View source for Confabulation

'''Confabulation''' is a [[Memory error|memory error]] consisting of the production of fabricated, distorted, or misinterpreted memories about oneself or the world. It is generally associated with certain types of brain damage (especially [[Medicine:Aneurysm|aneurysm]] in the anterior communicating artery) or a specific subset of [[Medicine:Dementia|dementia]]s.<ref>Berrios G E (1998) Confabulations: A Conceptual History. ''Journal of the History of the Neurosciences''. 7: 225-241.</ref> While still an area of ongoing research, the [[Biology:Basal forebrain|basal forebrain]] is implicated in the phenomenon of confabulation. People who confabulate present with incorrect memories ranging from subtle inaccuracies to surreal fabrications, and may include confusion or distortion in the temporal framing (timing, sequence or duration) of memories.<ref>{{cite web| url=http://www.memorylossonline.com/pastissues/summer2000/confabulation.html| title=The truth about confabulation| last=Pendick| first=Daniel| publisher=Rutgers University-Newark| date=Summer 2000| work=Memory Loss & the Brain: Newsletter of the Memory Disorders Project| access-date=7 April 2022| archive-url=https://web.archive.org/web/20130103034502/http://www.memorylossonline.com/pastissues/summer2000/confabulation.html| archive-date=3 January 2013| url-status=dead}}</ref> In general, they are very confident about their recollections, even when challenged with contradictory evidence.<ref name=book>{{cite book| editor-last=Nalbantian| editor-first=Suzanne| title=The memory process: neuroscientific and humanistic perspectives| date=2010| publisher=MIT Press| location=Cambridge, Massachusetts| isbn=978-0-262-01457-1| last1=Matthews| first1=Paul M.| last2=McClelland| first2=James L.}}</ref>

Confabulation occurs when individuals mistakenly recall false information, without intending to deceive. Brain damage, dementia, and anticholinergic toxidrome can cause this distortion. Two types of confabulation exist: provoked and spontaneous, with two distinctions: verbal and behavioral. Verbal statements, false information, and the patient's unawareness of the distortion are all associated with this phenomenon. Personality structure also plays a role in confabulation.

Numerous theories have been developed to explain confabulation. {{shy|Neuro|psycho|log|i|cal}} theories suggest that cognitive dysfunction causes the distortion. Self-identity theories posit that people confabulate to preserve themselves. The temporality theory believes that confabulation occurs when an individual cannot place events properly in time. The monitoring and strategic retrieval account theories argue that confabulation arises when individuals cannot recall memories correctly or monitor them after retrieval. The executive control and [[Fuzzy-trace theory|fuzzy-trace theories]] also attempt to explain why confabulation happens.

Confabulation can occur with nervous system injuries or illnesses, including [[Medicine:Korsakoff syndrome|Korsakoff's syndrome]], Alzheimer's disease, [[Medicine:Schizophrenia|schizophrenia]], and traumatic brain injury. It is believed that the right [[Biology:Frontal lobe|frontal lobe]] of the brain is damaged, causing false memories. Children are especially susceptible to forced confabulation as they are highly impressionable. Feedback can increase confidence in false memories. In rare cases, confabulation occurs in ordinary individuals.

Different memory tests, including recognition tasks and free recall tasks, can be used to study confabulation. Treatment depends on the underlying cause of the distortion. Ongoing research aims to develop a standard test battery to discern between different types of confabulations, distinguish [[Medicine:Delusion|delusions]] from confabulations, understand the role of unconscious processes, and identify pathological and nonpathological confabulations.

== Description ==

Confabulation was originally defined as "the emergence of memories of events and experiences which never took place".<ref>{{cite book |last1=Wernicke |first1=Carl |title=Grundriss der Psychiatrie in klinischen Vorlesungen |date=1900 |publisher=Thieme |location=Leipzig |page=139}}</ref><ref name="The Confabulating Mind">{{cite book |last1=Schnider |first1=Armin |title=The Confabulating Mind. How the brain creates reality. 2nd edition. |date=2018 |publisher=Oxford University Press |location=Oxford, New York |isbn=9780198789680 |url=https://global.oup.com/academic/product/the-confabulating-mind-9780198789680?cc=ch&lang=en&}}</ref>

Confabulation is distinguished from lying as there is no intent to deceive and the person is unaware the information is false.<ref name="Moscovitch">Moscovitch M. 1995. "Confabulation". In (Eds. Schacter D.L., Coyle J.T., Fischbach G.D., Mesulum M.M. & Sullivan L.G.), ''Memory Distortion''. pp. 226–51. Cambridge, Massachusetts: Harvard University Press.</ref> Although individuals can present blatantly false information, confabulation can also seem to be coherent, internally consistent, and relatively normal.<ref name="Moscovitch" />

Most known cases of confabulation are symptomatic of brain damage or dementias, such as [[Medicine:Aneurysm|aneurysm]], [[Medicine:Alzheimer's disease|Alzheimer's disease]], or [[Medicine:Wernicke–Korsakoff syndrome|Wernicke–Korsakoff syndrome]] (a common manifestation of [[Physics:Thiamine|thiamine]] deficiency caused by alcohol use disorder).<ref>{{cite journal |pmid=23887463 | volume=113 | issue=6 Pt 2 | title=[Wernicke encephalopathy and Korsakoff's psychosis: clinical-pathophysiological correlation, diagnostics and treatment] | year=2013 | journal=Zh Nevrol Psikhiatr Im S S Korsakova | pages=20–26 | author = Sivolap IuP Damulin IV}}</ref> Additionally confabulation often occurs in people with anticholinergic [[Chemistry:Toxidrome|toxidrome]] when interrogated about bizarre or irrational behaviour.

