Confabulation and False Memory in Clinical Psychology: A Review of Theoretical Perspectives and Clinical Implications

Background:False memories and confabulations are both forms of memory distortion, but they differ in typical aetiology and clinical meaning. False memories are common in healthy cognition and often arise from source-monitoring errors, schema-driven reconstruction, and exposure to misleading post-event information. Confabulation is most often observed following neurological insult and reflects impaired reality monitoring and executive control.Aims:This narrative review integrates contemporary cognitive and clinical neuroscience accounts of false memory and confabulation, with a focus on mechanisms, neural correlates, identification and differential diagnosis, interventions and risk mitigation, and therapeutic and forensic implications.Methods:Targeted searches prioritised systematic reviews, meta-analyses, preregistered studies, and clinically informative lesion or case series evidence, with emphasis on literature published since 2015. Classic foundational work was retained where necessary for definitional and theoretical grounding.Results:Evidence converges on a reconstructive model of remembering in which episodic retrieval is guided by prior knowledge, goals, and contextual cues. False memories are best explained by interactions between gist-based reconstruction and failures of source monitoring, moderated by plausibility, repetition, social influence, and warning or feedback procedures. Confabulation is characterised by a breakdown in control and verification of retrieved information, linked to dysfunction in prefrontal systems and their interaction with medial temporal and diencephalic structures. Recent lesion-network mapping work suggests that spontaneous confabulation reflects disruption within a functionally connected network involving orbitofrontal and subcortical regions.Conclusions:Memory distortion is not a discrete pathology but a graded outcome of otherwise adaptive reconstructive processes. Clinically, distinguishing false memory from confabulation requires attention to elicitation conditions, suggestive influences, neurological status, and patterns of monitoring failure. In psychotherapy and forensic interviewing, risk reduction depends on non-suggestive practice and early collection of uncontaminated accounts. In neurorehabilitation, management of confabulation is supported by structured cueing, external verification, and metacognitive strategies, although controlled trials remain limited.