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What to Know About Confabulation

Medically Reviewed by Carol DerSarkissian, MD on May 26, 2021

No one's memory is 100% percent accurate, but some people make many memory errors. They believe in the accuracy of these faulty memories and can be convincing when talking about them. This is what scientists call confabulation. Some brain conditions can cause these errors in memory.

What Is Confabulation?

Confabulations are usually autobiographical, involving people misremembering their own experiences. Sometimes they place experiences in the wrong time or place. They may wrongly recall other details, large or small. Occasionally confabulations have little basis in reality. Details can be drawn from movies, television, and overheard conversations.

Of course, people with no brain disorders can have faulty memories. Normal mistakes in memory become confabulation when people remember false information in vivid detail, often claiming to relive the event. They may exhibit genuine emotions, such as grieving over a friend who has not died. Listeners often believe what they are hearing is true. 

What Confabulation Is Not

Confabulation is not lying. Confabulation differs from other forms of falsehood. Confabulators have no reason to tell a lie and don't realize that they're not telling the truth. Their brains simply filled in some missing spots with false information. Some people have called this "honest lying".  

Confabulations are not delusions. Both involve false beliefs, but confabulation almost always involves a memory, while delusions are less anchored in the real world. Delusions occur mostly in psychiatric disorders such as schizophrenia. Confabulation is more common in brain disorders such as dementia.

Two Kinds of Confabulation

Confabulations can be either provoked or spontaneous. They're provoked if they occur in response to a question. The person may feel compelled to answer even if they don't know what to say. They're spontaneous if they're offered voluntarily. Spontaneous confabulations are usually less believable and might be fantastic or bizarre. 

Conditions Linked to Confabulation

Confabulation is caused by brain damage or poor brain function, but researchers are unsure which parts of the brain are at fault. The frontal lobe or the basal forebrain may be involved. Confabulation occurs with several brain disorders. These are some of the most common. 

Wernicke-Korsakoff syndrome. Confabulation was first studied by a Russian psychiatrist, Sergeievich Korsakoff. He noticed that his clients who overused alcohol often had faulty memories. He gave his name to a condition that occurs with an alcohol use problem. Wernicke-Korsakoff syndrome is caused by a vitamin B1 deficiency.

Alzheimer's disease. Those with Alzheimer's disease experience a range of symptoms. Delusions, such as believing that someone is stealing from them, are common. Provoked confabulations are common in early Alzheimer's. Spontaneous confabulations can become a serious problem if the person with Alzheimer's acts on their mistaken beliefs.

Traumatic brain injury. A blow to the head can cause problems in thinking and memory. Confabulation can be a special problem for those with traumatic brain injury. They may misreport events leading up to the injury or make mistakes about other important details.

Fetal Alcohol Spectrum Disorder. Exposure to alcohol in the womb can cause a person to have a variety of brain problems, including confabulation. Often those with fetal alcohol spectrum disorder are suggestible and eager to please. These characteristics can make them likely to create false memories.  

Can Confabulation Be Treated?

Confabulation won't go away unless the underlying condition is addressed. Doctors can treat some conditions. For example, Wernicke-Korsakoff syndrome is treated with vitamin B1. Other conditions lack effective treatments.   

Those who live or work with confabulators can reduce problems by using strategies such as these:

  • Minimizing distractions
  • Avoiding leading questions
  • Allowing extra time for processing
  • Reducing stress
  • Using simple language
  • Checking to see if they understand

Some confabulators can be taught how to monitor themselves. Memory aids can help. They can keep memory diaries so they don't feel pressure to remember everything.

Results of Confabulation

For the self. Confabulation performs several functions for those who do it:

  • It lets them make sense of their situation.
  • It enhances their sense of self.
  • It makes them relevant in the world. 

For family members. Dealing with confabulation can make family members frustrated, angry, or sad. They should remember that their relative is not being untruthful on purpose. A support system is vital for those who confabulate. They may give inaccurate information in a variety of situations. Family can be a part of that support system. 

In the legal system. Individuals who confabulate can make false confessions and give false testimony. Although they are not lying on purpose, the results can be serious. Those who interview people with certain brain disorders should understand confabulation. They should avoid long interviews, suggestive questions, and other techniques that could cause the subject to give false information.

WebMD Medical Reference

Sources

SOURCES:

Alzheimer's Association: "Confabulation: Honest Lying."

Counseling Today: "A beginner’s guide to client confabulation." 
Discourse Studies: "Confabulation: sense-making, self-making and world-making in dementia." 
International Journal of Neurology and Neurotherapy: "Confabulation: A Guide for Mental Health Professionals."
Journal of Law Enforcement: "Confabulation: Connections between Brain Damage, Memory, and Testimony." 
StatPearls{Internet]: "Confabulation."  
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