease, a form of dementia that is associated with memory loss, cognitive impairment, language problems, and other neurological issues Traumatic brain injury, damage to specific regions of the brain like the inferior medial frontal lobe Schizophrenia, a mental health disorder that affects a person’s ability to recognize and understand reality, causing abnormal experiences and behaviors
There is not one specific area of the brain that is responsible for confabulation, but damage to the frontal lobe (which is vital to helping us form memories) and the corpus callosum (which has a key role in visual and auditory memory) has been associated with confabulation.
Explanations for Confabulation
Different theories attempt to explain why people confabulate. Some research suggests that two main factors play a role in this type of memory disruption:
Overlearning
This factor can cause certain types of information to be present at the forefront of a person’s mind. When certain information looms large in a person’s memory, it tends to crowd out other details. If gaps in memory occur, overlearned information can dominate and force out more specific facts and memories. This can lead to memory distortions and inaccuracies.
Poor Encoding
This factor leads to information not being fully stored in the brain’s long-term memory in the first place. For example, if a person is distracted during an event, they are less likely to pay attention to details. If the information is not fully encoded, the person is more susceptible to forgetting or misremembering it.
False Memory
Being confabulated can sometimes stem from a false memory. This can be a case of “honest lying,’ since people are relating a confabulated memory that seems entirely truthful from their perspective. False memories can form for several different reasons. In many cases, memories are encoded improperly or become corrupted due to interference from other information and memories.
Memory Loss
Confabulation can also happen when people are trying to fill in the gaps in memory caused by memory loss. This may be why people experiencing conditions that affect memory—such as dementia and amnesia—are sometimes more likely to confabulate.
Treatment for Confabulation
Research suggests that confabulation can be difficult to treat. The recommended approach to treatment depends on the underlying cause (if it is possible to identify the source). In some instances, confabulation can be addressed with psychotherapeutic and cognitive behavioral treatments. These approaches help individuals become more aware of the inaccuracies in their memory. Techniques that encourage a person to question what they do and do not remember can also be useful. People are asked to respond that they do not know something or that they are not sure rather than confabulate a response. The findings of a 2017 study supported neuropsychological treatment for confabulation in people who experienced a brain injury. Researchers in the study asked participants to complete a memory task then showed them their incorrect responses. As participants were shown their errors, they were given specific instructions to pay closer attention to the material and to think about their answers before responding. The results of the study indicated that this approach was effective at reducing confabulations and that the effects could also be generalized to other areas post-treatment.
Coping With Confabulated Memories
In addition to cognitive and behavioral treatments, there are strategies that people can use to help deal with confabulation.
Get support: Having social support is essential when dealing with confabulated memories. Ask trusted loved ones who are familiar with your health history and other information to accompany you to the doctor to ensure that your healthcare provider gets accurate information.Corroborate information: Don’t rely on memory alone for necessary information, particularly if it involves potentially life-changing decisions. Ask friends or family to verify your information, or check written records.Keep a diary: Having a written record or events can be helpful when coping with confabulated memories. Looking back on your journal can help you better notice problems with your own memories of events.
A Word From Verywell
Family members and friends of people prone to being confabulated may become frustrated or distressed. It may seem like their loved one is lying, but understanding that confabulation is not an attempt to deceive can make it easier to cope. Confabulation can be confusing or frustrating, but sometimes it helps people with memory disruptions cope with their current reality. Gaps in memory can be difficult and even frightening for people who experience them. Confabulated memories are one way the mind might try to make sense of the world. If you are concerned that a loved one may be showing signs of confabulation, it’s essential that you seek help. Consider talking to a mental health professional who can identify the underlying cause and support you and your loved one as you deal with the effects of confabulation.