Confabulated memories of all types most often occur in [[Biology:Autobiographical memory|autobiographical memory]] and are indicative of a complicated and intricate process that can be led astray at any point during [[Biology:Encoding (memory)|encoding]], [[Biology:Storage (memory)|storage]], or [[Biology:Recall (memory)|recall]] of a memory.<ref name=book/> This type of confabulation is commonly seen in Korsakoff's syndrome.<ref>{{cite journal|title=The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment|journal=Alcohol and Alcoholism |volume=44|issue=2|pages=148–54|doi=10.1093/alcalc/agn118|pmid=19151162 |year=2009|last1=Kopelman |first1=M. D. |last2=Thomson |first2=A. D. |last3=Guerrini |first3=I |last4=Marshall |first4=E. J. |doi-access=free }}</ref>

=== Distinctions ===
Several forms of confabulation have been distinguished which vary in terms of behaviour, mechanism, and location of brain damage.<ref name= "Forms of confabulation" >{{cite journal |last1=Nahum |first1=L |last2=Bouzerda-Wahlen |first2=A |last3=Guggisberg |first3=A |last4=Ptak |first4=R |last5=Schnider |first5=A |title=Forms of confabulation: dissociations and associations. |journal=Neuropsychologia |date=2012 |volume=50 |issue=10 |pages=2524–34 |doi=10.1016/j.neuropsychologia.2012.06.026 |pmid=22781813|url=https://archive-ouverte.unige.ch/unige:31478 }}</ref> The most common distinction is between the following two types:
* '''Provoked''' confabulations represent a normal response to a faulty memory, are common in both amnesia and dementia,<ref name="ReferenceA"/> and can become apparent during memory tests.<ref name="models of confabulation" />
* '''Spontaneous''' confabulations do not occur in response to a cue<ref name="models of confabulation" /> and seem to be involuntary.<ref name="mechanisms of spontaneous confabulation">{{cite journal|last=Gilboa|first=A.|title=Mechanisms of spontaneous confabulations: a strategic retrieval account|journal=Brain|date=13 April 2006|volume=129|issue=6|pages=1399–1414|doi=10.1093/brain/awl093|pmid=16638795|doi-access=free}}</ref> They are relatively rare, more common in cases of dementia, and may result from the interaction between frontal lobe pathology and organic amnesia.<ref name="ReferenceA">{{cite journal|pmid=3694207|pmc=1032561|year=1987|last1=Kopelman|first1=M. D.|title=Two types of confabulation|journal=Journal of Neurology, Neurosurgery, and Psychiatry|volume=50|issue=11|pages=1482–87|doi=10.1136/jnnp.50.11.1482}}</ref> A subgroup of patients at least occasionally act according to their confabulations betraying a confusion of current reality.<ref>{{cite journal |last1=Schnider |first1=A |last2=von Däniken |first2=C |last3=Gutbrod |first3=K |title=The mechanisms of spontaneous and provoked confabulations. |journal=Brain|date=1996 |volume=119 ( Pt 4) |issue=4 |pages=1365–75 |doi=10.1093/brain/119.4.1365 |pmid=8813298}}</ref><ref>{{cite journal |last1=Schnider |first1=A |last2=Ptak |first2=R |title=Spontaneous confabulators fail to suppress currently irrelevant memory traces. |journal=Nature Neuroscience |date=1999 |volume=2 |issue=7 |pages=677–81 |doi=10.1038/10236 |pmid=10404203}}</ref> These patients are always disoriented about their current role, location, and time. This form has been called '''behaviorally spontaneous confabulation'''.<ref name="Forms of confabulation" /><ref name="The Confabulating Mind" /> It is strongly associated with damage, disconnection, or dysfunction of the posterior medial [[Biology:Orbitofrontal cortex|orbitofrontal cortex]] (area 13)<ref name="Nature Reviews" >{{cite journal |last1=Schnider |first1=A |title=Spontaneous confabulation and the adaptation of thought to ongoing reality. |journal=Nature Reviews Neuroscience |date=2003 |volume=4 |issue=8 |pages=662–71 |doi=10.1038/nrn1179 |pmid=12894241}}</ref> and appears to have a specific mechanism: a failure of "orbitofrontal reality filtering", a preconscious mechanism normally verifying whether an upcoming thought refers to current reality or not.<ref>{{cite journal |last1=Schnider |first1=A |title=Orbitofrontal reality filtering. |journal=Frontiers in Behavioral Neuroscience |date=2013 |volume=7 |pages=67 |doi=10.3389/fnbeh.2013.00067 |doi-access=free |pmid=23772208|pmc=3677127 }}</ref><ref name="The Confabulating Mind" />

== Signs and symptoms ==
Confabulation is associated with several characteristics:
# False verbal statements that may include autobiographical and non-personal information, such as historical facts, [[Social:Fairy tale|fairy-tales]], or other aspects of semantic memory.
# The account is normally coherent and is usually drawn from the patient's memory of actual experiences. Very rarely, it is fantastic.
# Both the premise and the details of the account can be false.
# The patient is unaware of the accounts' distortions or inappropriateness, and is not concerned when errors are pointed out.
# There is no hidden [[Philosophy:Motivation|motivation]] behind the account.
# The patient's personality structure may play a role in their readiness to confabulate.<ref name="Moscovitch" />

