Measuring Risk, Not Harm: Detecting Psychological Harm Risk Factors in LLM Conversations

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.

Safety evaluations of large language models (LLMs) typically report binary outcomes, i.e. attack success rate (ASR), refusal rate, or harmful versus safe classification, which hide how risk changes between prompt and response. We present a paired analysis over human labeled prompt and response records across four harm categories (Sexual, Self harm, Hate and Violence) and ordinal severity levels (Safe, Low, Medium, High). 61% of responses reduce harm relative to the prompt, 36% preserve severity, and 3% escalate. The escalation splits into two mechanisms: benign prompts triggering unrequested harmful detail, and answers that stay on task at higher severity than the prompt. Category decomposition shows that Sexual content exhibits the highest harm persistence in this sample, driven by compliance at the same severity rather than drift from benign inputs. Joint relevance analysis exposes a helpfulness versus harmlessness tradeoff: compliance escalations remain highly relevant, whereas safe responses include generic refusals with low relevance. A public supporting evaluation over 600 prompts and six models reproduces the framework's measurements and two directional signals, while few-shot LLM graders exhibit a prompt/response detection asymmetry that data calibration does not close. Grader prompts, public-evaluation artifacts, and analysis code are shared at https://github.com/microsoft/PairedSafety.

Autonomous systems increasingly rely on Large Language Models (LLMs) yet the safety infrastructure surrounding these models introduces latency and compute overhead. This limits utility in resource-constrained, time-critical deployments. Existing external guardrail models remain blind to the model's internal workings, creating a fundamental assurance gap. We ask: does the model already know when the content is harmful? We extract activations from LLaMA-3.1-8B and train lightweight MLP classifier probes (12.6M parameters) to detect harmful prompts. Evaluated on WildJailbreak, Beavertails, and AEGIS 2.0, our probes achieve F1 scores of 99%, 83%, and 84%, respectively competitive with 1000x larger guard models while cutting latency and compute costs.