Confabulation

Verbal confabulations, spoken false memories are

more common, and

In psychiatry, confabulation (verb: confabulate) is a

disturbance of memory, dened as the production of
fabricated, distorted or misinterpreted memories about
oneself or the world, without the conscious intention
to deceive.[1] Individuals who confabulate present incorrect memories ranging from subtle alterations to bizarre
fabrications,[2] and are generally very condent about
their recollections, despite contradictory evidence.[3]

Behavioral confabulations, occur when an individual acts on their false memories.

2 Signs and symptoms

Confabulation is associated with several characteristics:

Description

1. Typically verbal statements but can also be nonverbal gestures or actions.

Confabulation is distinguished from lying as there is no

intent to deceive and the person is unaware the information is false.[4] Although individuals can present blatantly
false information, confabulation can also seem to be coherent, internally consistent, and relatively normal.[4]

2. Can include autobiographical and non-personal information, such as historical facts, fairy-tales, or
other aspects of semantic memory.

Most known cases of confabulation are symptomatic

of brain damage or dementias, such as aneurysm,
Alzheimers disease, or WernickeKorsako syndrome
(a common manifestation of thiamine deciency caused
by alcoholism).[5] Additionally confabulation often occurs in people who are suering from anticholinergic
toxidrome when interrogated about bizarre or irrational
behaviour.[6][7]

3. The account can be fantastic or coherent.

4. Both the premise and the details of the account can
be false.
5. The account is usually drawn from the patients
memory of actual experiences, including past and
current thoughts.

Confabulated memories of all types most often occur

in autobiographical memory, and are indicative of a
complicated and intricate process that can be led astray
at any point during encoding, storage, or recall of a
memory.[3] This type of confabulation is commonly seen
in Korsakos syndrome.[8]

1.1

6. The patient is unaware of the accounts distortions or

inappropriateness, and is not concerned when errors
are pointed out.
7. There is no hidden motivation behind the account.
8. The patients personality structure may play a role in
their readiness to confabulate. [4]

Distinctions

Two types of confabulation are often distinguished:

Provoked (momentary, or secondary) confabula- 3 Theories
tions represent a normal response to a faulty memory, are common in both amnesia and dementia,[9]
Theories of confabulation range in emphasis. Some
and can become apparent during memory tests.[10]
theories propose that confabulations represent a way
Spontaneous (or primary) confabulations do not for memory-disabled individuals to maintain their selfoccur in response to a cue[10] and seem to be identity.[10] Other theories use neurocognitive links to exinvoluntary.[11] They are relatively rare, more com- plain the process of confabulation.[12] Still other theomon in cases of dementia, and may result from the ries frame confabulation around the more familiar coninteraction between frontal lobe pathology and or- cept of delusion.[13] Other researchers frame confabulation within the fuzzy-trace theory.[14] Finally, some reganic amnesia.[9]
searchers call for theories that rely less on neurocognitive
Another distinction is that between:[11]
explanations and more on epistemic accounts.[15]
1

3.1

Neuropsychological theories

The most popular theories of confabulation come

from the eld of neuropsychology or cognitive
neuroscience.[12] Research suggests that confabulation is associated with dysfunction of cognitive processes
that control the retrieval from long-term memory.
Frontal lobe damage often disrupts this process, preventing the retrieval of information and the evaluation
of its output.[16][17] Furthermore, researchers argue
that confabulation is a disorder resulting from failed
reality monitoring/source monitoring (i.e. deciding
whether a memory is based on an actual event or whether
it is imagined.[18] Some neuropsychologists suggest
that errors in retrieval of information from long-term
memory that are made by normal subjects involve
dierent components of control processes than errors
made by confabulators.[19] Kraepelin distinguished
two subtypes of confabulation, one of which he called
simple confabulation, caused partly by errors in the
temporal ordering of real events. The other variety he
called fantastic confabulation, which was bizarre and
patently impossible statements not rooted in true memory. Simple confabulation may result from damage to
memory systems in the medial temporal lobe. Fantastic
confabulations reveal a dysfunction of the Supervisory
System,[20] which is believed to be a function of the
frontal cortex.

3.2

Self-identity theory

Some argue confabulations have a self-serving, emotional

component in those with memory decits that aids to
maintain a coherent self-concept.[10] In other words, individuals who confabulate are motivated to do so, because
they have gaps in their memory that they want to ll in
and cover up.