==Theories==
Theories of confabulation range in emphasis. Some theories propose that confabulations represent a way for memory-disabled people to maintain their self-identity.<ref name="models of confabulation">{{cite journal|last=Metcalf|first=Kasey |author2=Langdon, Robyn |author3=Coltheart, Max|title=Models of confabulation: A critical review and a new framework|journal=Cognitive Neuropsychology|date=1 February 2007|volume=24|issue=1|pages=23–47|doi=10.1080/02643290600694901|pmid=18416482 |s2cid=45885109 }}</ref> Other theories use neurocognitive links to explain the process of confabulation.<ref name="Spontaneous and Fantastic Review">{{cite journal|last=Glowinski|first=Remy |author2=Payman, Vahid |author3=Frencham, Kate|title=Confabulation: a spontaneous and fantastic review|journal=Australian and New Zealand Journal of Psychiatry|date=2008|volume=42|issue=11|pages=932–40|doi=10.1080/00048670802415335|pmid=18941957 |s2cid=23586700 }}</ref> Still other theories frame confabulation around the more familiar concept of delusion.<ref name="varieties of confabulation and delusion">{{cite journal|last=Kopelman|first=Michael D.|title=Varieties of confabulation and delusion|journal=Cognitive Neuropsychiatry|date=2010|volume=15|issue=1–3|pages=14–37|doi=10.1080/13546800902732830|pmid=19753493|s2cid=19764950}}</ref> Other researchers frame confabulation within the [[Fuzzy-trace theory|fuzzy-trace theory]].<ref name="fuzzy trace theory">{{cite journal|last=Brainerd|first=C.J.|author2=Reyna, V.F.|s2cid=12290995|title=Fuzzy-Trace Theory and Children's False Memories|journal=Journal of Experimental Child Psychology|date=1 November 1998|volume=71|issue=2|pages=81–129|doi=10.1006/jecp.1998.2464|pmid=9843617}}</ref> Finally, some researchers call for theories that rely less on neurocognitive explanations and more on epistemic accounts.<ref name="faultless ignorance">{{cite journal|last=Bortolotti|first=Lisa|author2=Cox, Rochelle E.|title='Faultless' ignorance: Strengths and limitations of epistemic definitions of confabulation|journal=Consciousness and Cognition|date=1 December 2009|volume=18|issue=4|pages=952–65|doi=10.1016/j.concog.2009.08.011|pmid=19773185|s2cid=35121072}}</ref>

===Neuropsychological theories===
The most popular theories of confabulation come from the field of [[Medicine:Neuropsychology|neuropsychology]] or cognitive neuroscience.<ref name="Spontaneous and Fantastic Review"/> Controlled experimental evidence is, however, scarce.<ref name="The Confabulating Mind" /> 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.<ref name=Baddeley1986>{{cite book|doi=10.1017/CBO9780511558313.020|chapter=Amnesia, autobiographical memory, and confabulation|title=Autobiographical Memory|pages=225–52|year=1986|last1=Baddeley|first1=Alan|last2=Wilson|first2=Barbara|isbn=9780511558313|editor-last1= Rubin |editor-first1=David C.|location=Cambridge|publisher=Cambridge University Press}}</ref><ref>{{cite journal |author1=Moscovitch M. |author2=Melo B. | year = 1997 | title = Strategic retrieval and the frontal lobes: evidence from confabulation and amnesia | journal = Neuropsychologia | volume = 35 | issue = 7| pages = 1017–34 | doi=10.1016/s0028-3932(97)00028-6|pmid=9226662 |s2cid=33862514 }}</ref> 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).<ref>Johnson, M.K. (1991). Reality monitoring: Evidence from confabulation in organic brain disease patients. In G.P. Prigatano & D.L. Schacter (Eds.), Awareness of deficit after brain injury. pp. 176–97. New York: Oxford.</ref> Some neuropsychologists suggest that errors in retrieval of information from long-term memory that are made by normal subjects involve different components of control processes than errors made by confabulators.<ref name="Burgess">{{cite journal|pmid=8817460|year=1996|last1=Burgess|first1=P. W.|title=Confabulation and the control of recollection|journal=Memory|volume=4|issue=4|pages=359–411|last2=Shallice|first2=T|doi=10.1080/096582196388906}}</ref> Fantastic confabulations have been attributed to a dysfunction of the Supervisory System,<ref>Norman, D.A., & Shallice, T. (1980). Attention to action. Willed and automatic control of behavior. University of California San Diego CHIP Report 99. Later published as: {{cite book|doi=10.1007/978-1-4757-0629-1_1|chapter=Attention to Action: Willed and Automatic Control of Behavior|title=Consciousness and Self-Regulation|pages=1–18|year=1986|last1=Norman|first1=Donald A.|last2=Shallice|first2=Tim|isbn=978-1-4757-0631-4}}</ref> which is believed to be a function of the frontal cortex.

