Technological folie à deux: feedback loops between AI chatbots and mental health

Artificial intelligence chatbots have achieved unprecedented adoption, with millions now using these systems for emotional support and companionship in contexts of widespread social isolation and capacity-constrained mental health services. While some users report psychological benefits, concerning edge cases are emerging, including reports of suicide, violence, and delusional thinking linked to emotional relationships with chatbots. To understand these risks we need to consider the interaction between human cognitive-emotional biases and chatbot behavioural tendencies, the latter including companionship-reinforcing behaviours such as sycophancy, role-play and anthropomimesis. Individuals with preexisting mental health conditions may face increased risks of chatbot-induced changes in beliefs and behaviour, particularly where these conditions manifest in altered belief-updating, reality-testing, and social isolation. To address this emerging public health concern, we need coordinated action across clinical practice, AI development, and regulatory frameworks.