Confabulations

Confabulations are false but confidently held memories or stories that fill gaps in an individual's recall, produced without the intention to deceive. Unlike deliberate lies, confabulations are experienced as true by the person and often arise from memory gaps or disruptions in reality monitoring.

They most commonly occur in neurological disorders that impair memory or frontal lobe function, such as Korsakoff syndrome, Alzheimer's disease and other dementias, traumatic brain injury, stroke, or Wernicke's encephalopathy. They can also appear in psychiatric conditions or severe medical illness with delirium. The phenomenon reflects impaired source monitoring and reality discrimination rather than deliberate fabrication.

Types include provoked confabulations, which arise to fill gaps when asked questions, and spontaneous confabulations, which occur without prompting and may be highly elaborate. Some classifications refer to persistent, repetitive, or systematized forms. The content is often plausible and detailed, and can be resistant to correction; individuals may show confidence despite contradictions.

Diagnosis relies on clinical assessment and cognitive testing to differentiate confabulations from intentional lying or delusions, and from memory errors. Management focuses on treating underlying conditions (for example, thiamine replacement in Wernicke-Korsakoff syndrome), safety planning, and strategies to improve memory and reality orientation. There is no specific pharmacological treatment for confabulation itself, though treatment is tailored to the underlying disorder and associated symptoms.