3.3

Temporality theory

Support for the temporality account suggests that confabulations occur when an individual is unable to place
events properly in time.[10] Thus, an individual might correctly state an action they performed, but say they did it
yesterday, when they did it weeks ago. In the Memory,
Consciousness, and Temporality Theory, confabulation
occurs because of a decit in temporal consciousness or
awareness.[21]

3.4

Monitoring theory

Along a similar notion are the theories of reality and

source monitoring theories.[11] In these theories, confabulation occurs when individuals incorrectly attribute memories as reality, or incorrectly attribute memories to a certain source. Thus, an individual might claim an imagined

THEORIES

event happened in reality, or that their friend told them

about an event, they actually heard about on television.

3.5 Strategic retrieval account theory

Supporters of the strategic retrieval account suggest that
confabulations occur when an individual cannot actively
monitor a memory for truthfulness after its retrieval.[11]
An individual recalls a memory, but there is some decit
after recall that interferes with the person establishing its
falseness.

3.6 Executive control theory

Still others propose that all types of false memories, including confabulation, t into a general memory and executive function model.[22] In 2007, a framework for confabulation was proposed that stated confabulation is the
result of two things: Problems with executive control and
problems with evaluation. In the executive control decit,
the incorrect memory is retrieved from the brain. In the
evaluative decit, the memory will be accepted as a truth
due to an inability to distinguish a belief from an actual
memory.[10]

3.7 In the context of delusion theories

Recent models of confabulation have attempted to build
upon the link between delusion and confabulation.[13]
More recently, a monitoring account for delusion, applied to confabulation, proposed both the inclusion of
conscious and unconscious processing. The claim was
that by encompassing the notion of both processes, spontaneous versus provoked confabulations could be better
explained. In other words, there are two ways to confabulate. One is the unconscious, spontaneous way in which
a memory goes through no logical, explanatory processing. The other is the conscious, provoked way in which a
memory is recalled intentionally by the individual to explain something confusing or unusual.[23]

3.8 Fuzzy-trace theory

Fuzzy-trace theory, or FTT, is a concept more commonly
applied to the explanation of judgement decisions.[14] According to this theory, memories are encoded generally
(gist), as well as specically (verbatim). Thus, a confabulation could result from recalling the incorrect verbatim
memory or from being able to recall the gist portion, but
not the verbatim portion, of a memory.
FTT uses a set of ve principles to explain false-memory
phenomena. Principle 1 suggests that subjects store verbatim information and gist information parallel to one another. Both forms of storage involve the surface content
of an experience. Principle 2 shares factors of retrieval

4.2

Location of brain lesions

of gist and verbatim traces. Principle 3 is based on dualopponent processes in false memory. Generally, gist retrieval supports false memory, while verbatim retrieval
suppresses it. Developmental variability is the topic of
Principle 4. As a child develops into an adult, there is
obvious improvement in the acquisition, retention, and
retrieval of both verbatim and gist memory. However,
during late adulthood, there will be a decline in these abilities. Finally, Principle 5 explains that verbatim and gist
processing cause vivid remembering. Fuzzy-trace Theory, governed by these 5 principles, has proved useful in
explaining false memory and generating new predictions
about it.[24]

3.9

Epistemic theory

However, not all accounts are so embedded in the neurocognitive aspects of confabulation. Some attribute confabulation to epistemic accounts.[15] In 2009, theories underlying the causation and mechanisms for confabulation
were criticized for their focus on neural processes, which
are somewhat unclear, as well as their emphasis on the
negativity of false remembering. Researchers proposed
that an epistemic account of confabulation would be more
encompassing of both the advantages and disadvantages
of the process.

4
4.1

Presentation
Associated neurological and psychological conditions

Confabulations are often symptoms of various syndromes and psychopathologies in the adult population
including: Korsakos syndrome, Alzheimers Disease,
Schizophrenia, and traumatic brain injury.

