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When Lying Is a Sign of a Health Problem

The creation of false memories can be concerning but is often unintentional

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Memory is a funny thing. We all get details wrong from time to time, misremember or simply have gaps in recall. You may remember eating in a nice Italian restaurant before seeing My Fair Lady but really you ate at that restaurant before seeing Chicago. This kind of memory confusion is normal. But less commonly, because of underlying neurological issues, people will generate false memories with no intent to deceive.

The medical term for this is confabulation. Because the person believes what they’re saying, the term “honest lying” is also used to describe this phenomenon.  

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Two types of confabulation

Confabulation can be provoked, in response to being asked questions or for details a person can’t quite recall correctly, or spontaneous, when the misremembering is just that — unprompted. This phenomenon is different from delusions, or false beliefs.

The latter, spontaneous confabulation, is rarer, and may point to an underlying medical condition such as Wernicke-Korsakoff syndrome — a neurological disorder that’s caused by a lack of vitamin B1 (thiamine), most frequently from chronic and severe alcohol use. It also can be caused by a range of other conditions, from Alzheimer’s dementia and traumatic brain injury to bipolar disorder and schizophrenia.

Even in cases where the underlying condition is already known, it can be concerning when a loved one suddenly seems be making up stories about the past.

“It’s very distressing when you see someone that you love isn’t remembering things or seeing things the way that you do,” says Susan Maixner, M.D., codirector of the geriatric psychiatry program and geriatric psychiatry fellowship director at the University of Michigan. This isn’t just about missing a few details here or there when recalling a shared experience. With confabulation, a person fabricates memories — for example, to fill in holes in what they recall — and believes their version of events completely, Maixner explains.

“They have no awareness that these things didn’t happen, and they’re not trying to lie or deceive anyone,” she emphasizes. Still, the resulting confusion can leave caregivers at a loss.

How to respond to ‘honest lying’

Confabulation tends to involve autobiographical memories, or what a person misremembers about their own past experiences, and can be as simple as getting small details wrong or as elaborate as fantastical odysseys unto themselves. The fabricated memories may be tied to real events but plugged into a different story — or have fictitious origins. “Sometimes you’ll see plotlines of television shows that have been playing in the background kind of woven into some of these stories that are told,” Maixner says.

But, in truth, the person isn’t lying — since they’re not trying to deceive anyone. However, loved ones may perceive the person is lying and become annoyed or offended — something experts say you’ll want to avoid.

It’s important in such instances not to be confrontational, says Chad Hales, M.D., associate professor of neurology at Emory University School of Medicine. Instead, he emphasizes the importance of educating family members about what’s going on.

Taking a compassionate, curious approach when a family member suddenly starts misremembering not only helps smooth interpersonal interactions, it also can lead to more clarity and support for the individual and family members.


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Possible sign of a brain condition

Often a person who confabulates has already been diagnosed with a neurological condition. But sometimes it’s not clear what’s causing it.

So a good place to start would be to see the family doctor.

“My recommendation would be to try to bring their loved one to their primary care physician and share their concerns,” says Jeffrey Rakofsky, M.D., associate professor in the department of psychiatry and behavior health sciences, also at Emory University School of Medicine.

If necessary, the primary care provider may refer the patient on to see a neurologist for further evaluation.

Because confabulation can be caused by issues ranging from alcoholism to dementia to mental health conditions, such as bipolar disorder, multiple medical opinions and experts in different disciplines may be required to address it. But experts like Rakofsky recommend starting with a primary care provider, who should be familiar with the patient’s medical history, and then getting a referral to a specialist if necessary.

Treating the underlying condition

Exactly what happens in the brain that causes confabulation isn’t clear. But the difficulties a person has faithfully recalling the past seem to be rooted in problems with memory and executive function. The latter involves mental processes that allow us to plan and organize, ignore distractions and focus on key details — like one might do when piecing together a story about a past experience.

Executive function and memory are both really important for being able to remember things accurately and free of the intrusions and other motivations that sometimes influence our memories as we’re sharing them, Rakofsky says. This also helps explain why so many different types of neuropsychiatric conditions might cause confabulation.

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“What a lot of these conditions have in common is the ways in which they impact both executive function and memory,” he says. Accordingly, the most common way to treat confabulation involves addressing the condition that causes it, whether that’s treating a vitamin deficiency with Wernicke-Korsakoff syndrome or giving a patient with schizophrenia antipsychotic medications.

With some conditions, such as Alzheimer’s, it may not be possible to reverse the course of a disease — or to differentiate between real and false memories. However, in some other cases, therapy may be helpful, and a person could also try to keep a diary as a reference.

This could include reality orientation therapy that helps people focus on their immediate surroundings, like a picture of a family member or personal belongings, to reduce confusion and correctly recall details in their lives.

Research published in PLOS One suggests approaches that address both the underlying disorder and the confabulation could also help, for example, after a person has experienced brain injury,

Adapting to messy memories — and finding support

Given how complex and intractable changes in the brain can be, part of addressing confabulation has everything to do with adapting to it. That means learning how to go along for the ride — if not indulging in fanciful memories, at least learning how to live with someone who can’t tell the difference, experts say.

But what it doesn’t mean for distraught caregivers is self-abandonment, or suffering silently as a loved one’s grip on reality slips away. Support groups, depending on the condition — like for caregivers of people with Alzheimer’s disease — can be especially beneficial. It’s important for family members to get support, Rakofsky says, given how difficult it can be to watch someone struggle with memory.

Also, make sure to discuss the impact on family members with a person’s primary care doctor to talk through ways to cope together.

“Don’t ignore it,” Rakofsky urges. “Get help for your loved one, but also get help for yourself … because this can be concerning and upsetting to see your loved one lose touch with the memories that maybe you both shared.”

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