DESIRE: Is it Lying or Confabulation?

By understanding the differences between confabulation and lying, caregivers can better support individuals with FASD, helping them navigate social interactions and build trusting relationships.

“Our family had a Truth Table available to anyone in our home. That meant if we needed space and safety to tell our story and decide what to do about it, we could stop and call a Truth Table, and at that point, the responsibility of Truth to our best. ability and what happened next rested on the person who asked for the Truth Table. No one was allowed to yell at the Truth Table. One time, Mom was so mad at something I did that I was trying to explain in my merry-go-round brain – she had to go to her room to calm down – THAT was FUNNY! You can read about that strategy in my book, The Best I Can Be!”
– In Solidarity, Liz

Confabulation is a memory error in which individuals unintentionally create false memories. This is not done with the intent to deceive. Instead, it occurs due to neurological issues, such as brain damage, that affect memory and perception. For example, a person might insist they met at a location they haven’t visited in years, believing this to be true.

Characteristics of Confabulation:

• Unintentional: The individual is unaware that their memory is false and genuinely believes in the accuracy of their recollections.
• Detailed and Convincing: Confabulated memories can be vivid and thorough, making them seem plausible to both the individual and others.
• Neurological Basis: Confabulation often results from brain injuries or conditions like dementia, affecting memory and cognitive functions.

Understanding Lying

Lying is when someone knowingly provides false information to deceive. It is a deliberate act often motivated to avoid consequences or gain an advantage.

Characteristics of lying:

• Being intentional: The individual knowingly provides false information.
• Purposeful: Lies are often told to achieve a specific outcome, such as avoiding punishment or gaining approval.

Strategies for Caregivers

• Create a Supportive Environment: Minimize opportunities for confusion by providing a structured and predictable environment. This can reduce the frequency of both confabulation and lying.
• Use Neutral Language: Instead of accusing someone of lying, use terms like “inaccurate information.” This approach is less confrontational and helps maintain trust
• Encourage Verification: Teach the individual to verify their memories by checking with others or using external sources like a planner. This helps them distinguish between real and confabulated memories.
• Foster Open Communication: Maintain open lines of communication between caregivers, educators, and the individual. This collaboration ensures consistent support and helps address issues as they arise.

How can I handle confabulation calmly?

Energy creates more energy! Calmly handling confabulations is essential for caregivers of individuals with Fetal Alcohol Spectrum Disorders (FASD) or other conditions that involve memory distortions.

Tips to manage these situations effectively.

• Stay Calm and Composed: It’s essential to control your emotions and remain calm when someone is confabulating. Avoid reacting with frustration or anger, as this can escalate the situation. Focus on providing comfort and reassurance. Minimize distractions and stress, which can exacerbate memory errors.
• Provide a Structured Environment: Create a predictable and structured environment to reduce confusion and the likelihood of confabulation. Consistent routines and clear communication can help individuals feel more secure.
• Create a Supportive Environment: A calm and structured environment helps individuals focus and reduces the likelihood of confabulation.
• Involve Family and Care Team: Engage family members and other caregivers in understanding confabulation. This ensures a consistent approach and helps everyone involved respond appropriately to confabulations.
• Acknowledge Emotions: Instead of correcting the discombobulated memory, acknowledge the emotions behind the confabulation. Respond to the feelings being expressed, which are real, even if the details are not. This helps the individual feel understood and supported.
• Use Distraction and Redirection: If the confabulation leads to agitation or distress, gently redirect the conversation or activity. Suggest a different topic or engage the person in a calming activity, such as going for a walk or reminiscing about positive past experiences.
• Implement Memory Aids: Consider using memory aids like a memory book or diary to help individuals differentiate between actual and imagined events. Go back through phone messages or photos. These tools can provide a reference point for recalling actual experiences and can be a collaborative activity.
• Avoid Confrontation: Do not argue or insist on correcting their memory. This can lead to defensiveness and strain the relationship. Instead, focus on maintaining a supportive and trusting interaction.

These strategies help caregivers effectively manage confabulations, fostering a supportive environment that prioritizes the well-being and dignity of the individual.

