Emergence of psychopathological computations in large language models

Psychological instruments designed for humans are increasingly used to assign large language models (LLMs) stable psychological profiles that affect their usability, safety assessment, and use as proxies for human participants in research. Using a formal psychometric framework, we show that these profiles are largely a measurement artifact. Administering a battery of personality and risk-preference instruments spanning self-reports and behavioral tasks to 56 instruction-tuned LLMs alongside large human reference samples, we report four findings. First, differences between models are driven not by the traits an instrument targets but by a directional response bias, a tendency to respond toward one end of the scale, or one labeled option, regardless of item content; a variance decomposition attributes 81-90% of between-model variation to this bias, against 9-16% in humans. Second, the bias declines with model capability but is not eliminated by it. Third, because bias rather than trait drives responding, an instrument's apparent reliability is almost entirely predicted by its response orthogonality, a term we coin for the proportion of items for which trait and bias point in opposite directions. Fourth, the profile a model appears to have shifts with the items used and can be manufactured through item selection. These results demonstrate that the apparent psychological profiles of LLMs are artifacts of the instrument used to measure them, not properties of the models themselves. As instruments borrowed from human psychology are rarely fully orthogonal and may inherently lack validity for LLMs, we call for dedicated assessments centered on response orthogonality.

Large language models are increasingly deployed to simulate patients for clinical training, research, and mental health tools, yet population-level validity remains largely untested. We introduce PsychBench, the first epidemiological audit of LLM patient simulation: 28,800 profiles from four frontier models (GPT-4o-mini, DeepSeek-V3, Gemini-3-Flash, GLM-4.7) evaluated against NHANES and NESARC-III baselines across 120 intersectional cohorts. The central finding is a coherence-fidelity dissociation: models produce clinically plausible individuals while misrepresenting the populations they are drawn from. Variance compression ranges from 14 percent (GLM-4.7) to 62 percent (DeepSeek-V3), eliminating the distributional tails of clinical reality. Despite test-retest correlations above r = 0.90, 36.66 percent of cases cross diagnostic thresholds between runs. Symptom correlation matrices diverge across demographic groups beyond split-half noise, with transgender populations diverging three to five times more than racial differences. Calibration bias is systematic and asymmetric. Models overestimate depression severity for most groups by 3.6 to 6.1 points (Cohen d = 1.13 to 1.91), consistent with training on clinical corpora with elevated base rates. For transgender women the direction inverts: models capture only 8 to 46 percent of documented minority stress elevation, yielding a -5.42 residual (d = -1.55). Models also attribute irritability to Black men and fatigue to women beyond matched controls, encoding racialized and gendered assumptions. Patterns replicate across US and Chinese architectures, indicating failures tied to current training paradigms rather than isolated implementations. For most users, LLM mental health tools risk pathologizing ordinary distress; for transgender users, algorithmic erasure of genuine need. The patients look right. They do not represent real populations.

Recent advances in Large Language Models (LLMs) have motivated their adoption across a wide range of domains, including Artificial Intelligence (AI) for mental health. Given the growing prevalence of mental health disorders worldwide and the limited accessibility of professional care, there is an increasing demand for scalable computational approaches that can assist in early detection and continuous monitoring of psychological well-being. In this area, ongoing efforts have focused on curating domain-specific datasets and leveraging them to develop LLMs capable of supporting holistic mental health analysis. In line with this direction, we propose an LLM-based pipeline for comprehensive mental health analysis over sequentially ordered user posts, as part of the CLPsych shared task. Our pipeline offers a unified framework that jointly enables post-level assessment and user-level temporal modeling.