===Temporality theory===
Support for the temporality account suggests that confabulations occur when an individual is unable to place events properly in time.<ref name="models of confabulation" /> 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 deficit in temporal consciousness or awareness.<ref name="temporal theory">{{cite journal|last=Dalla Barba|first=Gianfranco|author2=Boissé, Marie-Françoise|title=Temporal consciousness and confabulation: Is the medial temporal lobe "temporal"?|journal=Cognitive Neuropsychiatry|date=2010|volume=15|issue=1–3|pages=95–117|doi=10.1080/13546800902758017|pmid=19750399|s2cid=42447646}}</ref>

===Monitoring theory===
Along a similar notion are the theories of reality and source monitoring theories.<ref name="mechanisms of spontaneous confabulation" /> 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 event happened in reality, or that a friend told him/her about an event he/she actually heard about on television.

===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.<ref name="mechanisms of spontaneous confabulation" /> An individual recalls a memory, but there is some deficit after recall that interferes with the person establishing its falseness.

===Executive control theory===
Still others propose that all types of false memories, including confabulation, fit into a general memory and executive function model.<ref name="varieties of false memory">{{cite journal|last=Kopelman|first=Michael D.|title=Varieties of False Memory|journal=Cognitive Neuropsychology|date=1 May 1999|volume=16|issue=3–5|pages=197–214|doi=10.1080/026432999380762}}</ref> 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 deficit, the incorrect memory is retrieved from the brain. In the evaluative deficit, the memory will be accepted as a truth due to an inability to distinguish a belief from an actual memory.<ref name="models of confabulation" />

===In the context of delusion theories===
Recent models of confabulation have attempted to build upon the link between [[Medicine:Delusion|delusion]] and confabulation.<ref name="varieties of confabulation and delusion"/> 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.<ref name="confabulation and delusion">{{cite journal|last=Turner|first=Martha|author2=Coltheart, Max|title=Confabulation and delusion: A common monitoring framework|journal=Cognitive Neuropsychiatry|date=2010|volume=15|issue=1–3|pages=346–76|doi=10.1080/13546800903441902|pmid=20043250|s2cid=205768903}}</ref>

===Fuzzy-trace theory===
[[Fuzzy-trace theory]], or FTT, is a concept more commonly applied to the explanation of judgement decisions.<ref name="fuzzy trace theory" /> According to this theory, memories are encoded generally (gist), as well as specifically (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 five 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 of gist and verbatim traces. Principle 3 is based on dual-opponent processes in [[False memory|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.<ref name="Fuzzy-Trace Theory and False Memory">Brainerd, C. J., & Reyna, V. F. (2002). Fuzzy-Trace Theory and False Memory. Current Directions In Psychological Science (Wiley–Blackwell), 11(5), 164–69.</ref>

===Epistemic theory===
However, not all accounts are so embedded in the neurocognitive aspects of confabulation. Some attribute confabulation to epistemic accounts.<ref name="faultless ignorance"/> 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.

==Presentation==

===Associated neurological and psychological conditions===
Confabulations are often symptoms of various syndromes and psychopathologies in the adult population, including Korsakoff's syndrome, [[Medicine:Alzheimer's disease|Alzheimer's disease]], [[Medicine:Schizophrenia|schizophrenia]], and [[Medicine:Traumatic brain injury|traumatic brain injury]].

[[Medicine:Wernicke–Korsakoff syndrome|Wernicke–Korsakoff syndrome]] is a neurological disorder typically characterized by years of alcohol use disorder characterized by excessive alcohol consumption and a nutritional thiamine deficiency.<ref>{{cite journal|pmid=10487391|year=1999|last1=Homewood|first1=J|title=Thiamin deficiency and Korsakoff's syndrome: Failure to find memory impairments following nonalcoholic Wernicke's encephalopathy|journal=Alcohol |volume=19|issue=1|pages=75–84|last2=Bond|first2=N. W.|doi=10.1016/s0741-8329(99)00027-0}}</ref> Confabulation is one salient symptom of this syndrome.<ref>{{cite journal |author1=Dalla Barba G. |author2=Cipolotti L. |author3=Denes G. | year = 1990 | title = Autobiographical memory loss and confabulation in Korsakoff's syndrome: A case report | journal = Cortex | volume = 26 | issue = 4| pages = 525–34 | doi=10.1016/s0010-9452(13)80302-4|pmid=2081390 |s2cid=4481075 | doi-access=free }}</ref><ref>Kessels RP, Kortrijk HE, Wester AJ, Nys GM. Confabulation behavior and false memories in Korsakoff's syndrome: role of source memory and executive functioning. Psychiatry Clin Neurosci. 2008 Apr; 62(2) 220–25.</ref> A study on confabulation in Korsakoff's patients found that they are subject to provoked confabulation when prompted with questions pertaining to [[Biology:Episodic memory|episodic memory]], not [[Biology:Semantic memory|semantic memory]], and when prompted with questions where the appropriate response would be "I don't know."<ref name="Korsakoff's">{{cite journal|last=Damme|first=Ilse|author2=d'Ydewalle, Géry|title=Confabulation versus experimentally induced false memories in Korsakoff patients|journal=Journal of Neuropsychology|year=2010|volume=4|issue=2|pages=211–30|doi=10.1348/174866409X478231|pmid=19930792|url=https://lirias.kuleuven.be/handle/123456789/248737 |url-access=subscription}}</ref> This suggests that {{shy|con|fab|u|l|ation}} in these patients is "domain-specific." Korsakoff's patients who confabulate are more likely than healthy adults to falsely recognize [[Philosophy:Negative priming#Distractor inhibition model|distractor]] words, suggesting that false recognition is a "confabulatory behavior."