How can I understand or prevent provoked confabulation?

Provoked confabulations typically occur in response to direct questioning or prompts that challenge an individual’s memory, especially when they feel compelled to provide an answer.

These triggers highlight the role of direct questioning in eliciting confabulated responses, as individuals with memory impairments strive to offer answers even when they lack accurate recollections. Persons with brain injuries often find themselves in oppositional space with figures of authority – caregivers, parents, law enforcement.

Here are several strategies.

1. Avoid Leading Questions: Frame questions in a way that doesn’t pressure the individual to provide specific details. Open-ended questions can reduce the likelihood of confabulation by allowing the person to share what they remember without feeling compelled to fill in gaps.
2. Provide Memory Aids: Encourage memory aids, such as diaries or planners, to help individuals recall accurate information. These tools can serve as references and reduce the pressure to rely solely on memory. Write appointments and events on calendars, take photos on your cell phone, and text each other. All these counts to help create time stamps.
3. Allow Extra Processing Time: Give individuals ample time to process questions and formulate responses. Rushed situations can increase the likelihood of confusion as the brain tries to fill in missing information quickly.
4. Educate and Communicate: Educate family members and caregivers about confabulation to foster understanding and patience. Open communication can help everyone involved respond appropriately and supportively when confabulation occurs.

By implementing these strategies, caregivers can help manage provoked confabulation and support individuals in maintaining more accurate memories.

Here are some common triggers for provoked confabulations:

• Questions about Episodic Memory: Provoked confabulations are often triggered when individuals are asked about their experiences or events (episodic memory). For example, asking a person with memory impairment, “What did you do last weekend?” might lead them to create a false memory to fill in the gap, especially if the appropriate response would be “I don’t know.”
• Inquiries Requiring Specific Information: Questions that require specific factual information, such as dates, places, or historical facts, can also trigger provoked confabulations. For instance, if asked, “Who was the forty-fourth president of the United States?” a person might answer incorrectly rather than admit they don’t know.
• Questions about Injury or Disability: In individuals with brain injuries, questions about their injury or disability can provoke confabulation. These questions might lead them to fabricate details about their condition or recovery as they attempt to provide coherent responses despite memory deficits.

Confabulation triggers can differ significantly between healthy individuals and those with neurological disorders, primarily due to the underlying mechanisms affecting memory and cognitive processing.

Confabulation in Individuals with Neurological Disorders

• Neurological Damage: In individuals with neurological disorders like Fetal Alcohol Spectrum Disorders, Alzheimer’s disease, or traumatic brain injury, confabulation is more pronounced and frequent. The provoked confabulations in these cases often occur when individuals are asked questions about episodic memory (personal experiences) rather than semantic memory (general knowledge).
• Impaired Memory Systems: Brain damage or dysfunction, particularly in the frontal lobes, leads to significant memory recall and executive function impairments. This impairment makes individuals more susceptible to confabulation when prompted with questions, as they struggle to access accurate memories and instead generate false ones to fill in gaps.
• Domain-Specific Triggers: For those with disorders like Korsakoff’s syndrome, confabulation is often brain domain-specific, meaning it is more likely to occur in specific contexts, such as when the appropriate response to a question would be “I don’t know.”

Yes, Even Healthy Individuals Confabulate

• Standard Memory Errors: In healthy individuals, confabulation can be a normal response to faulty memory, especially when asked to recall specific details or events. These memory errors are often minor and occur because human memory is inherently reconstructive. For example, when asked about a past event, a healthy person might unintentionally fill in gaps with plausible but incorrect details without realizing it.
• Provoked by Complex Questions: Healthy individuals may experience confabulation when faced with complex or ambiguous questions that challenge their memory. These situations can lead to the creation of false memories as the brain attempts to provide coherent answers.

While healthy individuals may experience confabulation due to standard memory errors, those with neurological disorders are more prone to confabulation due to significant memory impairments and brain damage. These differences highlight the importance of understanding the context and underlying causes when addressing confabulation in various populations.