Brain Injury and Confabulation: A Review for Caregivers and Professionals

Posted July 16, 2014 | By csponline

A brain injury, either caused by a traumatic event (traumatic brain injury) or by other means (acquired brain injury) can cause damage to the brain in multiple ways. Depending on the area of the brain that is damaged, an individual may experience a wide variety of symptoms and changes associated with the injury. Brain damage can lead to difficulty performing daily skills, including eating, walking, getting dressed, thinking and speaking. Concordia University, St. Paul’s online forensic mental health programs, including our master’s in forensic mental health degree and forensic mental health certificate program, provide accessible educational outlets to further your understanding of brain injury and confabulation.

Difficulty with daily tasks can be frustrating – a variety of brain injuries can inhibit an individual’s ability to communicate and think clearly. These difficulties can range from trouble remembering facts, people, past events, or losing executive functions such as the ability to plan, organize, multitask, access riskiness of behavior, or connect consequences to actions. Understanding what is being said, being able to attend to conversation, and the ability to communicate all require areas of language and cognition to function appropriately.

There are many different communication deficits that can occur with a brain injury – one such problem with communication is called confabulation. Confabulation occurs in individuals that appear to have functional communication abilities. The individual is able to communicate relatively easily, using standard sentence structure and conversational language. It can occur in individuals with average or above-average functional I.Q. When speaking with others, this person appears to function normally, making it difficult for interviewers, probation officers, police officers, family members, or acquaintances hearing the adequately conveyed information to recognize the problem.

Many individuals with confabulating deficits have the ability to tell elaborate and detailed stories that seem plausible and realistic. The problem with confabulation is that the story or memory that the individual is discussing has been twisted and changed into a story that is not a true memory; this information has been created by the individual. Even odder, although the information often paints the storyteller in a positive light, he or she is completely unaware the information is false, believing wholeheartedly they are telling the truth. The alteration of information is not intentional, as the events in the story are perceived to have happened. This is why confabulation is often called “honestly lying.”

Confabulation is an interesting challenge due to the lack of awareness in individuals presenting the false information. The impacted individual generally has vivid memories that this information is true because, in their mind, the event happened. Confabulation is viewed as a normal pattern of memory, as the mind naturally fills in the gaps in memory. However, in those with brain damage, memory issues, or executive function damage, the system goes haywire. Family and friends can have difficulty understanding confabulation when they perceive an individual’s stories or lies to be a conscious effort. This is not the case with true confabulation, as the individual that is having the conversation is not lying – they are communicating information they believe to be true.

For most individuals that have this issue, there are pieces of the information that may be true. Often the brain mixes up events or facts, but there exists some element of truth in the information that the person is relaying. Because elements of truth do exist in the story, an uninformed person may perceive the information as perfectly logical and factually accurate. Furthermore, these individuals are at risk of having false memories implanted through suggestive questioning. When presented with misleading factual evidence or leading questions during interrogation, the risk of implanting memories is further heightened. Because these memories are real to the individual, it may be difficult to redirect this individual in a conversation. The individual also believes the memory is real and the information and conversation that they are having is perfectly logical and accurate. Accepting that information believed to be true is in fact false is often difficult to accept, and can cause a great deal of anxiety and stress for all parties involved.

When discussing errors in factual information with someone with a brain injury, it is important to be respectful of their inability to report information accurately. Utilizing professionals such as speech-language pathologists, psychologists and mental health professionals can be instrumental in assisting the individual to understand that they may not always have all of the information they need, or that some of the information that they believe to be true may not be factual. Although they may not be able to eliminate the process of confabulation completely, they may be able to outline strategies that allow the individual to check facts or consult with caregivers before relaying information.

Caregivers play an important role in the process of individuals with a brain injury. In the instance of confabulation, it is important to have a support system in place to ensure that when communicating with medical professionals or relaying important information, the individual does not inadvertently cause himself or herself harm. Information such as finances and personal and medical information should be verified to ensure accuracy and reliability. By double-checking information, utilizing caregiver information, or re-checking facts given by these individuals, errors can be avoided in changes to medical care or medications.

An individual that exhibits confabulation is not a bad person – they are suffering from memory loss, and an inability to regulate information. When an individual has damage to the part of the brain that controls executive functioning, information that may be completely believable and factual to the injured person can be comprised of memories and data that are inaccurate. Support and direction are important for all individuals living with a brain injury, and those working through this type of process are no different.


About the Authors:

Jerrod Brown, M.A., M.S., M.S., M.S. is the treatment director for Pathways Counseling Center, Inc. Pathways provides programs and services benefitting individuals impacted by mental illness and addictions. Mr. Brown is also the founder and CEO of the American Institute for the Advancement of Forensic Studies (AIAFS). His additional research interests include autism, fetal alcohol spectrum disorders, forensic aspects of sleep disorders, and serial killers.

Lisabeth Mackall, M.S., CCC-SLP is a speech-language pathologist with nineteen years of experience treating adults and children with neurological impairments.

Jeffrey Long-McGie, M.A. & M.B.A. is a Research Fellow at the AIAFS, and currently training to become a licensed police officer.

Erv Weinkauf, M.A. is a retired 40-year law enforcement veteran with 19 years of teaching experience. He currently serves as chairperson of the Concordia University Criminal Justice Department in St. Paul.

Auburn Jimenez is a graduating senior from Macalester College, currently working as an intern with Pathway Counseling Center, Inc.

Also published on Medium.