3
the advanced stages of the disease. Alzheimers patients
demonstrate comparable abilities to encode information
as healthy elderly adults, suggesting that impairments in
encoding are not associated with confabulation.[29] However, as seen in Korsakos patients, confabulation in
Alzheimers patients is higher when prompted with questions investigating episodic memory. Researchers suggest this is due to damage in the posterior cortical regions of the brain, which is a symptom characteristic of
Alzheimers Disease.
Schizophrenia is a psychological disorder in which confabulation is sometimes observed. Although confabulation is usually coherent in its presentation, confabulations of schizophrenic patients are often delusional[30]
Researchers have noted that these patients tend to make
up delusions on the spot which are often fantastic and
become increasingly elaborate with questioning.[31] Unlike patients with Korsakos and Alzheimers, patients
with schizophrenia are more likely to confabulate when
prompted with questions regarding their semantic memories, as opposed to episodic memory prompting.[32] In
addition, confabulation does not appear to be related to
any memory decit in schizophrenic patients. This is contrary to most forms of confabulation. Also, confabulations made by schizophrenic patients often do not involve
the creation of new information, but instead involve an attempt by the patient to reconstruct actual details of a past
event.
Traumatic brain injury (TBI) can also result in confabulation. Research has shown that patients with damage to
the inferior medial frontal lobe confabulate signicantly
more than patients with damage to the posterior area and
healthy controls.[33] This suggests that this region is key
in producing confabulatory responses, and that memory
decit is important but not necessary in confabulation.
Additionally, research suggests that confabulation can be
seen in patients with frontal lobe syndrome, which involves an insult to the frontal lobe as a result of disease
or traumatic brain injury (TBI).[34][35][36] Finally, rupture
of the anterior or posterior communicating artery, subarachnoid hemorrhage, and encephalitis are also possible
causes of confabulation.[16][37]

WernickeKorsako syndrome is a neurological disorder

typically characterized by years of chronic alcohol abuse
and a nutritional thiamine deciency.[25] Confabulation is
one salient symptom of this syndrome.[26][27] A study on
confabulation in Korsakos patients found that they are
subject to provoked confabulation when prompted with
questions pertaining to episodic memory, not semantic
memory, and when prompted with questions where the
appropriate response would be I dont know.[28] This
suggests that confabulation in these patients is domainspecic. Korsakos patients who confabulate are more 4.2 Location of brain lesions
likely than healthy adults to falsely recognize distractor
words, suggesting that false recognition is a confabula- Confabulation is believed to be a result of damage to the
tory behavior.
right frontal lobe of the brain.[4] In particular, damage
Alzheimers Disease is a condition with both neurologi- can be localized to the ventromedial frontal lobes and
cal and psychological components. It is a form of demen- other structures fed by the anterior communicating artery
tia associated with severe frontal lobe dysfunction. Con- (ACoA), including the basal forebrain, septum, fornix,
fabulation in individuals with Alzheimers is often more cingulate gyrus, cingulum, anterior hypothalamus, and
spontaneous than it is in other conditions, especially in head of the caudate nucleus.[38][39]

4.3

Developmental dierences

While some recent literature has suggested that older

adults may be more susceptible than their younger counterparts to have false memories, the majority of research
on forced confabulation centers around children.[40] Children are particularly susceptible to forced confabulations
based on their high suggestibility.[41][42] When forced to
recall confabulated events, children are less likely to remember that they had previously confabulated these situations, and they are more likely than their adult counterparts to come to remember these confabulations as
real events that transpired.[43] Research suggests that this
inability to distinguish between past confabulatory and
real events is centered on developmental dierences in
source monitoring. Due to underdeveloped encoding
and critical reasoning skills, childrens ability to distinguish real memories from false memories may be impaired. It may also be that younger children lack the
meta-memory processes required to remember confabulated versus non-confabulated events.[44] Childrens metamemory processes may also be inuenced by expectancies or biases, in that they believe that highly plausible
false scenarios are not confabulated.[45] However, when
knowingly being tested for accuracy, children are more
likely to respond, I dont know at a rate comparable to adults for unanswerable questions than they are
to confabulate.[46][47] Ultimately, misinformation eects
can be minimized by tailoring individual interviews to the
specic developmental stage, often based on age, of the
participant.[48]

DIAGNOSIS AND TREATMENT

tion as true when they are interviewed at a later time (after the event in question) than those who are interviewed
immediately or soon after the event.[53] Armative feedback for confabulated responses is also shown to increase
the confabulators condence in their response.[54] For instance, in culprit identication, if a witness falsely identies a member of a line-up, he will be more condent in
his identication if the interviewer provides armative
feedback. This eect of conrmatory feedback appears
to last over time, as witnesses will even remember the
confabulated information months later.[55]

4.6 Among normal subjects

On rare occasions, confabulation can also be seen in normal subjects.[19] It is currently unclear how completely
healthy individuals produce confabulations. It is possible that these individuals are in the process of developing
some type of organic condition that is causing their confabulation symptoms. It is not uncommon, however, for
the general population to display some very mild symptoms of provoked confabulations. Subtle distortions and
intrusions in memory are commonly produced by normal
subjects when they remember something poorly.

