Signal Delusions and Harms Associated with AI Chatbot Use: Early Evidence from 185 Real-World Reports

Summary

Motivated by concerns that AI chatbots may validate or elaborate delusional beliefs, respond inappropriately to suicidal ideation, and contribute to mental health harms, while real-world data on such harms remain limited, this study characterizes psychopathological features, chatbot behaviors, timing, and outcomes in first- and second-hand accounts of mental health harm linked with AI chatbot use. It is a cross-sectional secondary analysis of deidentified online survey responses gathered between August 7, 2025, and February 2, 2026, with the primary outcome being the presence of delusional beliefs coded by paired raters with relevant clinical experience. The analysis covered 95 first-hand and 90 second-hand accounts (185 total). Median age was 35.0 (IQR 27.0-45.0). Raters coded descriptions consistent with delusional beliefs in 102 reports (55.1%), with chatbot validation of beliefs in 50 of those 102 (49.0%). Common outcomes included isolation, relationship breakdown, hospital admission, job loss, and financial loss, and four second-hand reports described death by suicide. Because reports were retrospective, unverified, and collected from individuals seeking to report harm, the authors state that findings should be interpreted as preliminary signal detection rather than as suggesting prevalence or providing evidence of causality, and that prospective surveillance and trajectory-based safety evaluations are needed.