Confabulation: a clinical mental disorder

Confabulation: Clinical Mental Disorder
Kathleen Benjamin Rickard, DNP, APRN, FNP-C
Sept. 6, 2014
Upon recently completing a six-day conference on the mind and the benefits of
meditation, one of many terms popped out as a most fascinating concept for exploration. An
understanding of the word confabulation offers an opportunity to appreciate the complexity of
the mind.

In my personal world, I have been enmeshed in a significant amount of frustration
attempting to clarify, justify, understand, correct, and/or appreciate a person who clearing
restates sequences of events with strange and usually hurtful renditions that seem really odd to
everyone except the person stating them. When these topics are questioned, the rebuttal response
provided by this person is directed with more passion and anger than is appropriate for the
incident. It has been a befuddling incident until now.

The definition of this type of memory disorder is called confabulation. According to
Myers (2006), confabulation results from damage to the basal forebrain and frontal lobes. It is
described as a spontaneous production of false thoughts and memories. These memories can be
quite elaborate or very simple but can often lead to strong argumentative behavior to justify these
thoughts as truth. These memories are not actually lies because the person is not aware that they
are fabricated and inaccurate memories. Confabulation is a clinical syndrome. According to the
Memory Disorders Project newsletter, these distorted memories may resolve with time but often
require therapy to address the incidents and behaviors (Myers, 2006). Learning more about the
brain is important for understanding this condition.

The frontal lobe is divided into different functional domains. According to results from
research using magnetic resonance imaging (MRI), positron emission tomography (PET), and
single photon emission computed tomography (SPECT) scans, it has been determined that
symptoms such as impulsiveness, confabulatory verbosity, grandiosity, increased sexuality, and
mania are associated with right frontal as well as bilateral neurological disturbances (Joseph,
1999). These symptoms improve at times and are exacerbated by depression (Joseph, 1999).

Kapur and Coughlan (1980) described a case report of a patient with frontal lobe damage
who provided fictitious recounts post repair of a brain aneurism. When this patient was
confronted with these stories, he became puzzled but did not have a sense of having lied about
the incidents. In this case, improvement was noted with time.

Through human neuroimaging and animal studies, the ventromedial prefrontal cortex
(vmPFC) has been identified as a location for the development of different forms of memory,
particularly in facilitating new encoding of information by existing memory. Confabulation
appears following vmPFC damage. (Ghosh, Moscovitch, Colella, & Gilboa, 2014).

Appreciating the complexity of the brain, coping strategies under stress, detecting
possible underling pathology, and the marvels of modern technology all provide the opportunity
for dealing with this very difficult form of mental disease. Although definitely not an easy
disorder to repair partly due to the person being unaware that there is a problem, having
compassion and finding the appropriate diagnosis and treatment, offer enormous potential for
healing the afflicted person and all those they encounter.

Berlyne, N. (1972). Confabulation. The British Journal of Psychiatry 120, 31-39. doi:
Ghosh, V.E., Moscovith, M., Collela, B.M., & Gilboa. (2014). Schema representation in patients
with ventromedial PFC lesions. The Journal of Neuroscience. 34(36),12057-12070. doi:
Joseph, R. Frontal lobe psychopathology: mania, depression, confabulation, catatonia,
perseveration, obsessive compulsion, and schizophrenia. Psychiatry, 62(2). 138-172.
PMID: 10420428
Kapur, N., & Coughlan, A.K. (1980). Confabulation and frontal lobe dysfunction. Journal of
Neurology, Neurosurgery, and Psychiatry. 43, 461-463. doi: 10.1136/jnnp.43.5.461
Myers, C. E. (2006). Confabulation. Memory Loss and the Brain. Retrieved from the
newsletter of the Memory Disorders Project at Rutgers University, Winter, 2010.