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Brain Injury and Confabulation: A Review for Caregivers and Professionals

A brain injury, either caused by a traumatic event or by other means, can cause an individual to experience a variety of symptoms and changes, depending on the area of the brain that was affected. Brain damage can lead to difficulty performing daily skills, including eating, walking, getting dressed, thinking, and speaking. 

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.

Confabulation: “Honestly Lying”

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. Instead, the information has been created by the individual. Even odder, although the story often paints the person in a positive light, he or she is completely unaware that it is false. The alteration of the story is not intentional, as its events 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 story is true. 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 person who is having the conversation is not lying. They are communicating information they believe to be true.

For most people who have this issue, there are pieces of information that may be true. Often, the brain mixes up events or facts, but there exists some element of truth. Because elements of truth 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 increased. Because these memories are real to the person, it may be difficult to redirect them in a conversation. Accepting that the story believed to be true is in fact false is often difficult to accept, and it can cause a great deal of anxiety and stress for all parties involved.

Caring for Those With a Brain Injury

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. Using speech-language pathologists, psychologists, and mental health professionals can be instrumental in helping the person understand that they may not always have all of the information they need, or that some of the information they believe is true may not be. Although they may be unable to eliminate the process of confabulation completely, they can outline strategies that allow them to check facts or consult with caregivers.

Caregivers play a vital role in the process of those with a brain injury. In the instance of confabulation, it is crucial to have a support system in place to ensure that when communicating with medical professionals or relaying important information, the person does not inadvertently cause harm. Information such as finances and personal and medical information should be verified to ensure accuracy and reliability. By double-checking information, using caregiver information, or re-checking facts, medical care and medication errors can be avoided.

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

Help Those With Confabulation

With a better understanding of brain injuries and confabulation, you can help make a difference in the lives of those who are affected. Concordia University, St. Paul’s online master’s in forensic behavioral health and forensic behavioral health certificate programs can prepare you for a career of providing care to these individuals. Through them, you will explore how the behavioral health, criminal justice, legal, and related care systems affect each other. Both programs offer a flexible format that allows you to complete your studies when it’s most convenient. Start the next chapter of your story today.

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 benefiting 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 19 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 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 Concordia St. Paul’s Criminal Justice Department.

Auburn Jimenez graduated from Macalester College.