Shared Psychotic Disorder in the Digital Age: A Case Series of Virtual "Folie à Trois"

This case series presents a unique manifestation of shared psychotic disorder "folie à trois" transmitted entirely through digital interactions. It is among the first documented clinical accounts demonstrating that immersive online alliances - without physical proximity - can serve as fertile ground for psychotic contagion. The report contributes to evolving psychiatric frameworks by highlighting the role of "virtual cohabitation" in shaping shared delusional systems.

Three young adult males from different cities in West Bengal developed a shared persecutory delusional system over three years of daily interaction within an online gaming guild. The inducer (Case A) presented with severe paranoia, digital surveillance delusions, and insomnia. Recipients (Cases B and C) displayed alignment with these beliefs, marked social withdrawal, and psychological dependency on the inducer. All patients were diagnosed with shared psychotic disorder. Interventions included second-generation antipsychotics (risperidone, olanzapine, aripiprazole), structured cognitive-behavioral therapy, digital hygiene protocols, and psychoeducation. Separation of digital communication among the triad facilitated therapeutic gains. All three demonstrated symptomatic improvement over 2-3 months, with partial restoration of social functioning.

This case underscores that psychological proximity fostered through immersive digital platforms may suffice for the transmission of delusional beliefs. Clinicians must routinely explore virtual relationships and digital group identities as potential vectors of psycho-pathology. Early detection, digital boundary setting, and integrative therapy approaches are essential in managing such emerging presentations.