What is confabulation?

Confabulation is a symptom of various memory disorders in which made-up stories fill in any gaps in memory.

German psychiatrist Karl Bonhoeffer coined the term “confabulation” in 1900. He used it to describe when a person gives false answers or answers that sound fantastical or made up.

While this condition may at first sound like lying, confabulation only occurs when you have a condition that affects your memory. This is why confabulation is often described as “honestly lying.”

Someone with confabulation has memory loss that affects their higher reasoning. They subconsciously create stories as a way to conceal their memory loss. They aren’t aware that they aren’t telling the truth. They don’t have any doubt about the things they are saying, even if those around them know the story is untrue.

Sometimes a person with confabulation will only make up small stories to fill gaps in their memory. Doctors call these “confabulations of embarrassment.” Others may tell elaborate stories, which is known as “fantastic confabulation.”

Confabulation isn’t a disorder itself. It’s a symptom of an underlying disorder. Doctors are still working to define confabulation and their understanding of the brain changes that cause it to occur.

What causes confabulation?

A variety of conditions can result in confabulation. These include memory disorders, injuries, and mental health disorders. As a result, doctors haven’t identified a specific cause. They do know that most people who have symptoms of confabulation usually have damage in two areas of the brain: the frontal lobes and the corpus callosum. The frontal lobe is known for its role in memory.

Examples of conditions that can cause confabulation include:

Young children may also engage in confabulation.

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Confabulation examples

According to the Massachusetts Institute of Technology, there are two key components of confabulation. The first is when a person creates a false response. For example, someone could ask them, “Where’s the best place you’ve ever visited?” They may respond with a story about a trip to Antarctica, including details, even if they haven’t ever been to the continent. The second is when they don’t think further about what they’re saying and go on believing it without a second thought. This is very different from a person who is telling a lie with knowledge of their lie.

A person who doesn’t have a condition that affects their memory or thought process will often say “I don’t know” when asked a question they can’t recall or don’t know the answer to. A person with memory loss or affected brain may instead subconsciously create a story to fill in answers they can’t think of.

Sometimes confabulation isn’t a wildly elaborate story, but instead is a smaller story. Examples of this include:

  • making up an answer on how they got a cut or bruise
  • telling a story about what they did over the weekend, even though they didn’t engage in that activity

Confabulation treatment

Treatment usually focuses on addressing the underlying disorder to help reduce confabulation. There are also psychotherapy techniques that may help to correct the symptom. An example is cognitive rehabilitation, in which you “relearn” cognitive skills. This could include learning to question the things someone is saying and consider answering “I’m not sure” or “I don’t know” instead of confabulating. Other techniques include:

  • keeping a diary
  • having a family member re-orient someone with confabulation to their surroundings

If you have a loved one who is prone to confabulation, you may want to talk to their doctor or a therapist about the best way to treat it.