[[Medicine:Alzheimer's disease|Alzheimer's disease]] is a condition with both neurological and psychological components. It is a form of dementia associated with severe frontal lobe {{shy|dys|func|tion}}. Confabulation in individuals with Alzheimer's is often more spontaneous than it is in other conditions, especially in the advanced stages of the disease. Alzheimer's patients demonstrate comparable abilities to encode information as healthy elderly adults, suggesting that impairments in encoding are not associated with confabulation.<ref name=Alzheimer>{{cite journal|last=Cooper|first=Janine M.|author2=Shanks, Michael F. |author3=Venneri, Annalena |title=Provoked confabulations in Alzheimer's disease|journal=Neuropsychologia|date=11 May 2006|volume=44|issue=10|pages=1697–1707|doi=10.1016/j.neuropsychologia.2006.03.029|pmid=16697019|s2cid=41292107}}</ref> However, as seen in Korsakoff's patients, confabulation in Alzheimer's 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 Alzheimer's disease.

[[Medicine:Schizophrenia|Schizophrenia]] is a psychological disorder in which confabulation is sometimes observed. Although confabulation is usually coherent in its presentation, {{shy|con|fab|u|l|ations}} of schizophrenic patients are often delusional.<ref>Wing, J. K., Cooper, J. E., Sartorius, N. 1974. The description and classification of psychiatric symptoms: An instruction manual for the PSE and catego system. London: Cambridge University Press.</ref> Researchers have noted that these patients tend to make up delusions on the spot which are often fantastic and become increasingly elaborate with questioning.<ref>{{cite journal|pmid=17506924|year=2007|last1=Lorente-Rovira|first1=E|title=Confabulation in schizophrenia and its relationship to clinical and neuropsychological features of the disorder|journal=Psychological Medicine|volume=37|issue=10|pages=1403–12|last2=Pomarol-Clotet|first2=E|last3=McCarthy|first3=R. A.|last4=Berrios|first4=G. E.|last5=McKenna|first5=P. J.|doi=10.1017/S0033291707000566|s2cid=32121170}}</ref> Unlike patients with Korsakoff's and Alzheimer's, patients with schizophrenia are more likely to confabulate when prompted with questions regarding their semantic memories, as opposed to episodic memory prompting.<ref name=schizophrenia>{{cite journal|title=Confabulation in schizophrenia: A neuropsychological study|journal=Journal of the International Neuropsychological Society|date=1 November 2010|volume=16|issue=6|pages=1018–26|doi=10.1017/S1355617710000718|pmid=20630120|last1=Lorente-Rovira|first1=E|last2=Santos-Gómez|first2=J. L.|last3=Moro|first3=M|last4=Villagrán|first4=J. M.|last5=McKenna|first5=P. J.|hdl=10234/88477|s2cid=23194952|hdl-access=free}}</ref> In addition, confabulation does not appear to be related to any memory deficit in {{shy|schiz|o|phrenic}} 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.

[[Medicine:Traumatic brain injury|Traumatic brain injury]] (TBI) can also result in confabulation. Research has shown that patients with damage to the inferior medial frontal lobe confabulate significantly more than patients with damage to the posterior area and healthy controls.<ref>{{cite journal|last=Turner|first=Martha S. |author2=Cipolotti, Lisa |author3=Yousry, Tarek A. |author4=Shallice, Tim|title=Confabulation: Damage to a specific inferior medial prefrontal system|journal=Cortex|date=1 June 2008|volume=44|issue=6|pages=637–48|doi=10.1016/j.cortex.2007.01.002|pmid=18472034 |s2cid=17414598 |url=http://discovery.ucl.ac.uk/3668/1/3668.pdf }}</ref> This suggests that this region is key in producing confabulatory responses, and that memory deficit is important but not necessary in {{shy|con|fab|u|l|ation}}. 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).<ref>{{cite journal | year = 1988 | title = Frontal amnesia and the dysexecutive syndrome | journal = Brain and Cognition | volume = 7 | issue = 2| pages = 212–30 | doi=10.1016/0278-2626(88)90031-0|pmid=3377900 | last1 = Baddeley | first1 = A | last2 = Wilson | first2 = B | s2cid = 26954876 }}</ref><ref>{{cite journal | year = 1997 | title = Confabulation in a dysexecutive patient: Implications for models of retrieval | journal = Cortex | volume = 33 | issue = 4| pages = 743–52 | doi=10.1016/s0010-9452(08)70731-7|pmid=9444475 | last1 = Papagno | first1 = C | last2 = Baddeley | first2 = A | s2cid = 4484799 }}</ref><ref>{{cite journal  | year = 1996 | title = Exploring the Central Executive | journal = Quarterly Journal of Experimental Psychology | volume = 49A | issue = 1| pages = 5–28 |doi=10.1080/713755608| last1 = Baddeley | first1 = Alan | s2cid = 54633639 }}</ref> Finally, rupture of the anterior or posterior communicating artery, subarachnoid hemorrhage, and encephalitis are also possible causes of confabulation.<ref name=Baddeley1986/><ref name="DallaBarba1993a">{{cite journal | author = Dalla Barba G | year = 1993 | title = Confabulation: knowledge and recollective experience | journal = Cognitive Neuropsychology | volume = 10 | issue = 1| pages = 1–20 | doi=10.1080/02643299308253454}}</ref>

