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Confabulation An Introduction for Psychologists


Forensic Scholars Today

One of the key aspects of clinical interviews is the process where a psychologist gathers

reasonably believable information from a client. In some cases, however, the psychologist may detect

apparently nonsensical information. For example, facts presented during an interview may be conflicting,

inaccurate, or at odds with the age or socioeconomic status of the client. In such situations, the

psychologist must sift through the available information to determine its accuracy.

Accurate information enables the psychologist to determine the appropriate therapeutic course of

action for the client. In contrast, inaccuracy may render a very disparate approach that is characterized by

a multitude of inappropriate actions. Psychologists must remember that some clients intentionally lie,

whereas others unintentionally deceive by using fabricated experiences, dates, descriptions, and

anecdotes. These unintentional deceptions may be the result of confabulation.

Confabulation is considered a paramnesia. Here, gaps in memory are filled with misinformation. These

“memories” can range from rather harmless information to bizarre and elaborate stories that have no

connection to reality. This is very different from lying or the intentional manipulation of facts because the

confabulator is not aware of error in recall. In fact, the confabulator might appear emphatic about these

memories because he or she is truly oblivious to any mistakes. Below are important facts to bear in mind

about confabulation.

Why It Occurs

Confabulation typically occurs when there is a disturbance in one’s ability to make new

memories and to monitor recollections for accuracy, which suggests possible brain function deficits in

memory and executive functioning. Here, the failure of memory skills and the drive to make sense of a

situation overpower the now weakened part of the brain that checks for accuracy. Rather than simply

admitting that they do not recall what they saw on TV earlier, individuals make up a detailed account of

something else that they watched at a different time, becoming convinced it was earlier in the day. In this

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case, a genuine remote memory is dropped into this day’s memory gap, with no awareness of the

temporal error. Later, a host of confabulated information may fill in those gaps, such as “recalling” that the

TV had burst into flames earlier that day or “remembering” a former job as a schoolteacher (when they

have never been a teacher).

Who Is Prone To Such Errors

There are several neuropathological processes (e.g., Alzheimer’s disease, Wernicke-Korsakoff

syndrome, Fetal Alcohol Spectrum Disorder, and certain specifically located cerebral vascular accidents)

that can render someone more vulnerable to confabulation. Although even mild confabulations can occur

in healthy individuals, those with compromised brain function are disproportionately likely to make such

errors, particularly when questioned under stressful conditions such as neuropsychological testing (e.g.,

immediate or delayed memory tasks). The act of being asked to remember facts and situations may be

met with vaguely connected false information (e.g., falsely recalling “horse, milk, farm” on a word list or

that a woman worked in a shoe factory rather than a clothing store), or even totally disconnected

memories (e.g., inventing new information such as the woman in a story was 6 feet tall and wore a

spacesuit when there was no mention of her physical appearance or clothing). Of course, provocation of

confabulation in vulnerable populations can occur in health care, law enforcement, and even social


How To Address Confabulation When It Occurs

It is vitally important to corroborate important information when working with individuals who are

potentially at risk for confabulation. Seeking out collateral informants and records to confirm or disprove

self-report accounts will increase the accuracy of assessment and appropriateness of interventions.

Although gently offering corrections for misremembered information may be helpful, understanding that

confabulation is not intentional will definitely be helpful in establishing a working rapport.

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Christopher Mertz, Psy.D, LP, is a neuropsychologist at HealthEast-St. Joseph’s Hospital in St. Paul,

Minnesota, working with both inpatient and outpatient populations. He earned his doctorate at James

Madison University and completed his postdoctoral fellowship training at Cooper University Hospital in

Camden, New Jersey. Areas of professional interest include geriatric populations, delirium prevention,

and decision-making capacity. He is a member of the psychology doctoral internship program training

committee, ethics committee, and delirium prevention team at St. Joseph’s.

Jerrod Brown, M.A., M.S., M.S., M.S., is the Treatment Director at Pathways Counseling Center, Inc.

Pathways provides programs and services benefiting individuals impacted by mental illness and

addictions. Jerrod is also the founder and CEO of the American Institute for the Advancement of

Forensic Studies (AIAFS), and lead developer and program director of an online graduate degree

program in Forensic Mental Health from Concordia University, St. Paul, Minnesota. Jerrod is currently

pursuing a doctoral degree in psychology.