Confabulation Confabulation is a memory disturbance, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world,

without the con scious intention to deceive.[1] Confabulation is distinguished from lying as the re is no intent to deceive and the person is unaware the information is false.[2 ] Although individuals can present blatantly false information, confabulation ca n also seem to be coherent, internally consistent, and relatively normal.[2] Ind ividuals who confabulate present incorrect memories ranging from "subtle alterna tions to bizarre fabrications",[3] and are generally very confident about their recollections, despite contradictory evidence.[4] Most known causes of confabula tion are caused by brain damage or dementias, such as alcoholism, aneurysm or Al zheimer's disease. Two distinct types of confabulation are often distinguished: spontaneous and pro voked. Spontaneous, or primary, confabulations do not occur in response to a cue[5] and seem to be involuntary.[6] Spontaneous confabulation is relatively rare, may re sult from the interaction between frontal lobe pathology and organic amnesia, an d is more common in cases of dementia.[7] Provoked, momentary, or secondary confabulation represents a normal response to a faulty memory and is common in both amnesia and dementia.[7] Provoked confabul ations can become apparent during memory tests.[5] Another distinction found in confabulations is that between verbal and behavioral. Verbal confabulations are spoken false memories and are more common, while behavioral confabulations occur when an individual acts on their false memories.[6] Confabulated memories of al l types most often occur in autobiographical memory, and are indicative of a com plicated and intricate process that can be led astray at any point during encodi ng, storage, or recall of a memory.[4] This type of confabulation is commonly se en in Korsakoff's syndrome.[8] Contents 1 Characteristic features 2 Theories o 2.1 Neuropsychological theories o 2.2 Self-identity theory o 2.3 Temporality theory o 2.4 Monitoring theory o 2.5 Strategic retrieval account theory o 2.6 Executive control theory o 2.7 Confabulation in the context of delusion theories o 2.8 Fuzzy-trace theory o 2.9 Epistemic theory 3 Presentation o 3.1 Associated neurological and psychological conditions o 3.2 Location of brain lesions o 3.3 Developmental differences o 3.4 Provoked versus spontaneous confabulations o 3.5 Confidence in false memories o 3.6 Among normal subjects 4 Diagnosis and treatment o 4.1 Deese Roediger McDermott lists o 4.2 Recognition tasks o 4.3 Free recall tasks o 4.4 Treatment 5 Research 6 See also 7 References 8 Further reading Characteristic features 1. Typically verbal statements but can also be non-verbal gestures or actio ns. 2. Can include autobiographical and non-personal information, such as histo

rical facts, fairytales, or other aspects of semantic memory. 3. The account can be fantastic or coherent. 4. Both the premise and the details of the account can be false. 5. The account is usually drawn from the patient s memory of actual experienc es, including past and current thoughts. 6. The patient is unaware of the accounts distortions or inappropriateness, and is not concerned when errors are pointed out. 7. There is no hidden motivation behind the account. 8. The patient s personality structure may play a role in their readiness to confabulate. [2] Theories Theories of confabulation range in emphasis. Some theories propose that confabul ations represent a way for memory-disabled individuals to maintain their self-id entity.[5] Other theories use neurocognitive links to explain the process of con fabulation.[9] Still other theories frame confabulation around the more familiar concept of delusion.[10] Other researchers frame confabulation within the fuzzy -trace theory.[11] Finally, some researchers call for theories that rely less on neurocognitive explanations and more on epistemic accounts.[12] Neuropsychological theories The most popular theories of confabulation come from the field of neuropsycholog y or cognitive neuroscience.[9] Research suggests that confabulation is associat ed with dysfunction of cognitive processes that control the retrieval from longterm memory. Frontal lobe damage often disrupts this process, preventing the ret rieval of information and the evaluation of its output.[13][14] Furthermore, res earchers argue that confabulation is a disorder resulting from failed reality mon itoring/source monitoring (i.e. deciding whether a memory is based on an actual e vent or whether it is imagined.[15] Some neuropsychologists suggest that errors in retrieval of information from long-term memory that are made by normal subjec ts involve different components of control processes than errors made by confabu lators.[16] Detection of these errors are considered part of the Supervisory Sys tem,[17] which is believed to be a function of the frontal cortex. Self-identity theory Some argue confabulations have a self-serving, emotional component in those with memory deficits that aids to maintain a coherent self-concept.