===Location of brain lesions===
Confabulation is believed to be a result of damage to the right frontal lobe of the brain.<ref name="Moscovitch"/> In particular, damage can be localized to the ventromedial frontal lobes and other structures fed by the anterior communicating artery (ACoA), including the basal forebrain, septum, fornix, cingulate gyrus, cingulum, anterior hypothalamus, and head of the caudate nucleus.<ref>{{cite journal|pmid=6539437 |year=1984 |last1=Alexander |first1=M. P. |title=Amnesia after anterior communicating artery aneurysm rupture |journal=Neurology |volume=34 |issue=6 |pages=752–57 |last2=Freedman |first2=M |doi=10.1212/wnl.34.6.752|s2cid=34357231 }}</ref><ref>{{cite journal|pmid= 1596082 |year= 1992 |last1= Irle |first1= E |title= Memory disturbances following anterior communicating artery rupture |journal= Annals of Neurology |volume= 31 |issue= 5 |pages= 473–80 |last2= Wowra |first2= B |last3= Kunert |first3= H. J. |last4= Hampl |first4= J |last5= Kunze |first5= S |doi= 10.1002/ana.410310503 |s2cid= 42233017 }}</ref>

Behaviourally spontaneous confabulation may occur in the context of [[Medicine:Dementia|dementia]] or the [[Medicine:Wernicke–Korsakoff syndrome|Wernicke–Korsakoff syndrome]] where brain damage is difficult to localise. If it is due to circumscribed brain damage (e.g., after ruptured [[Medicine:Aneurysm|aneurysm]] of the anterior communicating artery, [[Medicine:Traumatic brain injury|traumatic brain injury]], [[Medicine:Stroke|stroke]]), lesions involved the posterior medial [[Biology:Orbitofrontal cortex|orbitofrontal cortex]] (area 13) or an area directly connected with it.<ref name="Nature Reviews" /><ref name="The Confabulating Mind" />

===Developmental differences===
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.<ref>{{cite journal |last=Brainerd |first=C. J. |author2=Reyna, V. F. |author3=Ceci, S. J.  |title=Developmental reversals in false memory: A review of data and theory |journal=Psychological Bulletin|year=2008|volume=134|issue=3|pages=343–82|doi=10.1037/0033-2909.134.3.343|pmid=18444700 }}</ref> Children are particularly susceptible to forced confabulations based on their high suggestibility.<ref>{{cite journal |last=Shapiro |first=Lauren R. |author2=Purdy, Telisa L. |title=Suggestibility and source monitoring errors: blame the interview style, interviewer consistency, and the child's personality|journal=Applied Cognitive Psychology |year=2005 |volume=19 |issue=4 |pages=489–506 |doi=10.1002/acp.1093}}</ref><ref>{{cite journal |last=Shapiro |first=Lauren R. |author2=Blackford, Cheryl |author3=Chen, Chiung-Fen |title=Eyewitness memory for a simulated misdemeanor crime: the role of age and temperament in suggestibility |journal=Applied Cognitive Psychology |year=2005 |volume=19 |issue=3|pages=267–89 |doi=10.1002/acp.1089}}</ref> 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.<ref name="Children">{{cite journal |last=Ackil |first=Jennifer K. |author2=Zaragoza, Maria S. |title=Memorial consequences of forced confabulation: Age differences in susceptibility to false memories |journal=Developmental Psychology |date=1 November 1998 |volume=34 |issue=6 |pages=1358–72 |doi=10.1037/0012-1649.34.6.1358|pmid=9823517 }}</ref> Research suggests that this inability to distinguish between past confabulatory and real events is centered on developmental differences in source monitoring. Due to underdeveloped encoding and critical reasoning skills, children's 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.<ref>{{cite journal |last=Ghetti |first=Simona |author2=Castelli, Paola |author3=Lyons, Kristen E. |title=Knowing about not remembering: developmental dissociations in lack-of-memory monitoring |journal=Developmental Science |year=2010 |volume=13 |issue=4 |pages=611–21 |doi=10.1111/j.1467-7687.2009.00908.x|pmid=20590725 }}</ref> Children's meta-memory processes may also be influenced by expectancies or biases, in that they believe that highly plausible false scenarios are not confabulated.<ref>{{cite journal |last=Ghetti |first=Simona |author2=Alexander, Kristen Weede|title="If It Happened, I Would Remember It": Strategic Use of Event Memorability in the Rejection of False Autobiographical Events |journal=Child Development |year=2004 |volume=75 |issue=2 |pages=542–61 |doi=10.1111/j.1467-8624.2004.00692.x|pmid=15056205 }}</ref> However, when knowingly being tested for accuracy, children are more likely to respond, "I don't know" at a rate comparable to adults for unanswerable questions than they are to confabulate.<ref>{{cite journal |last=Roebers |first=Claudia |author2=Fernandez, Olivia |title=The Effects of Accuracy Motivation on Children's and Adults' Event Recall, Suggestibility, and Their Answers to Unanswerable Questions |journal=Journal of Cognition and Development |year=2002 |volume=3 |issue=4 |pages=415–43 |doi=10.1207/S15327647JCD3,4-03}}</ref><ref>{{cite journal |last=Scoboria|first=Alan |author2=Mazzoni, Giuliana |author3=Kirsch, Irving|title="Don't know" responding to answerable and unanswerable questions during misleading and hypnotic interviews |journal=Journal of Experimental Psychology: Applied |year=2008 |volume=14 |issue=3 |pages=255–65 |doi=10.1037/1076-898X.14.3.255|pmid=18808279 }}</ref> Ultimately, misinformation effects can be minimized by tailoring individual interviews to the specific developmental stage, often based on age, of the participant.<ref>{{cite journal |last=Holliday |first=Robyn E. |author2=Albon, Amanda J. |title=Minimising misinformation effects in young children with cognitive interview mnemonics |journal=Applied Cognitive Psychology |year=2004 |volume=18 |issue=3 |pages=263–81 |doi=10.1002/acp.973}}</ref>