5 Diagnosis and treatment

Spontaneous confabulations, due to their involuntary nature, cannot be manipulated in a laboratory setting.[11]
However, provoked confabulations can be researched in
various theoretical contexts. The mechanisms found to
4.4 Provoked versus spontaneous confabu- underlie provoked confabulations can be applied to sponlations
taneous confabulation mechanisms. The basic premise
of researching confabulation comprises nding errors and
There is evidence to support dierent cognitive mech- distortions in memory tests of an individual.
anisms for provoked and spontaneous confabulation.[49]
One study suggested that spontaneous confabulation may
be a result of an amnesic patients inability to distin- 5.1 DeeseRoedigerMcDermott lists
guish the chronological order of events in his memory.
In contrast, provoked confabulation may be a compen- Confabulations can be detected in the context of the
satory mechanism, in which the patient tries to make up DeeseRoedigerMcDermott paradigm by using the
for his memory deciency by attempting to demonstrate DeeseRoedigerMcDermott lists.[56] Participants listen
competency in recollection.
to audio recordings of several lists of words centered
around a theme, known as the critical word. The participants are later asked to recall the words on their list. If
4.5 Condence in false memories
the participant recalls the critical word, which was never
explicitly stated in the list, it is considered a confabulaConfabulation of events or situations may lead to an tion. Participants often have a false memory for the criteventual acceptance of the confabulated information as ical word.
true.[50] For instance, people who knowingly lie about a
situation may eventually come to believe that their lies
are truthful with time.[51] In an interview setting, peo- 5.2 Recognition tasks
ple are more likely to confabulate in situations in which
they are presented false information by another person, as Confabulations can also be researched by using continopposed to when they self-generate these falsehoods.[52] uous recognition tasks.[11] These tasks are often used
Further, people are more likely to accept false informa- in conjunction with condence ratings. Generally, in a

5
recognition task, participants are rapidly presented with
pictures. Some of these pictures are shown once; others are shown multiple times. Participants press a key if
they have seen the picture previously. Following a period
of time, participants repeat the task. More errors on the
second task, versus the rst, are indicative of confusion,
representing false memories.

5.3

Free recall tasks

Confabulations can also be detected using a free recall

task, such as a self-narrative task.[11] Participants are
asked to recall stories (semantic or autobiographical) that
are highly familiar to them. The stories recalled are encoded for errors that could be classied as distortions in
memory. Distortions could include falsifying true story
elements or including details from a completely dierent
story. Errors such as these would be indicative of confabulations.

5.4

Treatment

Treatment for confabulation is somewhat dependent on

the cause or source, if identiable. For example, treatment of WernickeKorsako syndrome involves large
doses of vitamin B in order to reverse the thiamine
deciency.[57] If there is no known physiological cause,
more general cognitive techniques may be used to treat
confabulation. A case study published in 2000 showed
that Self-Monitoring Training (SMT)[58] reduced delusional confabulations. Furthermore, improvements were
maintained at a three-month follow-up and were found to
generalize to everyday settings. Although this treatment
seems promising, more rigorous research is necessary to
determine the ecacy of SMT in the general confabulation population.

delusions and confabulation. They question whether delusions and confabulation should be considered distinct or
overlapping disorders and, if overlapping, to what degree? They also discuss the role of unconscious processes
in confabulation. Some researchers suggest that unconscious emotional and motivational processes are potentially just as important as cognitive and memory problems. Finally, they raise the question of where to draw
the line between the pathological and the nonpathological. Delusion-like beliefs and confabulation-like fabrications are commonly seen in healthy individuals. What are
the important dierences between patients with similar
etiology who do and do not confabulate? Since the line
between pathological and nonpathological is likely blurry,
should we take a more dimensional approach to confabulation? Research suggests that confabulation occurs along
a continuum of implausibility, bizarreness, content, conviction, preoccupation, and distress, and impact on daily
life.[60]