[5] In other word s, individuals who confabulate are motivated to do so, because they have gaps in their memory that they want to fill in and cover up. Temporality theory Support for the temporality account suggests that confabulations occur when an i ndividual is unable to place events properly in time.[5] Thus, an individual mig ht correctly state an action they performed, but say they did it yesterday, when they did it weeks ago. In the Memory, Consciousness, and Temporality Theory, co nfabulation occurs because of a deficit in temporal consciousness or awareness.[ 18] Monitoring theory Along a similar notion are the theories of reality and source monitoring theorie s.[6] In these theories, confabulation occurs when individuals incorrectly attri bute memories as reality, or incorrectly attribute memories to a certain source. Thus, an individual might claim an imagined event happened in reality, or that their friend told them about an event, they actually heard about on television. Strategic retrieval account theory Supporters of the strategic retrieval account suggest that confabulations occur when an individual cannot actively monitor a memory for truthfulness after its r etrieval.[6] An individual recalls a memory, but there is some deficit after rec all that interferes with the person establishing its falseness. Executive control theory Still others propose that all types of false memories, including confabulation, fit into a general memory and executive function model.[19] In 2007, a framework for confabulation was proposed that stated confabulation is the result of two t hings: problems with executive control and problems with evaluation. In the exec utive control deficit, the incorrect memory is retrieved from the brain. In the

evaluative deficit, the memory will be accepted as a truth due to an inability t o distinguish a belief from an actual memory.[5] Confabulation in the context of delusion theories Recent models of confabulation have attempted to build upon the link between del usion and confabulation.[10] More recently, a monitoring account for delusion, a pplied to confabulation, proposed both the inclusion of conscious and unconsciou s processing. The claim was that by encompassing the notion of both processes, s pontaneous versus provoked confabulations could be better explained. In other wo rds, there are two ways to confabulate. One is the unconscious, spontaneous way in which a memory goes through no logical, explanatory processing. The other is the conscious, provoked way in which a memory is recalled intentionally by the i ndividual to explain something confusing or unusual.[20] Fuzzy-trace theory Fuzzy-trace theory, or FTT, is a concept more commonly applied to the explanatio n of judgment decisions.[11] According to this theory, memories are encoded gene rally (gist), as well as specifically (verbatim). Thus, a confabulation could re sult from recalling the incorrect verbatim memory or from being able to recall t he gist portion, but not the verbatim portion, of a memory. FTT uses a set of five principles to explain false-memory phenomena. Principle 1 suggests that subjects store verbatim information and gist information parallel to one another. Both forms of storage involve the surface content of an experie nce. Principle 2 shares factors of retrieval of gist and verbatim traces. Princi ple 3 is based on dual-opponent processes in false memory. Generally, gist retri eval supports false memory, while verbatim retrieval suppresses it. Developmenta l variability is the topic of Principle 4. As a child develops into an adult, th ere is obvious improvement in the acquisition, retention, and retrieval of both verbatim and gist memory. However, during late adulthood, there will be a declin e in these abilities. Finally, Principle 5 explains that verbatim and gist proce ssing cause vivid remembering. Fuzzy-trace Theory, governed by these 5 principle s, has proved useful in explaining false memory and generating new predictions a bout it.[21] Epistemic theory However, not all accounts are so embedded in the neurocognitive aspects of confa bulation. Some attribute confabulation to epistemic accounts.[12] In 2009, theor ies underlying the causation and mechanisms for confabulation were criticized fo r their focus on neural processes, which are somewhat unclear, as well as their emphasis on the negativity of false remembering. Researchers proposed that an ep istemic account of confabulation would be more encompassing of both the advantag es and disadvantages of the process. Presentation Associated neurological and psychological conditions Confabulations are often symptoms of various syndromes and psychopathologies in the adult population including: Korsakoff's syndrome, Alzheimer s Disease, Schizop hrenia, and traumatic brain injury. Wernicke Korsakoff syndrome is a neurological disorder typically characterized by years of chronic alcohol abuse and a nutritional thiamine deficiency.[22] Confab ulation is one salient symptom of this syndrome.[23][24] A study on confabulatio n in Korsakoff s patients found that they are subject to provoked confabulation wh en prompted with questions pertaining to episodic memory, not semantic memory, a nd when prompted with questions where the appropriate response would be I don t kno w. [25] This suggests that confabulation in these patients is domain-specific. Korsa koff s patients who confabulate are more likely than healthy adults to falsely rec ognize distractor words, suggesting that false recognition is a confabulatory beh avior. Alzheimer s Disease is a condition with both neurological and psychological compon ents. It is a form of dementia associated with severe frontal lobe dysfunction. Confabulation in individuals with Alzheimer s is often more spontaneous than it is in other conditions, especially in the advanced stages of the disease. Alzheime r s patients demonstrate comparable abilities to encode information as healthy eld erly adults, suggesting that impairments in encoding are not associated with con

