Chatbot relational dependence and psychosis risk: Conversational artificial intelligence as a potential behavioral addiction context

J Behav Addict. 2026 May 18:2006.2026.00080. doi: 10.1556/2006.2026.00080. Online ahead of print.

ABSTRACT

Conversational artificial intelligence (AI) chatbots are increasingly used for emotional support, companionship, and psychological reflection. Their capacity to simulate attentiveness, empathy, and conversational continuity may shift technology use from instrumental interaction toward relational engagement. Emerging clinical observations suggest that intensive chatbot use may, in vulnerable individuals, contribute to psychiatric destabilization, including reinforcement of maladaptive beliefs and, in rare cases, psychotic symptoms. This viewpoint proposes that conversational AI engagement can be conceptualized within a behavioral addiction framework capable of interacting with psychosis vulnerability without requiring biological intoxication. An illustrative clinical case is presented involving a young adult woman who developed paranoid psychosis following escalating emotional reliance on a chatbot, including a fixed delusional belief that her husband was covertly communicating through the system. Potential mechanisms include persistent algorithmic attention, sleep disruption, social withdrawal, cognitive reinforcement loops, and displacement of attachment needs. Although causal relationships cannot be inferred from current evidence, systematic assessment of intensive AI engagement may become clinically relevant in behavioral addiction psychiatry and early psychosis evaluation. Further empirical research is needed to clarify prevalence, mechanisms, and clinical implications of AI-mediated relational dependence.

PMID:42149657 | DOI:10.1556/2006.2026.00080