7 Notable examples
7.1 Mandela eect
An internet meme related to confabulation is known as
the Mandela eect. This is a situation where a number
of people have memories that are dierent from available evidence. The term was coined by paranormal enthusiast Fiona Broome, who says she and other people
remember Nelson Mandela dying in the 1980s, rather
than in 2013.[61][62] She argues that common memories
which appear mistaken could be explained by the existence of parallel universes that are able to interact with
each other.[63]
A common thread of discussion regarding this eect
is misremembering the Berenstain Bears being spelled as
Berenstein Bears.[64]

Research

Although signicant gains have been made in the understanding of confabulation within recent years, there is still
much to be learned. One group of researchers in particular has laid out several important questions for future
study. They suggest that more information is necessary
regarding the neural systems that support the dierent
cognitive processes needed for normal source monitoring.
They also proposed the idea of developing a standard neuropsychological test battery that is able to discriminate
between the dierent types of confabulations. Furthermore, there is a considerable amount of debate regarding the best way to organize and combine neuroimaging,
pharmacological, and cognitive/behavioral approaches to
understand confabulation.[59]
In a recent review article, another group of researchers
contemplate issues concerning the distinctions between

8 See also
Confabulation (neural networks)
Anosognosia
Cryptomnesia
Misinformation eect
Hindsight Bias
Revelation

9 References
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[46] Roebers, Claudia; Fernandez, Olivia (2002). The Eects
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(1992). Memory disturbances following anterior communicating artery rupture. Annals of Neurology. 31 (5):
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mixed eects of lying on memory. Applied Cognitive
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Forced confabulation more strongly inuences event
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10 FURTHER READING

10 Further reading
Hirstein, William (2005), Brain Fiction: Selfdeception and the riddle of confabulation, Cambridge, Massachusetts: MIT Press, ISBN 0-26208338-8, retrieved 21 March 2012
Sacks, Oliver (1985), The Man Who Mistook His
Wife for a Hat, New York: Perennial Library, ISBN
0-06-097079-0

[55] Zaragoza, M. S.; Payment, K. E.; Ackil, J. K.; Drivdahl,

S. B.; Beck, M. (2001). Interviewing Witnesses: Forced
Confabulation and Conrmatory Feedback Increase False
Memories. Psychological Science. 12 (6): 473477.
doi:10.1111/1467-9280.00388. PMID 11760134.
[56] Howe, Mark L.; Cicchetti, Dante; Toth, Sheree L.;
Cerrito, Beth M. (1 September 2004). True and
False Memories in Maltreated Children. Child Development. 75 (5): 14021417. doi:10.1111/j.14678624.2004.00748.x. PMID 15369522.
[57] Spiegel, D. R.; Lim, K. J. (2011). A Case of Probable
Korsakos Syndrome: A Syndrome of Frontal Lobe and
Diencephalic Structural Pathogenesis and a Comparison
with Medial Temporal Lobe Dementias. Innovations in
Clinical Neuroscience. 8 (6): 1519. PMC 3140893 .
PMID 21779537.
[58] Dayus, B.; Van Den Broek, M.D. (2000). Treatment
of stable delusional confabulations using self-monitoring
training. Neuropsychological Rehabilitation. 10 (4):
415427. doi:10.1080/096020100411998.
[59] Johnson, M; Raye, C. L. (1998). False memories and
confabulation. Trends in Cognitive Sciences. 2 (4):
137145. doi:10.1016/S1364-6613(98)01152-8. PMID
21227110.
[60] Langdon, R.; Turner, M (2010), Delusion and confabulation: Overlapping or distinct distortions in reality?", Cognitive Neuropsychiatry, 15 (1): 113,
doi:10.1080/13546800903519095, PMID 20043251
[61] Shermer, Michael (2015-09-20). The Mandela Effect"". Skeptic. Retrieved 2016-06-28.
[62] Crollard, Joe (2014-08-30).
NewsVine http:
//joecrollard.newsvine.com/_news/2014/08/30/
25732689-the-berenstain-bears-nelson-mandela-and-how-we-may-have-slipped-into-an-alternate-time-stream.
Retrieved 2016-06-28. Missing or empty |title= (help)
[63] Lamoureux, Mack (August 11, 2015).
The
Berenst(E)ain Bears Conspiracy Theory That Has
Convinced the Internet There Are Parallel Universes.
Vice News. Retrieved June 28, 2016.
[64] Smith, Russell (August 14, 2015). Berenstain Bears debate is a case of Schrodingers nostalgia. The Globe and
Mail. Retrieved June 28, 2016.

11
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