fabulation.[26] However, as seen in Korsakoff's patients, confabulation in Alzhe imer s patients is higher when prompted with questions investigating episodic memo ry. Researchers suggest this is due to damage in the posterior cortical regions of the brain, which is a symptom characteristic of Alzheimer s Disease. Schizophrenia is a psychological disorder in which confabulation is sometimes ob served. Although confabulation is usually coherent in its presentation, confabul ations of schizophrenic patients are often delusional[27] Researchers have noted that these patients tend to make up delusions on the spot which are often fanta stic and become increasingly elaborate with questioning.[28] Unlike patients wit h Korsakoff's and Alzheimer's, patients with schizophrenia are more likely to co nfabulate when prompted with questions regarding their semantic memories, as opp osed to episodic memory prompting.[29] In addition, confabulation does not appea r to be related to any memory deficit in schizophrenic patients. This is contrar y to most forms of confabulation. Also, confabulations made by schizophrenic pat ients often do not involve the creation of new information, but instead involve an attempt by the patient to reconstruct actual details of a past event. Traumatic brain injury (TBI) can also result in confabulation. Research has show n that patients with damage to the inferior medial frontal lobe confabulate sign ificantly more than patients with damage to the posterior area and healthy contr ols.[30] This suggests that this region is key in producing confabulatory respon ses, and that memory deficit is important but not necessary in confabulation. Ad ditionally, research suggests that confabulation can be seen in patients with fr ontal lobe syndrome, which involves an insult to the frontal lobe as a result of disease or traumatic brain injury (TBI).[31][32] Finally, rupture of the anteri or or posterior communicating artery, subarachnoid hemorrhage, and encephalitis are also possible causes of confabulation.[33][34] Location of brain lesions Confabulation is believed to be a result of damage to the right frontal lobe of the brain.[2] In particular, damage can be localized to the ventromedial frontal lobes and other structures fed by the anterior communicating artery (ACoA), inc luding the basal forebrain, septum, fornix, cingulate gyrus, cingulum, anterior hypothalamus, and head of the caudate nucleus.[35][36] Developmental differences While some recent literature has suggested that older adults may be more suscept ible than their younger counterparts to have false memories, the majority of res earch on forced confabulation centers around children.[37] Children are particul arly susceptible to forced confabulations based on their high suggestibility.[38 ][39] When forced to recall confabulated events, children are less likely to rem ember that they had previously confabulated these situations, and they are more likely than their adult counterparts to come to remember these confabulations as real events that transpired.[40] Research suggests that this inability to disti nguish between past confabulatory and real events is centered on developmental d ifferences in source monitoring. Due to underdeveloped encoding and critical rea soning skills, children's ability to distinguish real memories from false memori es may be impaired. It may also be that younger children lack the meta-memory pr ocesses required to remember confabulated versus non-confabulated events.[41] Ch ildren's meta-memory processes may also be influenced by expectancies or biases, in that they believe that highly plausible false scenarios are not confabulated .[42] However, when knowingly being tested for accuracy, children are more likel y to respond, I don t know at a rate comparable to adults for unanswerable questions than they are to confabulate.[43][44] Ultimately, misinformation effects can be minimized by tailoring individual interviews to the specific developmental stag e, often based on age, of the participant.[45] Provoked versus spontaneous confabulations There is evidence to support different cognitive mechanisms for provoked and spo ntaneous confabulation.[46] One study suggested that spontaneous confabulation m ay be a result of an amnesic patient s inability to distinguish the chronological order of events in his memory. In contrast, provoked confabulation may be a comp ensatory mechanism, in which the patient tries to make up for his memory deficie ncy by attempting to demonstrate competency in recollection.