===Provoked versus spontaneous confabulations===
There is evidence to support different cognitive mechanisms for provoked and spontaneous confabulation.<ref name="Provoked Versus Spontaneous">{{cite journal|last=Schnider|first=Armin |author2=von Däniken, Christine |author3=Gutbrod, Klemens|title=The mechanisms of spontaneous and provoked confabulations|journal=Brain|date=19 February 1996|volume=119|issue=4|pages=1365–75|doi=10.1093/brain/119.4.1365|pmid=8813298 |doi-access=free}}</ref> One study suggested that spontaneous confabulation may be a result of an amnesic patient's inability to distinguish the chronological order of events in their memory. In contrast, provoked confabulation may be a compensatory mechanism, in which the patient tries to make up for their memory deficiency by attempting to demonstrate competency in recollection.

===Confidence in false memories===
Confabulation of events or situations may lead to an eventual acceptance of the confabulated information as true.<ref>{{cite journal|last=Pickel|first=Kerri|title=When a lie becomes the truth: The effects of self-generated misinformation on eyewitness memory|journal=Memory|year=2004|volume=12|issue=1|pages=14–26|doi=10.1080/09658210244000072|pmid=15098618|s2cid=21383980}}</ref> For instance, people who knowingly lie about a situation may eventually come to believe that their lies are truthful with time.<ref>{{cite journal|last=Polage|first=Danielle C.|title=Fabrication deflation? The mixed effects of lying on memory|journal=Applied Cognitive Psychology|year=2004|volume=18|issue=4|pages=455–65|doi=10.1002/acp.995}}</ref> In an interview setting, people are more likely to confabulate in situations in which they are presented false information by another person, as opposed to when they self-generate these falsehoods.<ref>{{cite journal|last=Pezdek|first=Kathy|author2=Lam, Shirley T. |author3=Sperry, Kathryn |title=Forced confabulation more strongly influences event memory if suggestions are other-generated than self-generated|journal=Legal and Criminological Psychology|year=2009|volume=14|issue=2|pages=241–52|doi=10.1348/135532508X344773}}</ref> Further, people are more likely to accept false information 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.<ref>{{cite journal|last=Melnyk|first=Laura|author2=Bruck, Maggie|title=Timing moderates the effects of repeated suggestive interviewing on children's eyewitness memory|journal=Applied Cognitive Psychology|year=2004|volume=18|issue=5|pages=613–31|doi=10.1002/acp.1013}}</ref> Affirmative feedback for confabulated responses is also shown to increase the confabulator's confidence in their response.<ref>{{cite journal|last=Hafstad|first=Gertrud Sofie |author2=Memon, Amina |author3=Logie, Robert|title=Post-identification feedback, confidence and recollections of witnessing conditions in child witnesses|journal=Applied Cognitive Psychology|year=2004|volume=18|issue=7|pages=901–12|doi=10.1002/acp.1037}}</ref> For instance, in culprit identification, if a witness falsely identifies a member of a line-up, he will be more confident in his identification if the interviewer provides affirmative feedback. This effect of confirmatory feedback appears to last over time, as witnesses will even remember the confabulated information months later.<ref>{{cite journal|last=Zaragoza|first=M. S.|author2=Payment, K. E. |author3=Ackil, J. K. |author4=Drivdahl, S. B. |author5=Beck, M. |title=Interviewing Witnesses: Forced Confabulation and Confirmatory Feedback Increase False Memories|journal=Psychological Science|year=2001|volume=12|issue=6|pages=473–77|doi=10.1111/1467-9280.00388|pmid=11760134|s2cid=11951759}}</ref>

===Among normal subjects===
On rare occasions, confabulation can also be seen in normal subjects.<ref name="Burgess"/> 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.

==Diagnosis and treatment==
Spontaneous confabulations, due to their involuntary nature, cannot be manipulated in a laboratory setting.<ref name="mechanisms of spontaneous confabulation" /> However, provoked confabulations can be researched in various theoretical contexts. The mechanisms found to underlie provoked confabulations can be applied to spontaneous confabulation mechanisms. The basic premise of researching confabulation comprises finding errors and distortions in memory tests of an individual.

===Deese–Roediger–McDermott lists===
Confabulations can be detected in the context of the [[Philosophy:Deese–Roediger–McDermott paradigm|Deese–Roediger–McDermott paradigm]] by using the Deese–Roediger–McDermott lists.<ref name="True and False">{{cite journal|last=Howe|first=Mark L. |author2=Cicchetti, Dante |author3=Toth, Sheree L. |author4=Cerrito, Beth M.|title=True and False Memories in Maltreated Children|journal=Child Development|date=1 September 2004|volume=75|issue=5|pages=1402–17|doi=10.1111/j.1467-8624.2004.00748.x|pmid=15369522 }}</ref> Participants listen 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 the participant recalls the critical word, which was never explicitly stated in the list, it is considered a confabulation. Participants often have a false memory for the critical word.

