Confabulation is distinguished from lying as there is no intent to deceive and the person is unaware the information is false. Although individuals can present blatantly false information, confabulation can also seem to be coherent, internally consistent, and relatively normal.
Most known cases of confabulation are symptomatic of brain damage or dementias, such as aneurysm, Alzheimer's disease, or Wernicke–Korsakoff syndrome (a common manifestation of thiamine deficiency caused by alcoholism). Additionally confabulation often occurs in people who are suffering from anticholinergic toxidrome when interrogated about bizarre or irrational behavior.
Confabulated memories of all types most often occur in autobiographical memory, and are indicative of a complicated and intricate process that can be led astray at any point during encoding, storage, or recall of a memory. This type of confabulation is commonly seen in Korsakoff's syndrome.
Two types of confabulation are often distinguished:
- Provoked (momentary, or secondary) confabulations represent a normal response to a faulty memory, are common in both amnesia and dementia, and can become apparent during memory tests.
- Spontaneous (or primary) confabulations do not occur in response to a cue and seem to be involuntary. They are relatively rare, more common in cases of dementia, and may result from the interaction between frontal lobe pathology and organic amnesia.
Another distinction is that between:
- Verbal confabulations, spoken false memories and are more common, and
- Behavioral confabulations, occur when an individual acts on their false memories.
Confabulation is associated with several characteristics:
- Typically verbal statements but can also be non-verbal gestures or actions.
- Can include autobiographical and non-personal information, such as historical facts, fairytales, or other aspects of semantic memory.
- The account can be fantastic or coherent.
- Both the premise and the details of the account can be false.
- The account is usually drawn from the patient’s memory of actual experiences, including past and current thoughts.
- The patient is unaware of the accounts’ distortions or inappropriateness, and is not concerned when errors are pointed out.
- There is no hidden motivation behind the account.
- The patient’s personality structure may play a role in their readiness to confabulate.