Speaking to No One: Ontological Dissonance and the Double Bind of Conversational AI

Conversational AI systems are increasingly used for personal reflection and emotional disclosure, raising concerns about their effects on vulnerable users. Recent anecdotal reports suggest that prolonged interactions with AI may reinforce delusional thinking---a phenomenon sometimes described as AI Psychosis. However, empirical evidence on this phenomenon remains limited. In this work, we examine how delusion-related language evolves during multi-turn interactions with conversational AI. We construct simulated users (SimUsers) from Reddit users' longitudinal posting histories and generate extended conversations with three model families (GPT, LLaMA, and Qwen). We develop DelusionScore, a linguistic measure that quantifies the intensity of delusion-related language across conversational turns. We find that SimUsers derived from users with prior delusion-related discourse (Treatment) exhibit progressively increasing DelusionScore trajectories, whereas those derived from users without such discourse (Control) remain stable or decline. We further find that this amplification varies across themes, with reality skepticism and compulsive reasoning showing the strongest increases. Finally, conditioning AI responses on current DelusionScore substantially reduces these trajectories. These findings provide empirical evidence that conversational AI interactions can amplify delusion-related language over extended use and highlight the importance of state-aware safety mechanisms for mitigating such risks.

"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.

LLM chatbots increasingly serve as a first source of support for people in psychological distress, including those whose distress is entangled with delusional beliefs. Prior work on LLM mental-health safety largely evaluates general therapeutic quality or single-turn crisis detection, leaving unclear how models behave when distress is intertwined with delusion over sustained conversations. We address this gap with matched multi-turn simulations, across clinically grounded personas and six LLMs, that pair each delusional conversation with a distress-only control to isolate the effect of delusional framing. This reveals a recognition-intervention gap: models detect distress at comparable rates regardless of framing, yet sharply fail to act on it once distress is embedded in delusion, with safety interventions suppressed by up to 4.5x. The failure tracks accumulated acceptance of the user's premises rather than emotional validation. Worse, the intuitive fix of prompting models to assess user distress backfires under delusional framing; only delusion-aware prompting with explicit response guidance closes the gap, and even this depends on a delusion classifier that is itself unreliable on the most vulnerable models. Safe deployment therefore requires treating delusional framing as a distinct risk signal that overrides conversational accommodation.