Confidence in false memories Confabulation of events or situations may lead to an eventual acceptance of the confabulated information as true.[47] For instance, people who knowingly lie abo ut a situation may eventually come to believe that their lies are truthful with time.[48] In an interview setting, people are more likely to confabulate in situ ations in which they are presented false information by another person, as oppos ed to when they self-generate these falsehoods.[49] Further, people are more lik ely to accept false information as true when they are interviewed at a later tim e (after the event in question) than those who are interviewed immediately or so on after the event.[50] Affirmative feedback for confabulated responses is also shown to increase the confabulator s confidence in their response.[51] For instanc e, in culprit identification, if a witness falsely identifies a member of a line -up, he will be more confident in his identification if the interviewer provides affirmative feedback. This effect of confirmatory feedback appears to last over time, as witnesses will even remember the confabulated information months later .[52] Among normal subjects On rare occasions, confabulation can also be seen in normal subjects.[16] It is currently unclear how completely healthy individuals produce confabulations. It is possible that these individuals are in the process of developing some type of organic condition that is causing their confabulation symptoms. It is not uncom mon, however, for the general population to display some very mild symptoms of p rovoked confabulations. Subtle distortions and intrusions in memory are commonly produced by normal subjects when they remember something poorly. Diagnosis and treatment Spontaneous confabulations, due to their involuntary nature, cannot be manipulat ed in a laboratory setting.[6] However, provoked confabulations can be researche d in various theoretical contexts. The mechanisms found to underlie provoked con fabulations can be applied to spontaneous confabulation mechanisms. The basic pr emise of researching confabulation comprises finding errors and distortions in m emory tests of an individual. Deese Roediger McDermott lists Confabulations can be detected in the context of the Deese Roediger McDermott paradi gm by using the Deese Roediger McDermott lists.[53] Participants listen to audio rec ordings of several lists of words centered around a theme, known as the critical word. The participants are later asked to recall the words on their list. If th e participant recalls the critical word, which was never explicitly stated in th e list, it is considered a confabulation. Participants often have a false memory for the critical word. Recognition tasks Confabulations can also be researched by using continuous recognition tasks.[6] These tasks are often used in conjunction with confidence ratings. Generally, in a recognition task, participants are rapidly presented with pictures. Some of t hese pictures are shown once; others are shown multiple times. Participants pres s a key if they have seen the picture previously. Following a period of time, pa rticipants repeat the task. More errors on the second task, versus the first, ar e indicative of confusion, representing false memories. Free recall tasks Confabulations can also be detected using a free recall task, such as a self-nar rative task.[6] Participants are asked to recall stories (semantic or autobiogra phical) that are highly familiar to them. The stories recalled are encoded for e rrors that could be classified as distortions in memory. Distortions could inclu de falsifying true story elements or including details from a completely differe nt story. Errors such as these would be indicative of confabulations. Treatment Treatment for confabulation is somewhat dependent on the cause or source, if ide ntifiable. For example, treatment of Wernicke Korsakoff syndrome involves large do ses of vitamin B in order to reverse the thiamine deficiency.[54] If there is no known physiological cause, more general cognitive techniques may be used to tre at confabulation. In a recent case study, Self-Monitoring Training (SMT)[55] was

