Confabulation is the unintentional creation of false or distorted memories and facts. It’s different from delusions and lying, and here’s why you may want to take it seriously.

Some psychologists call confabulation “honest lying” because those who confabulate stories genuinely believe what they’re saying. In this sense, the message is honest, even if untrue.

For example, a person with dementia who experiences confabulation may tell a story about their childhood that never occurred, but for them, it did. It’s also possible they remember something that did happen but in a completely different way.

In their mind, this is the true version of events. In other words, confabulation is a memory error.

Confabulation is a memory disruption that causes distorted or even completely made-up memories. Some psychiatrists think of it as a neuropsychological disorder in itself, while others think of it as a symptom of other underlying disorders.

Confabulation can sometimes be difficult to identify, even for mental health professionals. In fact, confabulated memories often sound quite realistic. Without a family member or close friend of the person to corroborate their version of events, it can take therapists longer to realize a patient is confabulating.

Confabulation usually happens when a person with memory loss is prompted to recall a past event. This is called provoked confabulation. But, cases of spontaneous confabulation, in which a patient tells a false or distorted memory without being asked, are also common.

Some experts categorize confabulation based on how elaborate it is. Confabulation can be as simple as misremembering what you ate yesterday or as complex as inventing detailed, elaborate scenarios and life events.

The simpler form of confabulation is sometimes referred to as “confabulations of embarrassment.” The person may create false memories subconsciously to compensate for not being able to remember significant events or feeling confused about those.

The more complex confabulation is referred to as “fantastic confabulations.”

Outside of a clinical context, the term confabulation is also used in other disciplines, like law, which intersects with forensic psychology.

“Individuals who confabulate can make false confessions and provide inaccurate witness accounts or alibis, leading to wrongful incarcerations,” says Collen Clark, lawyer and the founder of Schmidt & Clark, LLP. “This is usually apparent during interviews, memory tests, and even under cross examination.”

Is confabulation lying?

Confabulation is sometimes mistaken for lying. This misunderstanding can be frustrating for both friends and family members, as well as for the person affected by memory loss.

But confabulation and lying are not the same things.

Confabulation is an unintentional creation or conflation of memories due to a cognitive error.

Lying is conscious, purposeful, and used to deceive others.

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These may be common signs of memory errors in confabulation:

  • It’s difficult to convince the person that their memories may be flawed or untrue.
  • There’s no hidden agenda as to why the person would intentionally lie.
  • The person may have difficulty staying engaged in conversations, particularly those that involve past events.
  • Increased apathy and lack of interest in usual hobbies may be present.
  • The memory errors aren’t saved for one or a few topics, but may involve simple and complex events.

Confabulation can be a symptom of many different types of cognitive disorders, memory loss, or head injuries.

“It is most often seen in those who have damage to the frontal lobe or other parts of the brain that control executive functioning,” says Harold Hong, a psychiatrist at New Waters Recovery in North Carolina. Executive functions include the recollection of information, planning, and solving problems.

“Notably, the frontal lobe is responsible for higher cognitive functions such as working memory, reason and judgment, regulation of speech and language, and motivation.”

Disorders that impact the frontal lobe, like different types of dementia, most commonly develop with age. This is why confabulation may be more common among older adults. But it can be seen in young adults and even children due to other causes, like injuries.

Some examples of conditions that may involve confabulation include:

Confabulation vs. delusions

Delusions and confabulations are different types of false beliefs.

Delusions are typically caused by mental health disorders like schizophrenia, while confabulations usually stem from a neurological condition or memory disorder.

You can usually distinguish the two by identifying whether or not the false belief is related to a fault in memory recall. If so, it is likely confabulation.

If the false belief doesn’t relate to past events, but instead relates to current or future circumstances, this is likely a delusion.

For example, a delusion could be that your neighbor is breaking into your house while you’re gone or that a person on TV is trying to communicate something to you.

Identifying the nature of false beliefs helps mental health professionals diagnose and treat conditions properly.

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People without memory or cognitive disorders can confabulate to some degree, too.

Human brains naturally try to make sense of chaos, observe and link familiar patterns, and adapt to new situations. This can lead a person to fill in gaps in their memory with inaccurate information without even realizing it.

Elizabeth Lofthus, a psychologist who spent decades studying false memories, showed how recollections can be easily distorted – even from the recent past.

For example, when police ask bystanders about the details of a crime they witnessed, they tend to get details wrong and can even be influenced by the way the detective asks questions.

Some amount of confabulation is typical in most people and nothing to worry about.

For example, you may remember a childhood incident differently than a sibling who also experienced it. Emotions and how it impacted both of you may account for those differences.

In some cases, certain psychological and neurological disorders can increase the chance of a person experiencing confabulation. When it starts to affect an individual’s life or their relationships with family members, it may help to seek professional support.

The question of whether confabulation can be managed comes down to what is causing the memory errors.

If confabulation is due to a neurological condition like Alzheimer’s disease, there’s little chance of a cure. Scientists are still researching treatments for different types of dementia.

Still, there are ways to reduce instances of confabulation and improve the patient’s awareness.

“Environmental cues and prompts can remind an individual of the correct information or reduce the opportunity for confabulation,” Hong says. “For example, placing a picture of a family member besides their bed may cue the individual to identify them correctly.”

Reality orientation therapy (ROT) can also be helpful for individuals with memory disorders.

“ROT helps orient an individual to their current surroundings and time period through pictures, clocks, calendars, and personal belongings,” Hong says.

Confabulation that stems from other causes can be treated in different ways.

For instance, a person who experiences PTSD may confabulate to compensate for memories that have been “blocked out.”

Even after a traumatic event, memory errors can persist. In this case, PTSD must be treated appropriately to address the memory problems the person may continue to experience.

Confabulation refers to memory errors that may lead to false accounts of past events. It is unintentional and most often, the person isn’t aware their memory isn’t accurate.

Memory loss can be difficult to watch and to experience. But understanding why it’s happening can make the situation more manageable.

Even if the underlying cause of memory difficulties can’t be “cured,” professional management can make life more fulfilling for the person experiencing the problem and easier for their friends and family members.

Neurologists, cognitive psychologists, and other mental health professionals who specialize in memory loss can help you start the process of understanding what kind of memory loss you or your loved one is experiencing.