===Recognition tasks===
Confabulations can also be researched by using continuous recognition tasks.<ref name="mechanisms of spontaneous confabulation" /> These tasks are often used in conjunction with confidence ratings. Generally, in a 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 first, are indicative of confusion, representing false memories.

===Free recall tasks===
Confabulations can also be detected using a free recall task, such as a self-narrative task.<ref name="mechanisms of spontaneous confabulation" /> Participants are asked to recall stories ([[Biology:Semantic memory|semantic]] or [[Biology:Autobiographical memory|autobiographical]]) that are highly familiar to them. The stories recalled are encoded for errors that could be classified as distortions in memory. Distortions could include falsifying true story elements or including details from a completely different story. Errors such as these would be indicative of confabulations.

===Treatment===
Treatment for confabulation is somewhat dependent on the cause or source, if identifiable. For example, treatment of Wernicke–Korsakoff syndrome involves large doses of vitamin B in order to reverse the thiamine deficiency.<ref>{{cite journal|pmc=3140893|year=2011|last1=Spiegel|first1=D. R.|title=A Case of Probable Korsakoff's Syndrome: A Syndrome of Frontal Lobe and Diencephalic Structural Pathogenesis and a Comparison with Medial Temporal Lobe Dementias|journal=Innovations in Clinical Neuroscience|volume=8|issue=6|pages=15–19|last2=Lim|first2=K. J.|pmid=21779537}}</ref> 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)<ref>{{cite journal|doi=10.1080/096020100411998|title=Treatment of stable delusional confabulations using self-monitoring training|journal=Neuropsychological Rehabilitation|volume=10|issue=4|pages=415–27|year=2000|last1=Dayus|first1=B.|last2=Van Den Broek|first2=M.D.|s2cid=145657555}}</ref> 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 efficacy of SMT in the general confabulation population.

==Research==
Although significant gains have been made in the understanding of confabulation in 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 more information is needed regarding the neural systems that support the different cognitive processes necessary for normal source monitoring. They also proposed the idea of developing a standard neuropsychological test battery able to discriminate between the different types of confabulations. And there is a considerable amount of debate regarding the best approach to organizing and combining neuro-imaging, pharmacological, and cognitive/behavioral approaches to understand confabulation.<ref>{{cite journal|doi=10.1016/S1364-6613(98)01152-8|pmid=21227110|title=False memories and confabulation|journal=Trends in Cognitive Sciences|volume=2|issue=4|pages=137–45|year=1998|last1=Johnson|first1=M|last2=Raye|first2=C. L.|s2cid=10033853}}</ref>

In a recent review article, another group of researchers contemplate issues concerning the distinctions between 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 differences 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.<ref name=LangdonTurne2010>{{citation |date=2010 |author1=Langdon, R.  |author2=Turner, M |title=Delusion and confabulation: Overlapping or distinct distortions in reality? |journal=Cognitive Neuropsychiatry |volume= 15 |issue=1 |pages= 1–13 |pmid=20043251|doi=10.1080/13546800903519095|s2cid=35177831 }}</ref>

==See also==
* Compare with: 
** {{anl|Anosognosia}}
** [[Confabulation (neural networks)]]
** {{anl|Cryptomnesia}}
** {{anl|False memory}}
** {{anl|Hallucination}}
** {{anl|Hallucination (artificial intelligence)}}
** {{anl|Hindsight bias}}
** {{anl|Misinformation effect}}
** {{anl|Revelation}}
** {{anl|Rosy retrospection}}
* Not to be confused with: 
** {{anl|Gaslighting}}
** {{anl|Hoax|Hoaxes}}
** {{anl|Phishing}}
** Scams (swindles): 
*** {{anl|Confidence trick|Confidence tricks}}
*** {{anl|Fraud}}

==References==
{{Reflist}}

==Further reading==
*{{citation |year=2018 |author=Schnider, Armin |title=The Confabulating Mind. How the brain creates reality. 2nd edition |url= https://global.oup.com/academic/product/the-confabulating-mind-9780198789680?cc=ch&lang=en& |place=Oxford, New York |publisher=Oxford University Press |isbn= 9780198789680}}
*{{citation |year=2005 |author=Hirstein, William |title=Brain Fiction: Self-deception and the riddle of confabulation |url=https://books.google.com/books?id=_rkKxbevFZEC&q=brain+fiction+self-deception+and+the+riddle+of+confabulation |place=Cambridge, Massachusetts |publisher=MIT Press |isbn=978-0-262-08338-6 |access-date=21 March 2012}}
*{{citation |year=1985 |author=Sacks, Oliver |title=The Man Who Mistook His Wife for a Hat |journal=The British Journal of Psychiatry: The Journal of Mental Science |volume=166 |issue=1 |pages=130–1 |place=New York |publisher=Perennial Library |doi=10.1192/bjp.166.1.130 |pmid=7894870 |isbn=978-0-06-097079-6 |url-access=registration |url=https://archive.org/details/manwhomistookhis00sack }}

== External links ==
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{{Memory}}

[[Category:Error]]
[[Category:Ignorance]]
[[Category:Memory biases]]

{{Sourceattribution|Confabulation}}