Confabulation can be described as a type of memory disorder where the person communicates false information which they believe to be true. Confabulation may occur following Acquired Brain Injury, particularly in the context of significant memory impairment. It’s likely that the person who confabulates will also have other cognitive impairments.
Confabulation may also be observed in the context of dementia, alcohol related brain damage and neurodegenerative brain disorders. Confabulation occurs when gaps in the person’s memory are unwittingly filled by information which is fabricated, distorted or reflects their misinterpretation of events. Confabulation may range from small memory errors to the creation of elaborately detailed inaccurate memories.
When communicating confabulatory information, the person:
Is not attempting to deceive; rather they believe they are communicating accurate information, meaningful to them.- Has no awareness that the information they communicate is inaccurate.
- Is unconcerned by contradictory ‘evidence’ about events or if errors in the account are pointed out.
- May communicate information which sounds improbable, outlandish or bizarre however they seem unaware of the unlikely nature of this.
- May mix up past memories with their recent experience.
- May make confabulatory errors of either semantic or episodic memory.
- May produce repetitive confabulations.
- Can be extremely convincing to the extent that others are persuaded that these confabulatory memories are real.
Confabulation may be:
- Provoked e.g. when the person is responding to questions, commenting on a topic of conversation or responding to events in the environment.
- Spontaneous e.g. information given by the person without any obvious prompting or questioning.
The person who confabulates does not do this all the time; much of the information they give may be accurate. It may therefore be difficult to determine between accurate and confabulatory information; the person may convey both accurate and confabulatory information even within the same sentence. The person sees no difference between real and confabulatory memories.
It is important not to confuse confabulatory content of communication with:
- Errors due to receptive and/or expressive language processing.
- Delusional ideas associated with psychosis. Delusions are commonly defined as false beliefs where confabulation is typically described as a false/distorted memory.
Helpful hints to try and discriminate confabulatory information from accurate memories:
- Learn as much as possible about their autobiographical history (e.g. from family, friends, carers).
- Seek clarification regarding the accuracy of events communicated by the person from others present at the time.
- Avoid becoming upset/irritated by repeated confabulatory information being unwittingly communicated by the person.
- Aim to provide the person with an accurate accounts of events if possible, however, if the person does not accept this, play down and distract from the topic. Repeatedly discussing the confabulatory memories with the person may unwittingly strengthen/reinforce their belief that these are real.
- At times, depending on the nature of the inaccurate memory, accepting the person’s account of their reality and not trying to correct them may be helpful and reduce distress.
Recognise that, on occasion, false information may knowingly be provided (e.g. to meet a need, avoid conflict); this would not be described as confabulation.- Record daily events in order to support memory. Use of a diary, tablet device etc may be helpful.
