Confabulations: Definition, Causes, & Examples

By Charlie Huntington, M.A., Ph.D. Candidate
​Reviewed by Tchiki Davis, M.A., Ph.D.
Confabulations are unintentional lies or mistaken beliefs brought on by an inability to remember the past clearly. Research has much to tell us about why this happens and whom it happens to.​
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My grandmother, who recently celebrated her 94th year on the planet, is the primary example in my life of what we might call “senior moments”. Most often, this has looked simply forgetting things – on what day did we say we were going to play bridge? – or calling one grandkid by another grandkid’s name. (In her defense, I do somewhat look like my cousin.)​
But I imagine my grandmother is also losing some of her memory, and this makes her susceptible to another kind of mental error called a confabulation. What is a confabulation, and is it just something the elderly would do? Let’s see what the science says.​
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What Are Confabulations? (A Definition)​

Confabulations, in their broadest form, are statements that reflect a distortion of one’s memories (Metcalf et al., 2007), such that the statement is related to actual events but not an accurate reflection of what happened. Confabulations are unconsciously-made distortions – people saying confabulations do not realize that they are being untruthful.
 
For a helpful example, let’s go back to my grandmother for a moment. Suppose I visit her at her retirement home. She greets me warmly, and over tea and biscuits (she is a British grandmother, after all), she starts to remind me of the last time I visited, how we took a walk around the grounds, looked at pictures of my mother as a child, and ate dinner in her dining room with a friend of hers. None of this sounds like the last time I visited her – it was a short visit in the winter, and we would not have gone outside. It takes me some time to realize that she is either combining previous visits from me in her mind or perhaps remembering the last time that my cousin (with whom she sometimes confuses me) came to see her.
 
This example highlights a couple of traits of confabulations (Metcalf et al., 2007). First, they usually are based on experiences a person has actually had – a person is unlikely to confabulate an experience in a country they have never visited or one that includes only people they have never met. Second, confabulations are typically pretty plausible; I certainly have spent a handful of afternoons with my grandmother doing some of the things she described. Third, in this hypothetical example, my grandmother spoke without a hint of irony – she was not joking with me and fully believed in the memories she was sharing.

Two Kinds of Confabulations

Scientists have decided to distinguish between two different kinds of confabulations (Metcalf et al., 2007). The first kind is called spontaneous confabulation – this is when somebody confabulates without any prompting. For example, a person with dementia might say, “I know we talked on the phone this morning” to a visiting loved one with whom they haven’t spoken in weeks. When their loved one disputes this, the person with dementia may become upset or confused because they genuinely believed in the memory they were recounting (Schnider et al., 1996).
 
People who spontaneously confabulate act on their inaccurate memories, whereas when people engage in the other kind of confabulation, called provoked confabulation, they usually do not (Metcalf et al., 2007). Provoked confabulation happens when a person is asked about their memory of an event and they give an inaccurate response. Perhaps because these confabulators have been given a prompt by someone else, they are less likely to become confused by the confabulation they have made and also less likely to act on their inaccurate remembering.

Causes of Confabulations​

I bet by now you’re pretty curious about how people end up confabulating. How do we end up inaccurately remembering the past? There are a couple different levels on which to consider this question. One thing that is clear is that confabulation means something is not functioning typically in the brain, either because of brain damage, a mental illness, or intense stress or trauma (Glowinski et al., 2008). While this tells us where the problems originate, it is not totally clear what exactly goes wrong along the way to a confabulation. There are three main hypotheses that scientists have about this (Dalla Barba et al., 1997).

Three Hypotheses about Confabulations

First, a person who is confabulating may be demonstrating “poor source monitoring”, which means they are not effectively distinguishing between their memories, knowledge, and beliefs. For example, a confabulator might confuse having read about the Sistine Chapel with having actually visited the Vatican.
 
Second, confabulations may result from accurately remembering things, but not accurately remembering the order in which they happened. For example, a person who has experienced severe trauma may have trouble accurately remembering the details of the event in the order that they actually occurred, especially if the event happened quite recently.
 
Finally, confabulations may occur because people do not possess effective abilities for memory retrieval in general. It is harder to give a concrete example for this theory, but imagine you were asked to recount, with as much detail as possible, what you did yesterday. You could probably share a lot of details, right? However, you might have a harder time keeping it all straight if you learned halfway through the day that your parent, or your child, had been involved in a car accident. In that scenario, suddenly the little details of your day might not be as easy to remember, because something else took up a great deal of your attention.  
 
Okay, back to the brain itself: it seems like nearly everyone who confabulates either has some kind of unusual brain activity or damage or has a psychiatric diagnosis that might also reflect atypical brain functioning (Schnider, 2003). People with diagnoses such as post-traumatic stress disorder (PTSD), dementia, schizophrenia, and other neurodegenerative conditions may engage in confabulations. People with brain injuries, such as severe concussions, aneurysms, and blunt force trauma to the head, also confabulate.
 
What exactly is different in the brain of somebody who is confabulating? I can briefly summarize a lot of neuroscience by telling you that most studies show damage or abnormal functioning in brain regions associated with memory, and in the prefrontal cortex, where most of our complicated decision-making takes place (Metcalf et al., 2007; Nedjam et al., 2004; Schnider, 2003). However, since many brain regions are involved in the processes of storing and retrieving memories, many different types of brain injuries can lead a person to start to confabulate.

