AI Psychosis: Does Conversational AI Amplify Delusion-Related Language?

Recent reports indicate that sustained interaction with conversational artificial intelligence (AI) systems can, in a small subset of users, contribute to the emergence or stabilisation of delusional experience. Existing accounts typically attribute such cases either to individual vulnerability or to failures of safety engineering. These explanations are incomplete. Drawing on phenomenology, psychiatry, and cognitive neuroscience, this paper argues that the risk arises from the relational and ontological structure of the interaction itself. Conversational AI generates ontological dissonance: a conflict between the appearance of relational presence and the absence of any subject capable of sustaining it. Maintained through a communicative double bind and amplified by attentional asymmetries, this dissonance tends, under conditions of affective vulnerability, to stabilise into a technologically mediated analogue of folie a deux. This account explains why explicit disclaimers often fail to disrupt delusional involvement and clarifies the ethical and clinical implications for the design and use of conversational AI.

"AI psychosis" or "delusional spiraling" is an emerging phenomenon where AI chatbot users find themselves dangerously confident in outlandish beliefs after extended chatbot conversations. This phenomenon is typically attributed to AI chatbots' well-documented bias towards validating users' claims, a property often called "sycophancy." In this paper, we probe the causal link between AI sycophancy and AI-induced psychosis through modeling and simulation. We propose a simple Bayesian model of a user conversing with a chatbot, and formalize notions of sycophancy and delusional spiraling in that model. We then show that in this model, even an idealized Bayes-rational user is vulnerable to delusional spiraling, and that sycophancy plays a causal role. Furthermore, this effect persists in the face of two candidate mitigations: preventing chatbots from hallucinating false claims, and informing users of the possibility of model sycophancy. We conclude by discussing the implications of these results for model developers and policymakers concerned with mitigating the problem of delusional spiraling.

Mental health professionals have raised concerns about risks of psychological harm from interaction with large language models (LLMs), including "delusional spirals" in which concerning human and LLM behaviors reinforce each other over time. With growing public use of LLM-powered chatbots, there is an urgent need to build evaluations grounded in real-world episodes of psychological harm experienced by users. We developed DelusionEval, an evaluation protocol that tests a model's tendencies to exhibit behaviors linked to promoting user delusions. We prompt each model with 589 unique conversation histories from 18 participants, comprising 12,591 messages from users who experienced delusions and psychological harm. We find that the tendency of an evaluated LLM to exhibit delusion-linked behavior does not reliably correlate with model size, release date, or the presence of test-time reasoning. However, extending the context of prior messages substantially increases rates of delusion-linked behaviors, providing evidence for the importance of context in LLM safety evaluation. For example, the rate of failing to discourage self-harm when the user expresses suicidal ideation increases from 30.0% to 41.1% when an additional 350 messages are prepended to the conversation history. All model families (e.g., GPT, Claude) exhibit substantial rates of delusion-linked behaviors. Within families, later, larger, or higher-reasoning models are not uniformly better across all behavior categories. Our results raise concerns regarding the potential psychological impact of LLMs and the need for more rigorous studies of real-world human-AI interaction.