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.
Jina Suh, Mihaela Vorvoreanu, Forough Poursabzi-Sangdeh +5cs.AI cs.CY cs.HC
As conversational AI systems become increasingly integrated into daily life, their potential effects on user well-being require ongoing attention. While consumer-facing generalist models can provide benefits, including improved access to information, learning, productivity, self-reflection, and companionship, they also introduce risks, such as emotional entanglement, unhealthy dependence, and the amplification of psychological vulnerabilities. Drawing on prior research and empirical observations of AI chatbot behavior, we propose a set of aspirational directions for guiding the behavior of general-purpose AI systems in ways that may reduce potential psychological harms and support user well-being. We acknowledge the difficulty of systematically assessing the long-term impacts of AI chatbot use and frame these directions as hypotheses for studying how AI behavior may influence users across general interactions, role-playing scenarios, and contexts that could be characterized as providing psychological support. While some proposed directions are supported by existing research and expert insights, others identify open questions and areas requiring deeper study. We hope that this formulation and these hypotheses encourage further discussion, empirical investigation, and exploration of interactive design approaches aimed at better accommodating users' psychological needs and promoting their well-being.