Examples of Confabulations

I like how one researcher characterizes confabulations, describing them as accurate memories with inaccurate settings and timing (Kopelman, 2010). This kind of confabulation is likely to occur in response to being asked a question (in other words, it is a provoked confabulation). A good example of such a confabulation is knowing that you have met a person before, but inaccurately remembering – with absolute conviction – where it was that you met them.
 
At the same time, confabulations can also be unusual or unlikely (Metcalf et al., 2007). For example, a person with psychosis might recount in detail having given birth recently, despite being childless or having last given birth decades ago. Or a retired doctor might suddenly “remember” that there are clients waiting for her, even though she left her practice several years ago.

Confabulation Thought Process

What is a person who is confabulating thinking? An illuminating study by Kopelman (1987) showed that people with amnesia who are sometimes known to confabulate, are as good at accurately remembering things they heard in the last hour as people without amnesia are at remembering things that they learned a week ago.
 
If you asked me what I was doing a week ago today, I would answer with plenty of conviction. I might make a couple of mistakes, but I would feel pretty confident about what I was saying. People who are confabulating are having a similar experience: they have done their remembering, not noticed anything abnormal about the process, and believe what they are saying (Kopelman, 1987).
 
We can also think of confabulation as taking ordinary patterns of elaboration or invention to a much greater level. All remembering is both an act of retrieving what happened, but also reinterpreting it (Wheeler & Buckner, 2004). Where somebody who does not confabulate might slightly exaggerate a memory to make it more entertaining or dramatic, that same tendency, thanks to atypical brain functioning, might be more exaggerated during confabulation.

Confabulation vs Delusion

Delusions are thoughts that are resistant to countering evidence and usually incomprehensible to others. In these regards, they are different from all but the most outlandish spontaneous confabulations (Langdon & Bayne, 2010). Delusions are often the result of brain processes that seem much less connected to reality or prior experience, whereas confabulations almost always have some grounding in a past reality (Schnider, 2003). Finally, delusions are usually focused on present-day or future events, whereas confabulations are usually plausible but inaccurate memories.

Confabulation vs Lying​

Is confabulation lying? It is certainly a statement of something which is not true, but it is something that is fully believed to be true. When people confabulate, they generally do not know any better – they are simply recalling the past as best they can. In this sense, confabulation is honest lying. While it may reflect an unconscious desire to remember things accurately or to appear a certain way, it is not deliberate deception (McKay & Kinsbourne, 2010).​

Confabulation Disorder

There is no such thing as a confabulation disorder. Instead, we can think of confabulation as a symptom of several kinds of neurological and psychiatric conditions, all of which involve brain damage or abnormal brain activity.

Confabulations in Dementia

Confabulations are common in people with dementia, whose brains become less effective as they age (Tallberg, 2007). A major aspect of dementia is the loss of memory, something which the person with dementia may not be completely aware of. Therefore, they are likely to confabulate with increasing frequency as their brain functioning continues to change.

Confabulations in Alcoholics

Most people who overdrink will not reach the point of confabulating; however, some experience of memory loss in general, in addition to memory loss associated with particularly intense binges or blackouts, is not uncommon in severe alcoholics (Zahr et al., 2011). Severe alcoholics will also experience impairments in their executive functioning because of their drinking. Taken together, these two symptoms may lead to confabulation on the part of some alcoholics.​

Confabulations in Schizophrenia

People with schizophrenia often experience psychosis – seeing, hearing, and/or believing things that are conclusively not real. This makes it likely that they will confabulate, although in a slightly different way from people without schizophrenia (Shakeel & Docherty, 2015). People with schizophrenia may confabulate by combining memories with other ideas, thoughts, or beliefs that they have.​

Confabulations After a Brain Injury

​Confabulation is especially common after brain injuries, as well as surgeries that affect the brain (Kopelman, 2010; Metcalf et al., 2007; Schnider, 2003). Most of the case studies on confabulation have looked at people with brain injuries, as scientists have wanted to see if the particular characteristics of each brain injury can help explain more of how confabulations work.

How to Deal With Confabulations

You are probably more likely to be around other people who confabulate than to do so yourself. If somebody seems to be confabulating, try to take the pressure off them to remember everything right, since experimental research suggests that even people without brain damage or a psychiatric disorder can be manipulated into endorsing false memories (Kassin & Kiechel, 1996).
 
Confabulation is not limited to adults – people of all ages, with developmental disabilities as well as neurodegenerative conditions, can engage in this behavior. If you would like to know more about how to support people who are confabulating, I recommend watching this video:

Video: Confabulation: When Lying Isn’t Lying

Articles Related to Confabulations

​Want to learn more? Check out these articles:

Books Related to Confabulations

If you’d like to keep learning more, here are a few books that you might be interested in.

Final Thoughts on Confabulations​

People who are confabulating are not doing so to manipulate others. They are unintentionally and without awareness misremembering something from their past (Bajo et al., 2017). People who confabulate may take actions as a result of their inaccurate remembering that make their lives worse, and the people in their lives often have a difficult time supporting them through these times. If you spend time with people who are confabulating, I hope you can be considerate of their situation. They are well-meaning and trying their best; they usually think they are remembering just as well as everyone else.​

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