shown to reduce delusional confabulations. Furthermore, improvements were maint ained at a three-month follow-up and were found to generalize to everyday settin gs. Although this treatment seems promising, more rigorous research is necessary to determine its efficacy in the general confabulation population. Research Although significant gains have been made in the understanding of confabulation within recent years, there is still much to be learned. One group of researchers in particular has laid out several important questions for future study. They s uggest that more information is necessary regarding the neural systems that supp ort the different cognitive processes needed for normal source monitoring. They also proposed the idea of developing a standard neuropsychological test battery that is able to discriminate between the different types of confabulations. Furt hermore, there is a considerable amount of debate regarding the best way to orga nize and combine neuroimaging, pharmacological, and cognitive/behavioral approac hes to understand confabulation.[56] In a recent review article, another group of researchers contemplate issues conc erning the distinctions between delusions and confabulation. They question wheth er delusions and confabulation should be considered distinct or overlapping diso rders and, if overlapping, to what degree? They also discuss the role of unconsc ious processes in confabulation. Some researchers suggest that unconscious emoti onal and motivational processes are potentially just as important as cognitive a nd memory problems. Finally, they raise the question of where to draw the line b etween the pathological and the nonpathological. Delusion-like beliefs and confa bulation-like fabrications are commonly seen in healthy individuals. What are th e important differences between patients with similar etiology who do and do not confabulate? Since the line between pathological and nonpathological is likely blurry, should we take a more dimensional approach to confabulation? Research su ggests that confabulation occurs along a continuum of implausibility, bizarrenes s, content, conviction, preoccupation, and distress, and impact on daily life.[5 7] See also Anosognosia References 1. ^ Fotopoulou, A., Conway, M. A., & Solms, M. (2007). Confabulation: Moti vated reality monitoring. Neuropsychologia, 45(10), 2180-2190. 2. ^ a b c d Moscovitch M. 1995. Confabulation. In (Eds. Schacter D.L., Coy le J.T., Fischbach G.D., Mesulum M.M. & Sullivan L.G.), Memory Distortion (pp. 2 26 251). Cambridge, MA: Harvard University Press. 3. ^ [Link] ml 4. ^ a b Nalbantian, edited by Suzanne; Matthews,, Paul M., McClelland, Jam es L. (2010). The memory process : neuroscientific and humanistic perspectives. Cambridge, Mass.: MIT Press. ISBN 978-0-262-01457-1. 5. ^ a b c d e f Metcalf, Kasey; Langdon, Robyn, Coltheart, Max (1 February 2007). "Models of confabulation: A critical review and a new framework". Cognit ive Neuropsychology 24 (1): 23 47. doi:10.1080/02643290600694901. 6. ^ a b c d e f g Gilboa, A. (13 April 2006). "Mechanisms of spontaneous c onfabulations: a strategic retrieval account". Brain 129 (6): 1399 1414. doi:10.10 93/brain/awl093. 7. ^ a b Kopelman, M.D. Two types of confabulation. J Neurol Neurosurg Psyc hiatry 1987a; 50: 1482 7. 8. ^ D. Kopelman, Michael; Allan D. Thomson,, Irene Guerrini, E. Jane Marsh all. "The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment". oxfor d journals 44 (2): 148 154. doi:10.1093/alcalc/agn118. PMID 19151162. Retrieved 5 March 2012. 9. ^ a b Glowinski, Remy; Payman, Vahid, Frencham, Kate (1 January 2008). " Confabulation: a spontaneous and fantastic review". Australian and New Zealand J ournal of Psychiatry 42 (11): 932 940. doi:10.1080/00048670802415335. 10. ^ a b Kopelman, Michael D. (1 January 2010). "Varieties of confabulation and delusion". Cognitive Neuropsychiatry 15 (1-3): 14 37. doi:10.1080/13546800902

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