Confabulation: Explaining a Symptom That Can Be Confused With Lying
Key takeaways:
Confabulation happens when people create and talk about false memories without knowing they aren't true.
It can occur in certain neurological disorders like dementia, Wernicke-Korsakoff syndrome, and traumatic brain injury.
The cause of confabulation is up for debate. But it may be a way for people to fill in the missing details of their memories, or to be optimistic about their condition.
Confabulation is a phenomenon that happens in people with conditions that affect the brain. It can be confused with lying if people don’t know this condition exists.
Read on to learn about which conditions cause confabulation, how to recognize it, and what can be done to treat it.
What is confabulation?
Sometimes people make up stories about their past and don’t realize that the stories aren’t true. This is known as confabulation — the creation of false memories.
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Confabulation is sometimes called “honest lying.” The person is telling a falsehood but believes that what they’re saying is true.
Confabulation is not lying, though. It’s a symptom of certain conditions that affect the brain. Experts believe that confabulation is linked to memory and thinking issues.
What are the symptoms of confabulation?
The symptoms of confabulation can differ from person to person. Sometimes confabulation can look like a few false details in a story. Other times it can look like a long and detailed story that makes no sense.
Sometimes, all the parts of the story are true, but they didn’t happen in the way that the person remembers. A person might take details from a different time and add them to a story. Everyone does this to a certain extent, as it’s common to remember details incorrectly.
It may be hard to convince people who confabulate that they’re remembering things wrong — even when you present evidence of what really happened. Some people can be taught to understand that they confabulate, though. It depends on the brain condition that’s causing the confabulation.
What conditions cause confabulation?
Confabulation can be present in certain neurologic conditions and disorders:
Dementia: This condition is characterized by disordered thinking and memory and personality changes. Common types include Alzheimer's disease and frontotemporal dementia.
Wernicke-Korsakoff syndrome: This condition is caused by vitamin B1 deficiency. It’s most common in people with alcohol use disorder, but it can also happen with other causes of malnutrition. Memory changes are one of the more noticeable symptoms.
Stroke: This happens when broken or blocked blood vessels cause damage to the brain. This can lead to problems with thinking, memory, and mood.
Traumatic brain injury (TBI): An external force to a person’s head can cause varying degrees of brain injury. TBI can lead to temporary or long-term memory and psychiatric issues.
Fetal alcohol spectrum disorder: This can happen to a baby when a pregnant mother consistently drinks a large amount of alcohol. It can lead to problems with thinking, emotions, and social interactions.
Hydrocephalus: This is a buildup of fluid that puts pressure on the brain. Some people are born with it. Others develop it later in life for a number of different reasons.
Multiple sclerosis: This autoimmune disease damages nerves in the brain and spinal cord. Possible symptoms include memory problems, slowed thinking, and mood issues.
Herpes and syphilis encephalitis: These infections reach the brain in some people. They can cause memory problems, personality changes, and other symptoms.
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What causes confabulation?
No one knows exactly what happens in the brain when someone confabulates. But experts agree it probably has something to do with the memory pathway in the brain. There are several steps involved in memory formation, and there may be problems at any of the steps.
Some experts say that in order for someone to develop confabulation, there must also be problems with executive functioning. Executive functioning includes thinking that allows people to plan and make decisions. Disorders that affect memory also can affect executive functioning.
One theory is that people want to fill in the gaps in their memory, even if they’re not aware of doing it. This is related to a human desire to make sense of why things happen. Even people without any neurological conditions are known to do this to some extent. People with confabulation have more “missing information” due to their disease. So they may fill in the gaps more noticeably.
Some experts also note that the details of confabulations are often positive. One theory suggests that it’s helpful to the person’s psychology to insert positive details. It may be a way to be optimistic about their condition, or to avoid negative emotions.
What can be done for confabulation?
Not a lot is known about treatments for confabulation. One reason is because it’s not very common. Another factor is that it shows up in very different conditions. And the exact cause of confabulation isn’t clear.
But, there’s some evidence that treatments are effective in a small number of people. It depends on the underlying condition. For example, vitamin B1 can help people with Wernicke-Korsakoff syndrome. Also, a shunt (a tube that drains excess fluid from around the brain) can help when a person has hydrocephalus.
And, in many cases, confabulation often clears up on its own, without treatment.
Sometimes people who confabulate can come to understand that they confabulate. This usually requires the help of caregivers and healthcare providers. The person would also need to be able to learn. Some helpful ways to improve confabulation are:
Keeping a diary
Fact-checking
Self-monitoring
Having people who can help is important for individuals who experience confabulation. They can make sure to provide correct information when it’s important — like with healthcare, financial, and legal matters.
If a person without a diagnosis is confabulating, a visit to a primary care provider may be helpful. This way, their provider can help figure out the underlying condition that’s causing it.
The bottom line
Confabulation is a condition in which people create false memories without knowing they aren’t true. It’s present in some people who have neurological conditions.
Knowing that the person isn’t giving false information on purpose is important. People who confabulate need others in their life who know the facts and can support them. Treatment options are limited, but confabulation often clears up on its own.
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References
Brown, J., et al. (2017). Confabulation: A guide for mental health professionals. International Journal of Neurology and Neurotherapy.
Christensen, J. N., et al. (2019). Confabulation resilience of the developing brain: A brief review. Cambridge University Press.
Coltheart, M. (2017). Confabulation and conversation. Cortex.
Francis, C., et al. (2022). Interventions for confabulation: A systematic literature review. The Clinical Neuropsychologist.
Moscovitch, M. (1989). Confabulation and the frontal systems: Strategic versus associative retrieval in neuropsychological theories of memory. Varieties of Memory and Consciousness: Essays in Honour of Endel Tulving.
Turnbull, O. H., et al. (2017). Confabulation: Developing the ‘emotional dysregulation’ hypothesis. Cortex.
