From the Super Mario Wiki, the Mario encyclopedia
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Confused is a status ailment found in the game Paper Mario: The Thousand-Year Door, indicated with an orange spiral found above the victim. A confused character, whether it be Mario, his partner, or an enemy, has an approximately 50% chance each turn to do something random and unexpected instead of what the player or the enemy's AI told it to do. One can tell a character is about to do something unusual if there is an extra-long pause before it acts. Possible results include:
Vivian's Infatuate attack, and the Ruin Powder item can confuse enemies, but several bosses and minibosses are highly resistant or immune to it. Random stage effects such as falling bugs can also confuse combatants. The Head Rattle badge can confuse grounded foes for 3 turns if the Action Command is successful; additional Head Rattles prolong the confusion by 2 more turns for each one equipped at the cost of more FP.
While confusion can be debilitating to either side of a battle, players should be cautious about which enemies they are confusing, as enemies such as Lava Bubbles will heal each other if they attack each other.